A Rare Case of Hepatocellular Carcinoma With Self-Embolization and Regression of Tumor

Abstract

Case Report: This is a 70-year-old female who presented with right upper quadrant abdominal pain. On computerized tomography, a large right hepatic lobe mass extending directly into the portal vein was identified. MRI abdomen confirmed the extension of thrombosis into the right portal vein. Alphafetoprotein was elevated at 62,148 ng/mL. Liver biopsy was done later and showed findings consistent with hepatocellular carcinoma. Although she had Child-Pugh class A, she declined radioembolization and systemic treatment, so she enrolled in hospice. The patient didn’t receive anticoagulation.During the following 4 months, the patient improved clinically with alleviation of her abdominal pain. She revoked hospice and had CT scan abdomen done, which showed spontaneous regression of her liver mass. Her Alpha-fetoprotein decreased significantly to 2448.24 ng/mL. Two months later, the patient continues to do well. The patient did not receive any forms of liver cancer treatments. This is a likely case of selfembolization of the hepatocellular carcinoma leading to spontaneous regression. Discussion: Advanced stages of hepatocellular carcinoma carry very poor prognosis. Portal vein thrombosis in hepatocellular carcinoma is associated with poor prognosis as it limits the blood supply to normal liver parenchyma. However, we postulate that in some rare cases like ours, tumor thrombosis can cause self-embolization of the tumor itself. The other alternative explanation for the spontaneous regression of the tumor could be that the immune system was able to control the tumor growth. We present this rare case of self-embolization of hepatocellular carcinoma to highlight the importance of follow-up patients while they are on hospice to detect potential regression in the tumor burden, differentiating between bland and tumor thrombosis to guide the anticoagulation therapy and the need for further studies in this subject to develop further treatment options and predict the prognosis of similar hepatocellular carcinomas.