Spontaneous Necrosis of Hepatocellular Carcinoma: A Case Report

Abstract

Background: Spontaneous regression of a malignant tumor is a rare phenomenon. So far, 13 cases of spontaneous regression of hepatocellular carcinoma (HCC) have been described in the English literature. We report a case of HCC, with spontaneous complete necrosis demonstrated by histological examination. Methods: A 73-year-old male was admitted to our hospital complaining of general fatigue. CT and US revealed a huge mass measuring 9.5 cm at the left lobe. Angiographies showed hypovascular tumor stains. The levels of alpha-fetoprotein (AFP) and PIVKA-2 on admission were high, at 55 ng/ml and 62,300 mAU/ml, respectively. We diagnosed hypovascular HCC and performed a left lobectomy on October 16, 2000. Results: In the histological examination, no viable cells were found. The levels of AFP and PIVKA-2 had already decreased to 14 ng/ml and 1,420 mAU/ml, before laparotomy. Conclusion: Changes in tumor markers and histological findings reveal that this phenomenon occurred without specific treatment.

Open-label phase II clinical trial in 75 patients with advanced hepatocellular carcinoma receiving daily dose of tableted liver cancer vaccine, hepcortespenlisimut-L

“…However, there is a significant body of evidence arguing against this consensus. There are, for example, multiple case reports of spontaneous regression of HCC; in cases where AFP was evaluated at baseline, there is a consistent correlation with decrease or normalization of tumor marker 29–32. There are also various immunotherapy trial reports pointing out that decrease in AFP was associated with favorable clinical response 15–21.…”

Management Considerations for Purported Spontaneous Regression of Hepatocellular Carcinoma: A Case Report

“…To date, 85 cases of apparently spontaneous regression of HCC have been described in the literature, most of which were established via radiological findings. By contrast, only 21 cases were examined pathologically, and 13 of these cases had proven total necrosis of HCC (table 1) [2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21]. In the present case, MRI indicated that the HCC lesion had undergone necrosis.…”

“…Approximately 85 cases of spontaneous regression of HCC have been described in the literature [2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21], most of which were established via radiological findings. By contrast, examination of surgically resected specimens following radiologic indications of spontaneous resolution of HCC was conducted in only 21 of these cases [2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21]. Of those, pathological examination revealed complete necrosis in 13 cases [2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14] and persistence of microscopically viable cancer cells in eight cases [14, 15, 16, 17, 18, 19, 20, 21].…”

Glypican‐3 and MAGE‐1 are predictors of tumor invasiveness of hepatocellular carcinoma

“…The development of new therapeutic tools for patients with HCC who have advanced stage disease or recurrent disease is essential for improvement of patient outcomes. Over the past decade immunotherapy has become a more promising approach to treatment; it may be useful for the treatment of HCC where some cases of spontaneous regression have been reported 2–4 . Experimental and clinical trials of immune‐based interventions for HCC have been performed.…”

“…Over the past decade immunotherapy has become a more promising approach to treatment; it may be useful for the treatment of HCC where some cases of spontaneous regression have been reported. [2][3][4] Experimental and clinical trials of immune-based interventions for HCC have been performed. However, the information on candidates for HCC-specific target antigens has not been confirmed in large scale studies.…”