Spontaneous Regression Of Hepatocellular Carcinoma: Myth Or Reality?
Costa-Santos, M. P., Gonçalves, A., Ferreira, A. O., & Nunes, J. (2020). Spontaneous regression of hepatocellular carcinoma: myth or reality?. BMJ case reports, 13(2), e233509. https://doi.org/10.1136/bcr-2019-233509
View Original Source →Abstract
We present a case of a 68-year-old man with chronic hepatitis C infection, with no evidence of chronic liver disease during the first years of follow-up, diagnosed with a hepatocellular carcinoma (HCC) with 40 mm (α-fetoprotein (AFP) 205 ng/mL). He underwent segmental liver resection and pathology analysis was consistent with HCC and cirrhosis in the adjacent liver. Four months after surgery, AFP raised up to 126 661 ng/mL and abdominal MRI revealed a multinodular HCC. Patient rejected treatment with sorafenib and started megestrol and an herbal medicine, soursop (Annona muricata). Six months later, AFP markedly decreased (28 ng/mL) and abdominal MRI showed decreasing size and number of lesions. At 5 years of follow-up, he has no evidence of HCC. Spontaneous regression of HCC is a rare condition and the underlying mechanism is unclear. In this case there is a temporal relation between the start of megestrol and Annona muricata and HCC regression.
Case Details
Disease Location
Liver
Personal Characteristics
68-year-old caucasian man. History of chronic hepatitis c virus (HCV) infection, genotype 1b, in the context of blood transfusion in 1977. History of prostatic adenocarcinoma and underwent surgery and radiotherapy.
Clinical Characteristics
Presented with a rise in alpha-fetoprotein level and abdominal ultrasonography revealed a suspected lesion in the liver. Abdominal CT showed a solid lesion with 40×40mm in segment IV. Suggestive of early-stage chronic liver disease. Atient underwent segmental liver resection and pathology analysis was consistent with trabecular hcc with vascular invasion and cirrhosis in the adjacent liver. He started on megestrol for anorexia and self-medicated with a herbal medicine, soursop (a. Muricata). Seven months after surgery, AFP peaked at 126661ng/ ml.
Remission Characteristics
Ten months later, AFP markedly decreased (28ng/ml), and abdominal MRI showed decreasing size, number, and vascularisation of lesions previously described
Treatment & Mechanisms
Proposed Remission Mechanisms
A. Muricata compounds have cytotoxic activity against liver cancer cells
Clinical Treatment
Megesterol
Non-Clinical Treatment
Herbal medicine: soursop (a. Muricata)