Spontaneous regression of hepatocellular carcinoma

Abstract

The widespread use of ultrasound in screening programmes for chronic liver disease has led to early diagnosis of hepatocellular carcinoma (HCC), and to the observation of some cases of tumour spontaneous regression. This is a rare event whose underlying mechanism is still unclear. We present here a case of spontaneous regression of HCC in a 71-year-old woman with chronic hepatitis and discuss possible aetiologies. None of the causative mechanisms proposed for spontaneous regression of HCC is completely satisfactory, so further studies are necessary to improve understanding of this unusual biological event. Therefore, we stress the importance of accumulating all such cases in the literature, because the clarification of aetio-pathogenic mechanisms may lead to the development of new treatment strategies for HCC.

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

“…Another plausible mechanism identified in cases is a vascular compromise. 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].…”

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

“…The ‘tumour hypoxia’ category 16–36 included patients with an occlusive portal vein thrombosis, spontaneous hepatic artery thrombosis, angiospasm during angiography, development of a large arterioportal shunt and a sustained period of hypotension because of a massive gastrointestinal bleed (Table 1).…”

Apresentações incomuns do hepatocarcinoma: ensaio iconográfico

“…É importante lembrar que tumores volumosos apresentam maior risco de ruptura espontânea, principalmente aqueles que ocupam quatro ou mais segmentos hepáticos (25) . Hepatocarcinoma com regressão espontânea -Existem diversos artigos na literatura demonstrando cerca de 30 casos de hepatocarcinomas com regressão e desaparecimento espontâneo (Figura 11) (26)(27)(28) , mesmo na presença de metástases a distância (29,30) . Apesar de várias hipóteses terem sido formuladas (p.…”

“…ex. : deficiência da irrigação tumoral (27,28) ), nenhuma parece ser completamente satisfatória (26) .…”