Complete spontaneous necrosis of hepatocellular carcinoma confirmed on resection: A case report

Complete regression of intrahepatic cholangiocarcinoma after right portal vein ligation. Case report

INTRODUCTION

Spontaneous tumor regression is an extremely rare phenomenon in the oncology field.

PRESENTATION OF CASE

We present the case of a 72-years-old male patient presenting with a bulky hepatic tumor mass located in segment V and extending into segments IVb and VI with MRI features of atypical cholangiocarcinoma with a liver metastasis in segment III. In first surgical step, excision of the metastasis, and ligation of the right portal vein was done. A new MRI examination performed 5 weeks later shows significant tumor regression, and 2 weeks later, during the second surgery, the tumor was not found. Under these conditions we performed a limited segment V liver resection, in the area indicated by the radiologist as the site of the tumor. No viable malignant cells existed in the tumor specimen, and a third MRI examination didn't identify any residual tumor.

DISCUSSION

From our literature study this is the only case of complete tumor regression of an intrahepatic cholangiocarcinoma following portal vein ligation. We believe the portal vein ligation resulted in a marked regression/deficiency in the tumor blood supply.

CONCLUSION

Serial MRI examinations demonstrated the regression of intrahepatic cholangiocarcinoma after portal vein ligation. Intrahepatic cholangiocarcinoma should be included in the tumors that could extremely rarely spontaneously regress.

A Curious Case of Vanishing Hepatocellular Carcinoma (HCC)

Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related mortality worldwide. Spontaneous regression of HCC is rare with few documented cases in literature. The mechanism of this phenomenon is unknown, but tumor hypoxia and systemic inflammatory response have been suggested as possible etiologies. This article aims to shed more light on this rare phenomenon and provides an opportunity to review the proposed pathophysiology of spontaneous HCC regression. In this case report, we describe an interesting case of a 39-year-old male with HCC who underwent spontaneous regression.

Spontaneous regression of hepatocellular carcinoma: what three cases of regression and disease reoccurrence can tell US

Hepatocellular carcinoma (HCC) is a highly morbid disease both in the United States and worldwide. Chronic liver inflammation puts people at risk of developing HCC. As chronic liver disease prevalence increases in the United States there can be an expected rise in HCC. Spontaneous regression of HCC is a rare phenomenon but can provide much needed information on how to better understand disease characteristics and progression. The two proposed theories that may explain spontaneous regression are tumor hypoxia and immunologic reaction. In these cases, we describe 3 patients with heavy disease burden at presentation who showed spontaneous regression of cancer. The patient's characteristics correlate most with systemic immunologic reaction resulting in spontaneous regression. Unfortunately, all of these patients had disease recurrence shortly after regression. By studying patient data in cases of spontaneous regression, we can gain a better understanding of disease progression and which exogenous or endogenous factors determine HCC mortality. With this knowledge we hope to better characterize how spontaneous regression occurs, and how we can use this information to help in developing treatment options in the future.

Spontaneous Regression of Hepatocellular Carcinoma From Autoinfarction and Implications on Liver Transplantation

Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide. Spontaneous regression of HCC due to autoinfarction is rare. This case series describes 2 cases of HCC autoinfarction that affected transplant candidacy: 1 patient previously ineligible because of tumor size and not meeting the Milan criteria became eligible after autoinfarction and tumor shrinkage while the second one was delisted in the view of improved symptoms of chronic liver disease and significant HCC regression. These cases provide an opportunity to review the pathogenesis of HCC autoinfarction and to remind practitioners of how this entity might alter decision-making around transplant eligibility.

Spontaneous regression of metastatic hepatocellular carcinoma following 3 weeks of lenvatinib

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality and is associated with a poor prognosis. Rarely, there is spontaneous regression of the tumour. We present a case of a middle-aged male with presumed metastatic HCC who experienced enduring regression following 3 weeks of lenvatinib, which was discontinued due to side effects. While this could represent an unusually successful response to therapy, spontaneous tumour regression or an alternative diagnosis should be considered. We discuss possible mechanisms that might explain this unusual case and advocate for tissue confirmation in select cases, where there is diagnostic doubt or when the disease pattern does not clearly follow the recognised natural history. Therefore, if regression occurs-whether spontaneous or in response to treatment-it can be better understood and subsequent therapies recommended.

Spontaneous regression of lung metastases in hepatocellular carcinoma: A case report

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The prognosis of patients with advanced HCC remains poor even if appropriate treatments are administered.

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Spontaneous regression of lung metastases of hepatocellular is a rare condition.

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We discuss the mechanism for spontaneous regression of multiple pulmonary recurrences of hepatocellular carcinoma.

Introduction

Spontaneous regression of hepatocellular carcinoma (HCC) is a rare condition. However, although there have been multiple reports of spontaneous regression, the definitive pathogenic mechanism of this phenomenon is still unclear.

Case presentation

We encountered a case of a 78-year-old man who was undergoing dialysis for end-stage kidney disease with hepatitis C virus-associated chronic hepatitis presenting with HCC. The patient had previously undergone right lobectomy of the liver, but the cancer recurred with multiple lung metastases after 5 months. Approximately 13 months after the initial diagnosis of recurrence, the lung metastases decreased in size and eventually resolved without any anticancer therapy. The patient remains alive for over 41 months after recurrence.

Discussion

Based on our case and literature, Hypoxia with hypotension due to hemodialysis can reduce the blood and oxygen supply of the body, which may lead to the spontaneous regression of the metastatic tumors.

Conclusion

We herein reported a case of spontaneous regression of HCC undergoing dialysis.

A Secretory Variant of Cerebral Meningioma with Partial Spontaneous Regression in a Cow

A 3.5-year-old Holstein cow presented with a 2-week history of weakness, ataxia and difficulty in rising, followed by recumbency. At necropsy, a 3 × 2.5 cm tumour mass was found in the subdural area of the left parietal lobe of the cerebrum. Histopathology revealed the tumour to be a variant of secretory meningeal tumour. Immunohistochemically, all of the neoplastic cells expressed vimentin and some were immunopositive for cytokeratin. There were variably sized, scattered pseudocysts containing eosinophilic material that stained positively with Alcian blue and periodic acid-Schiff stains. The marginal zone of the tumour exhibited regressive change characterized by lymphocytic infiltration and extensive fibrotic areas enclosing large numbers of tumour cell nests in which most tumour cells were apoptotic. This tumour was considered to be a secretory variant of cerebral meningioma with partial spontaneous regression.

A hepatic sclerosed hemangioma with drastic changes in contrast-enhanced ultrasonography

Hepatic sclerosed hemangioma is a rare benign liver tumor that originated from hepatic cavernous hemangioma; however, the process of its formation has been unclear. We herein present the patient of a histologically proven hepatic sclerosed hemangioma that showed drastic changes in diagnostic images in a short period. A 56-year-old man was referred to our hospital for the treatment of suspicious hepatocellular carcinoma with hepatitis C, approximately 2 cm in diameter in liver segment 8. Initially, the tumor manifested as early entire enhancement with mildly delayed washout in contrast-enhanced ultrasonography; however, it manifested as continuous peripheral enhancement with the central non-enhanced area after 1 month in various diagnostic images. He completely quit drinking and smoking 1 month preoperatively. No special symptoms and signs were found to suggest tumor ischemia. Anatomical resection of segment 8 was completed. Histological examination confirmed the final diagnosis of common type hepatic sclerosed hemangioma, derived from atypically enhancing cavernous hemangioma. No signs of impaired blood flow were observed in both diagnostic images and histological examination. Sclerosing changes in hepatic cavernous hemangioma may be completed in a relatively short time with no apparent reason.

Risk Factors of Tumor Recurrence After Liver Transplantation for Combined Hepatocellular Carcinoma and Cholangiocarcinoma

BACKGROUND

Combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) is commonly diagnosed as hepatocellular carcinoma (HCC) preoperatively. Therefore, unexpected recurrence occurs in some patients after liver transplantation (LT). The aim of this study was to identify the risk factors of recurrence.

METHODS

We retrospectively reviewed the data of 20 patients who underwent LT for cHCC-CC from January 2005 to December 2015.

RESULTS

Of the 20 patients, 11 (55%) had concurrent HCC and 10 (50%) had multiple cHCC-CCs. Before LT, 13 patients had undergone transarterial chemoembolization (TACE, n = 9), radiofrequency ablation, and TACE (n = 3) or surgical resection (n = 1). Four of the patients (20%) had the classical type, whereas 16 (80%) had subtypes with stem cell features. Six of the 16 patients (37.5%) with subtypes with stem cell features and 3 of the 4 patients (75%) with the classical type showed recurrence after LT. In multivariate analysis, the classical type was significantly associated with poorer recurrence-free survival (RFS) (hazard ratio [HR]: 8.65, confidence interval [CI]: 1.25-60.05, P = .03) and poorer overall survival (HR: 8.89, CI: 1.37-57.84, P = .02). Spontaneous tumor necrosis also showed significance on RFS (P = .03) among 11 patients with nontreated lesions.

CONCLUSION

In cHCC-CC, the classical type and spontaneous tumor necrosis were associated with recurrence. If these risk factors are found after LT, short-interval follow-up and strategies such as chemotherapy and/or use of mammalian target of rapamycin inhibitors to prevent recurrence are needed.

Complete spontaneous necrosis of hepatocellular carcinoma accompanied by portal vein tumor thrombosis: A case report

INTRODUCTION

We report a rare case of complete spontaneous necrosis of a hepatocellular carcinoma (HCC) accompanied by portal vein tumor thrombosis (PVTT), as confirmed by resection.

CASE PRESENTATION

A 64-year-old man was referred to our hospital for suspected HCC. Contrast-enhanced computed tomography (CECT) findings before admission revealed a 53-mm tumor in the posterior segment of the liver and were suspicious for PVTT in the right posterior PV. Both alpha-fetoprotein (AFP) and proteins induced by vitamin K absence or antagonist-II (PIVKA-II) were elevated at 17,562 ng/mL and 153 mAU/mL, respectively. We diagnosed the findings as HCC with PVTT. Seven days after the first CECT scan, we performed CECT volumetry, which revealed that the tumor had regressed to 30 mm, along with regression of the PVTT. We performed portal vein ligation (PVL), and 10 days later, CECT revealed that the tumor had shrunk to 20 mm. AFP and PIVKA-II levels were 643 ng/mL and 14 mAU/mL, respectively. We suspected spontaneous regression of the patient's HCC, but performed a hepatectomy. Histopathology revealed a 22-mm tumor with a thin fibrous capsule and a tumor thrombus in the PV. Trabecular and pseudoglandular structures consisting of denucleated HCC epithelial cells made up both the tumor and thrombus, and the finding confirmed the spontaneous necrosis of HCC.

CONCLUSIONS

We present an extremely rare case of complete spontaneous necrosis of HCC with PVTT. When spontaneous necrosis is suspected, surgery should be considered because of the potential risk of residual viable cancer cells.

Spontaneous regression of hepatocellular carcinoma: A mini-review

Spontaneous tumor regression is an extremely rare phenomenon in the oncology field. However, there are several case reports resulted in the regression of hepatocellular carcinoma (HCC) and the accumulation of clinical information and analyses of the mechanism can contribute to the development of a novel therapy. For this purpose, we have carefully reviewed 23 cases of spontaneously regressed HCC published in recent 5 years and our case. The information regarding the tumor size, tumor marker, treatments, etc., have been summarized. The mechanism of spontaneous regression has been discussed to date and presumed to be due to many factors, including hypoxia and immunological reactions. In this careful review of the 24 cases based on the clinical information, hypoxia, systemic inflammation, and both upon spontaneous regression were seen in 3, 8, and 4 cases, respectively among the 15 cases for which the information regarding the proposed mechanisms are available. Recent development of immunotherapeutic approaches in oncology shows promising results, therefore, accumulation of additional cases and analysis of mechanisms underlying the spontaneous regression of HCC are essential and could lead to the development of a new generation of immunotherapies including antibodies directed against immune reactions.

Complete necrosis of hepatocellular carcinoma after preoperative portal vein embolization: a case report

Background

Hepatocellular carcinoma has a poor prognosis; few patients can undergo surgical curative treatment according to Barcelona Clinic Liver Cancer guidelines. Progress in surgical techniques has led to operations for more patients outside these guidelines. Our case shows a patient with intermediate stage hepatocellular carcinoma presenting a good outcome after curative treatment.

Case presentation

We report the case of an 80-year-old Moroccan man, who was positive for hepatitis c virus, presenting an intermediate stage hepatocellular carcinoma (three lesions between 20 and 60 mm). He presented a complete tumor necrosis after portal vein embolization and achieved 24-month disease-free survival after surgery.

Conclusions

Perioperative care in liver surgery and multidisciplinary discussion can help to extend indications for liver resection for hepatocellular carcinoma outside European Association for the Study of the Liver/American Association for the Study of Liver Diseases recommendations and offer a curative approach to selected patients with intermediate and advanced stage hepatocellular carcinoma.