Rapid Dissemination Followed By Spontaneous Regression Of Metastatic Hepatocellular Carcinoma After Liver Radiofrequency Thermal Ablation: A Case Report With Correlative Immune Assay

Xu, Y. 2023Liver cancer

Xu, Y., Bayewitz, A., & Tary-Lehmann, M. (2023). Rapid Dissemination followed by Spontaneous Regression of Metastatic Hepatocellular Carcinoma after Liver Radiofrequency Thermal Ablation: A Case Report with Correlative Immune Assay. Case reports in oncology, 16(1), 129–136. https://doi.org/10.1159/000527229

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Abstract

Rapid intrahepatic and distant metastasis of hepatocellular carcinoma (HCC) after locoregional treatment for early stage tumor is very rare. Descriptions of spontaneous regression of HCC exist in case reports, but its true mechanism is unclear. Here, we describe a case of rapid dissemination with lung metastasis shortly after localized RFA treatment of HCC liver lesions, followed by spontaneous, sustained regression of those lung lesions. We also show the detection of cytotoxic T lymphocytes (CTLs) specific to hepatitis B antigens by immune assay in this patient. We propose immune-related destruction as the basis for spontaneous regression.

Case Details

Disease Location

Lung, liver

Personal Characteristics

81-year-old female. History of chronic active hepatitis b. She had been taking the antiviral drug entecavir. Past medical history included hypertension, diabetes, and type b aortic dissection, which were all medically managed. Family history was significant for colon cancer in one of her sons.

Clinical Characteristics

Presented after a finding of a mass in the right hepatic lobe upon serial abdominal ultrasound. MRI showed a 4.3 × 3.8-cm mass in segment 5 (close to the ivc) and a 2 × 1.4-cm mass in the periphery (segment 7). Both of these masses exhibited image patterns consistent with hcc. The patient was treated with tace 1 month after diagnosis. Eleven months after diagnosis, she underwent initial rfa for both lesions via laparotomy. CT scan 2 months after rfa showed a hematoma in one of the ablated cavities, which resolved on its own. It also showed development of numerous lung nodules consistent with metastases.

Remission Characteristics

On a routine follow-up 5 months from rfa, she reported feeling well with greatly improved symptoms. CT at that time showed significant decrease in size of the multiple lung nodules and the liver masses. Repeat CT scans 8 months and 14 months after rfa again showed further decrease in the size of the lung lesions.