Spontaneous Regression Of Hepatocellular Carcinoma With Portal Vein Tumor Thrombus
Koya, Y., Suzuki, T., Tai, M., Ichii, O., Matsuhashi, N., Ejiri, Y., Shibata, M., & Harada, M. (2018). Spontaneous Regression of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus. Case reports in gastroenterology, 12(2), 411–419. https://doi.org/10.1159/000490661
View Original Source →Abstract
An 83-year-old man underwent transcatheter arterial chemoembolization (TACE) for a 20-mm hepatocellular carcinoma (HCC) in Couinaud's segment 4. Computed tomography (CT) 4 months after TACE showed tumor thrombus in the portal vein in addition to diffuse metastases and arterioportal shunts in the left lobe. Although we performed the best supportive care, the tumor thrombus in the portal vein and tumors in the left lobe had completely disappeared on CT 16 months after the TACE. Rapidly grown portal vein tumor thrombus and arterioportal shunt might be the causes of spontaneous regression of HCC, probably associated with tumor hypoxia.
Case Details
Disease Location
Liver
Personal Characteristics
83-year-old man with hepatitis c virus infection. He had received a diagnosis of hcc and had been treated by radiofrequency ablation and transcatheter arterial chemoembolization (tace) since the age of 74 years. Past medical history of hypertension, diabetes mellitus, and benign prostatic hyperplasia at 60 years of age and cerebral infarction at 72 years of age he had been receiving oral treatment with diuretics and a preparation of branched chain amino acid
Clinical Characteristics
CT scan showed a tumor of 20 mm in diameter in couinaud’s segment 4 (s4) with the typical imaging of hcc. Tace was performed. The tumor progressed in the main portal vein after 4 months. Lipiodol in the left branch of the portal vein was completely washed out. Diffuse metastasis in the left lobe, ascites, and arterioportal shunts were newly detected by CT scan. Tumor markers were remarkably elevated
Remission Characteristics
His general condition gradually improved. A CT scan 16 months after the last tace revealed the disappearance of the thrombus of the left branch of the portal vein and atrophic change of the left lobe. The tumor thrombus in the main portal vein and the tumors in the left lobe also disappeared
Treatment & Mechanisms
Proposed Remission Mechanisms
The massive main portal vein tumor thrombus decreased portal blood flow, and the arterioportal shunt decreased blood supply from the hepatic artery to the tumors. These disturbances of the blood circulation could have induced hypoxia of rapidly increased tumors and precipitated a tumor regression
Clinical Treatment
Tace