Korean J Gastroenterol.  2015 May;65(5):312-315. 10.4166/kjg.2015.65.5.312.

Spontaneous Neoplastic Remission of Hepatocellular Carcinoma

• Kim SB
• Kang W
• Shin SH
• Lee HS
• Lee SH
• Choi GH
• Park JY

• KMID: 2373228
• DOI: http://doi.org/10.4166/kjg.2015.65.5.312

Abstract

We report on a case of a 57-year-old male who underwent a curative resection for hepatocellular carcinoma (HCC) with histological confirmation of a spontaneously necrotized tumor. Initial serum AFP level was 4,778 ng/mL. A 3.7 cm hyperechoic mass in segment 6 of the liver was observed on ultrasonography and dynamic contrast-enhanced liver MRI showed a 3.7x3.1 cm sized HCC. He was scheduled to undergo curative surgical resection under the clinical diagnosis of an early stage HCC (Barcelona Clinic Liver Cancer stage A). Without treatment, the serum AFP level declined rapidly to 50 ng/mL over five weeks. He underwent curative wedge resection of segment 6 of the liver. Histology revealed complete necrosis of the mass rimmed by inflamed fibrous capsule on a background of HBV-related cirrhosis with infiltration of lymphoplasma cells. Exact pathophysiology underlying this event is unknown. Among the proposed mechanisms of spontaneous neoplastic remission of HCC, circulatory disturbance and activation of host immune response offer the most scientific explanation for the complete histologic necrosis of HCC in the resected mass seen in our patient.

Keyword

Spontaneous neoplasm regression; Liver neoplasms; Spontaneous neoplasm remission

MeSH Terms

Carcinoma, Hepatocellular/*diagnosis/diagnostic imaging/pathology
Hepatitis B/complications/diagnosis
Humans
Liver/diagnostic imaging/pathology
Liver Cirrhosis/etiology
Liver Neoplasms/*diagnosis/diagnostic imaging/pathology
Magnetic Resonance Imaging
Male
Middle Aged
Necrosis
Radiography
Remission, Spontaneous
Ultrasonography
alpha-Fetoproteins/analysis
alpha-Fetoproteins

Figure

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  Fig. 1. Dynamic contrast-enhanced liver MRI shows a 3.7×3.1 cm mass (arrows) with arterial enhancement (A) and delayed washout (B) in T1-weighted images. (C) Graph illustrates the changes in AFP levels from referral to post resection of the tumor. Serum AFP level was 4,778 ng/mL at referral, but declined spontaneously to 650 ng/mL and dropped further to 50 ng/mL prior to surgery. After surgery, serum AFP level remained within normal limits.

• 

  Fig. 2. (A) Gross appearance of the resected tumor shows an expanding type of mass with necrotic features. (B, C) Histology reveals complete necrosis of hepatocellular carcinoma (asterisks) rimmed by inflamed fibrous capsule with lymphoplasma cell infiltration (H&E stain; B: ×12.5, C: ×100).

Reference

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