Spontaneous Massive Necrosis of Hepatocellular Carcinoma with Narrowing and Occlusion of the Arteries and Portal Veins

Tomino, Takahiro; Yamashita, Yo Ichi; Iguchi, Tomohiro; Itoh, Shinji; Ninomiya, Mizuki; Ikegami, Toru; Yoshizumi, Tomoharu; Soejima, Yuji; Kawanaka, Hirofumi; Ikeda, Tetsuo; Aishima, Shinichi; Shirabe, Ken; Maehara, Yoshihiko

doi:10.1159/000362440

Cited by 11 publications

(8 citation statements)

References 28 publications

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“…Tumors such as HCC with high metabolic rates are susceptible to SR in conjunction with a sudden fall in hepatic blood flow including rapid growth [13, 17, 18], arterioportal shunting [8, 19], and portal vein thrombosis [20, 21]. Thickening of the vessel intima leading to thrombus formation may also be an initiating factor [9]. In one case, a patient underwent angiography which resulted in regression due to the formation of a thromboembolus in the feeding arteries [22].…”

Section: Discussionmentioning

confidence: 99%

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

Chohan

Taylor

Coffin

et al. 2019

Case Reports in Medicine

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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.

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Section: Discussionmentioning

confidence: 99%

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

Chohan

Taylor

Coffin

et al. 2019

Case Reports in Medicine

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“…Identifying such nonviable areas and distinguishing them from VDA caused acute necrosis by Gd-DOTA enhanced T1WI proves crucial to precise evaluation of VDA therapeutic efficacy. In practice, spontaneous necrosis resulting from a lack of blood supply caused by rapid tumor growth [55,56] needs to be differentiated from CA4P induced acute necrosis by Gd-DOTA enhanced T1WI (Figure 4), in order not to overestimate treatment efficacy with VDAs.…”

Section: Nonspecific Mri Camentioning

confidence: 99%

Predicting Clinical Efficacy of Vascular Disrupting Agents in Rodent Models of Primary and Secondary Liver Cancers: An Overview with Imaging-Histopathology Correlation

et al. 2020

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Vascular disrupting agents (VDAs) have entered clinical trials for over 15 years. As the leading VDA, combretastatin A4 phosphate (CA4P) has been evaluated in combination with chemotherapy and molecular targeting agents among patients with ovarian cancer, lung cancer and thyroid cancer, but still remains rarely explored in human liver cancers. To overcome tumor residues and regrowth after CA4P monotherapy, a novel dual targeting pan-anticancer theragnostic strategy, i.e., OncoCiDia, has been developed and shown promise previously in secondary liver tumor models. Animal model of primary liver cancer is time consuming to induce, but of value for more closely mimicking human liver cancers in terms of tumor angiogenesis, histopathological heterogeneity, cellular differentiation, tumor components, cancer progression and therapeutic response. Being increasingly adopted in VDA researches, multiparametric magnetic resonance imaging (MRI) provides imaging biomarkers to reflect in vivo tumor responses to drugs. In this article as a chapter of a doctoral thesis, we overview the construction and clinical relevance of primary and secondary liver cancer models in rodents. Target selection for CA4P therapy assisted by enhanced MRI using hepatobiliary contrast agents (CAs), and therapeutic efficacy evaluated by using MRI with a non-specific contrast agent, dynamic contrast enhanced (DCE) imaging, diffusion weighted imaging (DWI) are also described. We then summarize diverse responses among primary hepatocellular carcinomas (HCCs), secondary liver and pancreatic tumors to CA4P, which appeared to be related to tumor size, vascularity, and cellular differentiation. In general, imaging-histopathology correlation studies allow to conclude that CA4P tends to be more effective in secondary liver tumors and in more differentiated HCCs, but less effective in less differentiated HCCs and implanted pancreatic tumor. Notably, cirrhotic liver may be responsive to CA4P as well. All these could be instructive for future clinical trials of VDAs.

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“…Immunological reactions are reported to be the main mechanism of spontaneous regression of HCC[ 17 , 34 ]. Abstinence from alcohol[ 12 , 46 , 47 ] and smoking[ 12 ], herbal medicines[ 11 , 25 ], prolonged fever[ 26 , 48 , 49 ], antidiabetics[ 50 ], and vitamin K administration[ 51 ] are considered to induce systemic immunological reaction with various patterns. Evdokimova et al[ 52 ] reported that APC-specific cluster of differentiation (CD) 4 positive T lymphocytes exhibit an anti-tumor capacity for HCC.…”

Section: Immunological Reactionsmentioning

confidence: 99%

Spontaneous regression of hepatocellular carcinoma: A mini-review

Sakamaki

Kamimura

Abe

et al. 2017

WJG

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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.

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Spontaneous Massive Necrosis of Hepatocellular Carcinoma with Narrowing and Occlusion of the Arteries and Portal Veins

Cited by 11 publications

References 28 publications

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

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

Predicting Clinical Efficacy of Vascular Disrupting Agents in Rodent Models of Primary and Secondary Liver Cancers: An Overview with Imaging-Histopathology Correlation

Spontaneous regression of hepatocellular carcinoma: A mini-review

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