To evaluate the helical CT findings of ruptured hepatocellular carcinoma (HCC), 12 patients with ruptured HCC were reviewed with regard to the tumour's location, size and contour protrusion, the appearance of the mass, the enhancement pattern, multiplicity and secondary changes. All ruptured tumours were located at the periphery of the liver and had a protruding contour. The maximum diameter of tumours ranged from 2 cm to 16 cm. Discontinuity of the hepatic surface was seen in 11 cases. In eight cases, CT images during the arterial phase showed a non-enhancing low attenuating lesion with focal discontinuity and peripheral rim enhancement. Seven cases showed separation of tumour content from the peripheral enhancing rim and intraperitoneal rupture of tumour content into the perihepatic space. Because of the similar appearance to an enucleated orbital globe with remaining sclera, this was termed the "enucleation sign". As well as ruptured masses, 10 cases with non-ruptured masses also showed a non-enhancing low attenuating pattern. Seven cases showed a haematoma with high attenuation around the ruptured mass. The peripheral location, protruding contour, discontinuity of the hepatic surface and surrounding haematoma are helpful signs in the diagnosis of ruptured HCC. The "enucleation sign" may be a characteristic finding in ruptured HCC.
Although rare spontaneous regression of either primary or metastatic mal ignant tumor in the absence of or inadequate therapy has been well documented. 5i nce the earliest day of this century various malign.ant tumors have been reported to spontaneously disappear or to be arrested of their growth , but the cases of hepatocarcinoma has been very rare. From the literature , we were able to find out 5 previously reported cases of hepatocarcinoma which showed spo ntaneou s regression at the primary site.Recently we have seen a case of multiple pulmonary metastatic nodules of hepatocarcinoma which completely regressed spontaneously and this forms the basis of the present case report.The patient was 55-year-old male admitted to 5t. Mary '5 Hospita l, Catholic Mediιal College because of a hard palpable mass in the epigastrium on April 26 , 1978 . The adm ission PA chest roentgenogram revealed multiple small nodular densities scattered throughout both lung fie ld espec ially in lower zones and toward the peripheral portion (Fig. 1). A hepatoscintigram revea led a large co ld area in volvi ng the left lobe and inermediate zone of the liver. Alfa.fetoprote in and hepatitis B serum antigen test were positive whereas many other standard, liver function tests turned out to be negative. A needle biopsy of the tumor revealed well differentiated hepatocellular carcinoma (Fig. 2-A and B). The patient was put under c hem ot he rapy which consisted of 5 FU 500 mg intravenously for 6 days from April 28 to May 3, 1978. The patient was discharged after th is single course of 5 FU treatment and was on a herb medicine , the nature and qu.a ntity of which obscure. No other specific treatment was given.The second admission took place on Dec. 3, 1980 because of ir regular ity in bowel habits and dyspepsia. A follow up PA chest roentgenogram obta in ed on the second admission revealed ιomplete disappearance of previously noted multiple pulmonary nodular lesions (Fig. 3). Fo ll ow up li ver scan revea le d persistence of the cold area in the left lobe with sli ght decrease in size. The patient was discharged again without any specific prescription after confi rming negat ive resu lts of various clinical studies including upper GI series and co lon study. At the time of finishing this paper the patient is do ing well without apparent medical problems.
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