Spontaneous Regression Of Hepatocellular Carcinoma With Complete Necrosis: Case Report.
Ohta, H., Sakamoto, Y., Ojima, H., Yamada, Y., Hibi, T., Takahashi, Y., Sano, T., Shimada, K., & Kosuge, T. (2005). spontaneous regression of hepatocellular carcinoma with complete necrosis: case report. abdominal imaging, 30(6), 734–737. https://doi.org/10.1007/s00261-005-0313-9
View Original Source →Abstract
Spontaneous regression of hepatocellular carcinoma is rare phenomenon. A 74-year-old man was found to have a hepatocellular carcinoma with intrahepatic metastases in the lateral segment of the liver. Before surgery, he developed severe cholangitis due to choledocholithiasis and was treated endoscopically. The tumor marker level decreased markedly, and hepatectomy was performed. The resected tumor demonstrated complete necrosis.
Case Details
Disease Location
Liver
Personal Characteristics
74-year-old man
Clinical Characteristics
Chief complaint of epigastralgia. Abdominal imaging studies displayed a mass lesion in the left lobe of the liver. Contrast-enhanced computed tomography (CT) demonstrated good enhancement of the tumor, which was 6 cm in diameter, in the lateral segment of the liver. Further CT showed several nodules around the main tumor in the lateral segment of the liver and a clearly enhancing lesion measuring 1 cm in diameter on cantlie line, all of which were diagnosed to be intrahepatic metastases. Hepatic angiogram also showed several tumor stains in the lateral segment and medial segment of the liver. Pivka-ii was elevated. Before surgery, the patient developed severe cholangitis due to choledocholithiasis. Immediately thereafter, endoscopic dilatation of the pa- pills of vater and excretion of stones was performed.
Remission Characteristics
Abdominal CT 17 days after endoscopic therapy showed a decrease (5 cm in diameter) of the main tumor in the liver, a marked decrease in the degree of early enhance- ment, and an increase in the nonenhancing area of the tumor (fig. 2). The small lesion on cantlie line was no longer visualized, and pivka-ii levels return to normal values. On september 22, 2003, laparotomy was conducted; the small intrahepatic metastasis on cantlie line could not be visualized even by intraoperative ultrasonography microscopic examination demonstrated that the entire tumor had undergone coagulation necrosis. Some vessels feeding the tumor were thickened and occluded due to arterial sclerosis
Treatment & Mechanisms
Proposed Remission Mechanisms
Necrosis secondary to severe cholangitis after choledocholithiasis.
Clinical Treatment
Endoscopic dilatation of the papilla of vater and excretion of stones was performed. Laparomoty.