Spontaneous Regression Of Hepatocellular Carcinoma Research Articles

Spontaneous Regression of a Poorly Differentiated Hepatocellular Carcinoma: A Case Report

Hepatocellular carcinoma (HCC) is the most common histological type of primary liver cancer, and spontaneous regression of HCC is rare. We report the case of a 76-year-old male diagnosed with poorly differentiated HCC that spontaneously regressed. Although the patient did not undergo any treatment or invasive diagnostic tests, such as angiography, before surgery, the resected tumor showed complete necrosis similar to that seen after transcatheter arterial embolization. The main cause of the necrosis in the present case was thought to be the occlusion of nutrient vessels and tumor hypoxia. Tumor hypoxia and immunological reactions are reported to be the main causes of spontaneous HCC regression, although the underlying mechanisms remain unclear. In this case report, we provide additional insights into this phenomenon.

Possible spontaneous regression of hepatocellular carcinoma with unique histopathological features confirmed by surgical resection: a case report

BackgroundSpontaneous regression of hepatocellular carcinoma (HCC) is a rare event, and its clinicopathological features and underlying mechanism are not fully understood.Case presentationAn 84-year-old female with hepatitis C virus infection and diabetes mellitus was referred to our hospital for further examination. Abdominal ultrasonography showed a 3.4-cm solid tumor with a heterogeneous irregular center and no fibrous capsule in liver segment 8 (S8). An enhanced computed tomography (CT) scan revealed a tumor in S8 with heterogeneous enhancement in the arterial phase and washed out insufficiently in the portal and equilibrium phase. The enhanced pattern on magnetic resonance imaging was similar to that of CT. Although the imaging findings were not typical for HCC, liver resection (S8) was performed with HCC as the most probable diagnosis. Histopathological examination of the resected specimen showed that the tumor was well to moderately differentiated HCC with unique features. Approximately half of the tumor was composed of well-differentiated HCC that was focally accompanied by dense lymphocyte infiltration. The other half of the tumor was fibrotic tissue that resembled an inflammatory pseudotumor. Several foci of moderately differentiated HCC were scattered within the tumor with a nodule-in-nodule appearance, and the foci totally showed coagulative necrosis. On immunostaining, lymphocytes in the tumor stroma were positive for CD8 and programmed death 1. The expression of programmed death-ligand 1 was observed in carcinoma cells and macrophages specifically within the lymphocyte-rich area of HCC.ConclusionsWe consider this case representative of spontaneous regression of HCC, and the immune response against HCC might contribute to tumor regression, leading to complex histopathological appearances. This case may provide insight into the mechanism of spontaneous regression of HCC.

Spontaneous regression of hepatocellular carcinoma: myth or reality?

We present a case of a 68-year-old man with chronic hepatitis C infection, with no evidence of chronic liver disease during the first years of follow-up, diagnosed with a hepatocellular...

Spontaneous Regression of Hepatocellular Carcinoma and Review of Reports in the Published English Literature

Background Spontaneous regression of hepatocellular carcinoma (HCC) is a rare event, although it has been described by numerous groups. The long-term fate of individuals experiencing an SR is not well described, and the underlying mechanism(s) of SR are unknown. Case Presentation: A 79-year-old Asian female with metastatic HCC taking only valsartan for hypertension had a marked reduction in tumor dimension in the primary tumor and the pulmonary metastases. Serum alpha-fetoprotein (AFP) decreased from 17,833 μg/L to 26 μg/L. Her disease progressed after 71 months, and she died shortly after. In a review of 66 patients with SR reported in the English literature, median survival was 83 months. Median survival in 37 cases that underwent resection after SR was 108 months. Conclusions The case and a review of the literature illustrate that SR is often durable and associated with an excellent prognosis. Understanding the underlying mechanism of SR may point to novel therapeutic strategies.

Spontaneous regression of hepatocellular carcinoma in a Caucasian male patient: A case report and review of the literature.

Hepatocellular carcinoma (HCC) is the most common primary hepatic cancer. As it often presents at an advanced stage, it generally has a poor prognosis. Spontaneous regression is a rare finding in HCC, and is often associated with tumour ischemia or a systemic inflammatory response. We herein present the case of a Caucasian patient with spontaneous regression of advanced HCC, not associated with either mechanism. Our patient was a 74-year old Caucasian male who presented with advanced biopsy-proven HCC, with α-fetoprotein levels of >16,600 kU/l. On computed tomography examination, multiple metastases were identified. Due to the poor performance status and as the patient declined treatment, he was referred to a general practitioner for supportive palliative care. Six months later, the patient was alive and feeling well. He had suffered a cerebrovascular accident with ensuing partial hemiparesis, and had been initiated on enalapril, furosemide and curcumin. On re-evaluation, the lung lesions had disappeared, whereas both the liver and peritoneal lesions had decreased in size. Following a review of the literature, the conclusion was that this case of spontaneous regression of advanced HCC was not caused by ischemia, inflammation, or any other previously reported mechanism. Further research is required to elucidate the mechanisms underlying spontaneous regression of HCC.

Spontaneous complete regression of multiple metastases of hepatocellular carcinoma: A case report

Spontaneous regression of cancer is a partial or complete disappearance of malignant tumor without specific treatment. Spontaneous regression of hepatocellular carcinoma (HCC) is a rare condition, and the mechanism underlying it is unclear. This report presents a rare case of spontaneous complete regression of HCC, as revealed by tumor markers and imaging studies. A 64-year-old Korean male patient with hepatitis B virus-associated chronic hepatitis presented with HCC. The patient had undergone right lobectomy of the liver but the cancer recurred with multiple lung and adrenal metastases after 14 months. The patient received palliative cytotoxic chemotherapy. However, there was no clinical benefit and the disease progressed. It was decided to discontinue anticancer therapy and administer only supportive care. After approximately six months, the symptoms disappeared and the HCC had completely regressed. The patient remains alive over five years after recurrence.

A Case of Spontaneous Regression of Hepatocellular Carcinoma after Ultrasound Guided Liver Biopsy

A Case of Spontaneous Regression of Hepatocellular Carcinoma after Ultrasound Guided Liver Biopsy

Spontaneous Complete Necrosis of Hepatocellular Carcinoma: Possible Immune System Hypothesis

Spontaneous regression of hepatocellular carcinoma (HCC) is an extraordinarily unusual phenomenon. The mechanisms underlying this intriguing phenomenon remain unknown. We report a 72-year-old man with a liver mass. MR pictures demonstrate arterial hypervascularity with venous washout. We performed a fine-needle aspiration cytology of this nodule and it allowed us to find an HCC well differentiated. Postoperative histopathologic findings demonstrated a spontaneous complete necrosis of HCC. The necrotic tissue was filled with large debris from a neoplastic tissue, regardless of no viable tumor cells were seen among them. The patient is alive and well for 2 years after surgery. The underlying mechanism of this phenomenon is not clear. The histologic findings of our patient are including the tumor necrosis, the severe inflammatory infiltration with lymphocytes and the thick fibrous capsule. We speculate that some immune mechanism may be involved in regression of HCC. J Curr Surg. 2014;4(1):26-28 doi: http://dx.doi.org/10.14740/jcs 204 w

Pathologically Confirmed Spontaneous Partial Regression of Hepatocellular Carcinoma

54세 남자 환자가 건강 검진에서 간 내 종괴를 진단받았다. 영상학적 소견 및 만성 B형간염 병력을 고려하여 간암으로 임상적으로 진단되었으나 개인적인 이유로 치료를 연기 하였고 5개월 후 다시 검사를 시행하였다. 역동적 복부 자기 공명영상에서 60% 이상 부피가 감소하여 간우엽 절제술을 시행하였고 병리조직학적 검사에서 간암으로 확진되었다. 부분적 자발 퇴행 간암은 다른 간암에 비해 림프구, 특히 CD4+ T 림프구 침윤이 많았으며 CD4+ T 림프구가 자발성 퇴행에 미치는 영향은 추가적인 연구가 필요할 것으로 사료 된다.

A case of solitary necrotic nodule treated with laparoscopic hepatectomy: spontaneous regression of hepatocellular carcinoma?

Solitary necrotic nodule of the liver is a rare benign lesion with a completely necrotic core and a hyalinized fibrotic capsule containing elastic fibers. The pathogenetic mechanism is still unclear. We here describe a case of SNN, whose central reticulin fibers within the nodule suggest the origin as hepatocellular carcinoma or other hepatocyte-origin tumors, treated with laparoscopic anatomical segmentectomy of the liver. A 76-year-old Japanese female, with no prior medical history and no symptom, visited our hospital with the heterogeneous hypoechoic lesion in the liver segment VI incidentally pointed out in abdominal ultrasonography. Computed tomography with contrast demonstrated a 1.1 cm sized low-density lesion with mild ring enhancement on the rim in the arterial phase. Since the possibility of malignant tumor with necrotic change could not be ruled out, she underwent laparoscopic anatomical segmentectomy of the liver. In the histological examination of the surgical specimen, the liver nodule was necrotic tissue without viable cells and signs of inflammation, which had fibrous capsule and central cystic change and showed trabecular pattern alignment of ghost cells and reticulin fibers orthogonal to the capsule. Also, the findings of chronic hepatitis were observed in the background liver.

Spontaneous regression of hepatocellular carcinoma

A 92-year-old Japanese woman with moderate liver fibrosis, schistosomiasis and steatohepatitis-like lesion, was diagnosed with hepatocellular carcinoma (HCC) by dynamic CT and elevated serum levels of alpha-fetoprotein and des-gamma-carboxyprothrombin. During follow up, the levels of tumor markers became normal without any treatment, and dynamic CT showed disappearance of the tumor and progression of hepatic steatosis. The mechanism of this spontaneous regression of HCC is unclear although massive necrosis due to rapid tumor growth or cancer immunity may have played a role.

Spontaneous regression of hepatocellular carcinoma is most often associated with tumour hypoxia or a systemic inflammatory response

BackgroundSpontaneous regression of hepatocellular carcinoma (HCC) is well documented, although the aetiology of this phenomenon remains unknown. MethodsA review of the English literature was performed for reports of spontaneous regression of HCC. Reports were classified by mechanism based on the available information. ResultsSpontaenous regression of HCC has been identified in 75 patients. The most common mechanisms of regression identified were tumour hypoxia (n= 21, 28.0%), a systemic inflammatory response (n= 25, 33.3%) and unknown (n= 29, 38.7%). In patients where tumour hypoxia was described as the aetiology, mechanisms included spontaneous hepatic artery thrombosis and sustained systemic hypotension. In patients where a systemic inflammatory response was the aetiology, mechanisms included cholangitis, trauma and elevated cytokine levels. DiscussionSpontaneous regression of HCC is most commonly associated with tumour hypoxia or a systemic inflammatory response. Determining the aetiology of spontaneous regression may identify potential therapeutic pathways. Tumour hypoxia is already the basis of treatment modalities such as hepatic artery embolization and the anti-angiogenic agent sorafenib. However, treatment modalities for HCC do not currently include immune-directed therapies; this may prove to be a worthy target for future research.

Mechanisms underlying spontaneous regression of hepatocellular carcinoma

Mechanisms underlying spontaneous regression of hepatocellular carcinoma

Spontaneous regression of hepatocellular carcinoma repeated 3 times with invasion of portal vein and inferior vena cava: report on a rare case.

A 65-year-old man suffered from advanced hepatocellular carcinoma in the right lobe of the liver, for which he received no treatment. His serum was positive for hepatitis C antibody. In spite of his poor prognosis, he remained in good clinical condition and at 6-month follow-up the tumor had regressed without specific treatment, as assessed both radiologically and from a decrease of a previously elevated serum tumor marker level (1st regression). The tumor regrew in size, but at 23-month follow-up could no longer be visualized radiologically (2nd regression). A follow-up computed tomography (CT) scan did not show any relapse of hepatocellular carcinoma until March 2005. At that time, a new lesion had developed in the caudate lobe and tumor size had increased to ≥10cm in diameter, and in June 2006 had invaded the portal vein and inferior vena cava. Afterwards, the tumor lesion gradually decreased again. In June 2007, a CT scan showed a further reduction of tumor size (3rd regression). Here, we report a rare case of spontaneous regression of hepatocellular carcinoma in which spontaneous regression and recurrence were repeated 3 times.

Spontaneous regression of multiple pulmonary recurrences of hepatocellular carcinoma after hepatectomy: report of a case

Spontaneous regression of hepatocellular carcinoma (HCC) is an extremely rare phenomenon. We herein report the case of a 73-year-old man who showed the spontaneous regression of multiple pulmonary recurrences of HCC that had occurred after hepatectomy. The patient was undergoing dialysis due to diabetic renal failure when ultrasonography revealed a liver tumor (diameter~10cm). A preoperative diagnosis of HCC with hepatic vein thrombosis was made. The liver function was well preserved and then the right hepatic vein area was resected. Two months after hepatectomy the α-fetoprotein level increased, and multiple lung nodules were observed on follow-up computed tomography. A diagnosis of multiple lung metastases was made, but no therapy was started because of the patient's renal failure. Five months after hepatectomy the α-fetoprotein level normalized, and the metastases regressed completely. The patient is now doing well without any recurrence at 13months after the surgery. The associated literature on spontaneous HCC regression is also reviewed.

Spontaneous regression of a large hepatocellular carcinoma: case report.

The prognosis of untreated advanced hepatocellular carcinoma (HCC) is grim with a median survival of less than 6 months. Spontaneous regression of HCC has been defined as the disappearance of the hepatic lesions in the absence of any specific therapy. The spontaneous regression of a very large HCC is very rare and limited data is available in the English literature. We describe spontaneous regression of hepatocellular carcinoma in a 65-year-old male who presented to our clinic with vague abdominal pain and weight loss of two months duration. He was found to have multiple hepatic lesions with elevation of serum alpha-fetoprotein (AFP) level to 6,500 µg/L (normal <20 µg/L). Computed tomography revealed advanced HCC replacing almost 80% of the right hepatic lobe. Without any intervention the patient showed gradual improvement over a period of few months. Follow-up CT scan revealed disappearance of hepatic lesions with progressive decline of AFP levels to normal. Various mechanisms have been postulated to explain this rare phenomenon, but the exact mechanism remains a mystery.

A Case of Spontaneous Regression of Hepatocellular Carcinoma with Multiple Lung Metastases

Spontaneous regression of hepatocellular carcinoma (HCC) is extremely rare. We report a case of 67-year-old man having HBV-associated HCC with multiple lung metastases which regressed spontaneously. The patient had single liver mass and received surgical resection. The mass was confirmed as HCC histopathologically. Nine years after surgical resection, a 3.3 cm sized recurred HCC was detected on the resection margin in CT scan. Transarterial chemoembolization (TACE) was performed 3 times, and lung metastases developed thereafter. The patient received 2 more sessions of TACE, however, metastatic lung nodules were in progress very rapidly. We decided to stop TACE and followed the patient regularly without any anti-cancer treatment. Nine months after development of lung metastasis, the size and number of metastatic lung nodules decreased and were not detected anymore after 14 months. Serum alpha-fetoprotein levels also decreased to normal range and no viable tumor was noted in the liver. The patient is still alive 12 years after the first diagnosis of HCC and 16 months after lung metastasis developed.

Spontaneous regression of hepatocellular carcinoma: a systematic review

To estimate the actual frequency of spontaneous regression of hepatocellular carcinoma. A systematic review of the literature published during 1978-2007 has been carried out to identify randomized clinical trials of hepatocellular carcinoma that included a control arm receiving either placebo or best supportive care, and in which patients were followed prospectively for tumor response using predefined criteria. Data extraction was conducted independently by two investigators. A meta-analysis to provide a global estimation of regressions in the control arms was performed using an empiric Bayesian random-effects model. We identified 16 cases of regression (including minor and partial responses) in 10 phase III clinical trials. The rate of spontaneous objective partial regression among patients with hepatocellular carcinoma was 0.406% [95% confidence interval: 0.067-1.043%]. Although very infrequent, spontaneous regression is not an extraordinary event among patients with hepatocellular carcinoma. Therefore, individual responses to any given therapy should be assessed with caution and this fact may be considered at the time of calculating sample size of pilot clinical trials of new agents.

Hepatocellular carcinoma with massive lymphoid infiltration: A regressing phenomenon?

Spontaneous regression of hepatocellular carcinoma (HCC) is extremely rare. Among the numerous proposed mechanisms of spontaneous regression for HCC, immunological factors, which have yet to be fully understood, may have the most important roles in this rare phenomenon. A regressing HCC with lymphoid stroma is reported. A hepatic mass was detected in a 57-year-old man by abdominal computed tomography during a follow-up health check. The resected tumor was 2.7×2.4 cm 2 in size, and was composed of two distinct nodules with a complete rim of fibrous tissue separating the tumor from the adjacent liver parenchyma. Microscopically, one nodule was replaced by a remarkable infiltration of inflammatory cells with insignificant amounts of vital tumor cells. The other nodule demonstrated a small portion of well- to moderately-differentiated hepatocellular carcinoma cells forming 2–3 thick trabeculae with massive inflammatory infiltrates. Infiltrating inflammatory cells were composed of T cells (CD4+>CD8+), macrophages, B cells, and other cells in order of prevalence. Epstein-Barr virus was not detected. After 60 months of follow-up, the patient is in good health without evidence of tumor recurrence.

Spontaneous regression of advanced hepatocellular carcinoma: a case report

Spontaneous regression of advanced hepatocellular carcinoma is extremely rare. A 66-year-old Taiwanese male patient with liver cirrhosis related to chronic hepatitis C presented with hepatocellular carcinoma with portal vein thrombosis. At first, he refused curative therapy, except for silymarin medicine. Spontaneous regression of hepatocellular carcinoma occurred with a decline in tumour size and tumour marker in imaging studies. The patient agreed to undergo surgery approximately 14 months after presentation because of no further decrease in tumour size and an increase in tumour marker in the imaging studies. The resected tumour was hepatocellular carcinoma with portal vein thromboses. Presently, the patient is alive and in good condition without any symptoms or tumour recurrence. We concluded that this was a rare case of spontaneous regression of advanced hepatocellular carcinoma.