Spontaneous Regression Of Advanced Hepatocellular Carcinoma
Sonbare, D. J., Bandi, R., Sharma, V., Cacciarelli, T., & Shaikh, O. S. (2020). Spontaneous Regression of Advanced Hepatocellular Carcinoma. Case reports in gastroenterology, 14(3), 491–496. https://doi.org/10.1159/000508847
View Original Source →Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality. The tumor carries poor prognosis with curative therapeutic options limited to surgical resection, tumor ablation, and liver transplantation. Rarely, there is spontaneous regression of the tumor. We describe the case of a 74-year-old male with cirrhosis from non-alcoholic steatohepatitis who developed advanced HCC that was associated with tumor invasion of the portal vein and marked elevation of serum alfa-fetoprotein level. The patient received no cancer-specific therapy. However, 1 year after the initial diagnosis, he was noted to have complete regression of the tumor. In this report, we discuss possible mechanisms of spontaneous tumor regression and its therapeutic implications.
Case Details
Disease Location
Liver
Personal Characteristics
74-year-old white male. History of obesity, type 2 diabetes, dyslipidemia, hypertension, hypothyroidism, and prostatism. He had coronary artery stenoses requiring bypass grafting and also had a cholecystectomy. His medications included aspirin, amlodipine, metoprolol, atorvastatin, insulin, metformin, ferrous sulfate, finasteride, and levothyroxine.
Clinical Characteristics
Presented with abdominal pain and was incidentally noted to have cirrhotic liver morphology on CT. He was diagnosed with cirrhosis from nash. 9 months later, he presented with abdominal distention, nausea, and vomiting. AFP level was markedly elevated. Abdominal ultrasound revealed a nodular liver and a 5-cm hypoechoic lesion in the right hepatic lobe and thrombosed right portal and main portal veins. A contrast-enhanced CT scan showed cirrhosis and a 4-cm hypodense lesion in hepatic segment 8. An upper gastrointestinal endoscopy showed large non-bleeding esophageal varices. The patient reported periodic confusion that was treated with oral lactulose and rifaximin. Ascites was well managed with low salt diet and diuretics
Remission Characteristics
One year after the initial diagnosis, a contrast-enhanced abdominal CT showed large ascites, nodular liver, a 2.5-cm ill-defined, non-enhancing right hepatic lobe lesion and resolution of expansile right portal and main portal vein thrombus. Repeat testing showed persistently normal serum AFP levels.
Treatment & Mechanisms
Proposed Remission Mechanisms
Likely involved vascular phenomena and immunologic pathways
Clinical Treatment
Endoscopy, lactulose, rifaximin, diuretics
Non-Clinical Treatment
Low salt diet