Spontaneous Regression of a Large Hepatocellular Carcinoma with Portal Vein Tumor Thrombi: Report of a Case

Abstract

A 65-year-old man with chronic hepatitis C showed a markedly elevated serum alpha-fetoprotein concentration. Computed tomography revealed a huge tumor occupying the entire right hepatic lobe. Three months later, the tumor regressed spontaneously from 12 cm to 7 cm in diameter without any medical treatment. A right hepatic lobectomy was performed 4 months after the initial diagnosis. The main tumor, located in the posterior inferior segment, was completely necrotic, and had a thick fibrous capsule. Many inflammatory cells had also infiltrated into the tumor. Only a small portion of a tumor thrombus in the portal vein and one of three intrahepatic metastases contained viable cancer cells. The tumor was found to be poorly differentiated hepatocellular carcinoma. Tumor regression may have been caused by a disturbance in hepatic circulation associated with the portal vein thrombus.

Unusual Atrophic Change After Repeated Arterial Therapy for Hepatocellular Carcinoma: Report of a Case

“…8 Moreover, there have also been a few reports of marked atrophic change in liver tissues during the natural course of patients with HCC or CCC. [9][10][11] It is hypothesized that these changes are due to an obstruction of portal vein or bile tract by the invasive tumor. The same atrophic change to the liver has been reported regarding hepatolithiasis.…”

Spontaneous regression of a biopsy confirmed hepatocellular carcinoma

“…In Huz's report, 28% of spontaneous regressions of HCC were as a result of tumour ischaemia 15. Disruption of blood supply, either due to the local effect of vascular injury,21 aterioportal shunt22 or portal vein thrombosis23 or due to the systemic hypoperfusion from bleeding,24 can lead to necrosis and regression of hepatocellular carcinoma. This mechanism is exploited artificially by hepatic artery embolisation and antiangiogenic agents such as sorafenib, which are well-known therapeutic manoeuvres that induce tumour hypoxia and subsequent regression 15…”

Spontaneous regression of diffuse intrahepatic recurrence with portal vein tumor thrombus after resection of hepatocellular carcinoma

“…Firstly, ischemia due to injuries of the feeding arteries associated with angiography and arterial thrombosis [6,7], the occlusion of the feeders caused by cancerous invasion [8], PVTT [9,10], deprivation of oxygen due to rapid tumor growth [11], and gastrointestinal bleeding [12] have been thought to be reasons for SR of HCC, because malignant tissue is more sensitive to ischemic change than normal hepatic tissue.…”