Spontaneous Regression Of Hepatocellular Carcinoma With Multiple Lung Metastases: A Case Report And Review Of The Literature.
Pectasides, E., Miksad, R., Pyatibrat, S., Srivastava, A., & Bullock, A. (2016). spontaneous Regression of Hepatocellular Carcinoma with Multiple Lung Metastases: A Case report and Review of the Literature. Digestive diseases and sciences, 61(9), 2749–2754. https://doi.org/10.1007/s10620-016-4141-2
View Original Source →Abstract
Spontaneous regression of hepatocellular carcinoma (HCC) is a rare event. Here we present a case of spontaneous regression of metastatic HCC. A 53-year-old man with hepatitis C and alcoholic cirrhosis was found to have a large liver mass consistent with HCC based on its radiographic features. Imaging also revealed left portal and hepatic vein thrombosis, as well as multiple lung nodules concerning for metastases. Approximately 2 months after the initial diagnosis, both the primary liver lesion and the lung metastases decreased in size and eventually resolved without any intervention. Thereafter, the left hepatic vein thrombus progressed into the inferior vena cava and the right atrium, and the patient died due to right heart failure. In this case report and literature review, we discuss the potential mechanisms for and review the literature on spontaneous regression of metastatic HCC.
Case Details
Disease Location
Liver + lung mets + ivc thrombus
Personal Characteristics
53-year-old man, history of hepatitis c and alcoholic cirrhosis
Clinical Characteristics
Liver ultrasound in october 2009 revealed a 5-cm hypoechoic mass in the left hepatic lobe. AFP was markedly elevated. Subsequent CT abdomen in november 2009 confirmed a mass in the left lobe of the liver measuring 9 9 6 cm, de monthstrating arterial hyperenhancement and washout on delayed images, findings diagnostic of hcc. Additionally, there were multiple satellite lesions and enlarged lymph nodes at the porighta hepatis and a filling defect in a branch of the left portal vein. CT chest revealed hilar lymphadenopathy and innumerable lung nodules.
Remission Characteristics
In december 2009 there was persistent left portal vein thrombosis as well as hepatic vein thrombosis, and the previously seen pulmonary nodules had either decreased in size or resolved. Abdominal ultrasound prior to the scheduled liver biopsy did not show a definitive lesion, and the plan for biopsy was aborighted. In march 2010 CT chest at that time revealed resolution of the pulmonary nodules and hilar lymphadenopathy. Follow-up imaging showed no evidence of disease in the liver or lung parenchyma; however, the tumor thrombus persisted.
Treatment & Mechanisms
Proposed Remission Mechanisms
Tumor ischemia in the setting of portal vein thrombosis + immune response
Clinical Treatment
Sorafenib, capecita- bine, doxorubicin, and bevacizumab/erlotinib (after partial remission)