Spontaneous Regression Of Hepatocellular Carcinoma In A Cirrhotic Patient: Possible Vascular Hypothesis.
Bastawrous, S., Kogut, M. J., & Bhargava, P. (2012). spontaneous regression of hepatocellular carcinoma in a cirrhotic patient: possible vascular hypothesis. Singapore medical journal, 53(10), e218–e221.
View Original Source →Abstract
Spontaneous regression of hepatocellular carcinoma is extremely rare, and the exact pathogenesis leading to this remarkable phenomenon remains unclear. We describe a case of spontaneous regression of an incidentally discovered hepatocellular carcinoma in a 63-year-old man with hepatitis C cirrhosis. The regression followed a series of events, in particular, an upper gastrointestinal haemorrhage. Ischaemic insult may be a major pathway leading to tumour regression. As limited data is available in the literature, knowledge and recognition of this rare event will have implications for patient management and may alter treatment. Further, data may be useful to assess if these patients have an altered prognosis with improved survival.
Case Details
Disease Location
Right hepatic lobe
Personal Characteristics
63-year old caucasian man with hepatitis c and child's class a cirrhosis presented with mental status changes related to hepatic encephalopathy, demonstrated asterixis and presence of ascites; reported recent fatigue and anorexia; medical history included post-traumatic stress disorder and thrombocytopenia
Clinical Characteristics
After admission to the hospital, patient experienced upper gastrointestinal bleed and became haemodynamically unstable; oesophagogastroduodenoscopy showed small gastric ulcer in gastric fundus; abdominal ultrasonography showed nodular hepatic contour indicating cirrhosis, plus solid echogenic mass in right hepatic lobe; mild ascites and splenomegaly present, indicating portal hypertension; CT showed right hepatic lobe pass with hypervascularity in arterial phase and subsequent washout in portal venous phase
Remission Characteristics
CT two months after diagnosis showed that known mass had decreased in size and was now predominately cystic; multiphase CT showed that tumour was no uniformly hypodense and cystic on all four phases, without arterial enhancement or portal venous phase washout, no new masses detected; CT 10 months after initial presentation showed continued reduction in size, was non-enhancing and remained cystic with no additional masses
Treatment & Mechanisms
Proposed Remission Mechanisms
Proposed vascular etiology related to hemorrhage-induced ischaemia, possible that acute onset of haemodynamic instability had altered the tumoural blood supply, resulting in tumour infarction and necrosis
Clinical Treatment
Copious intravenous fluids and transfusion of two units packed red blood cells for bleed, plus proton pump inhibitor infusion