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

Abstract

We report a rare case of spontaneous regression of diffuse intrahepatic recurrence with portal vein tumor thrombus (PVTT) after resection of hepatocellular carcinoma (HCC). A 68-year-old man with hepatitis C virus-related liver cirrhosis presented with a 40 mm tumor in the right anterior segment of the liver. The tumor was diagnosed as HCC by typical imaging findings and elevated serum alpha-fetoprotein (AFP) (716 ng/ml) and protein induced by vitamin K absence II (PIVKA II) (8,100 ng/ml). A right anterior sectionectomy of the liver was performed. Microscopically, the tumor was moderately differentiated HCC. Four months after resection, a computed tomography (CT) scan showed diffuse intrahepatic recurrence with PVTT. Serum AFP was 12,319 ng/ml and PIVKA II was 168,000 ng/ml. The patient did not receive any further treatment for HCC including herbal medicine, and stopped smoking. Two years and 5 months later, no lesion was detected on a CT scan when serum AFP was 1.9 ng/ml. Ischemia due to main portal vein occlusion and rapid tumor growth might have induced tumor regression in the present case. Moreover, abstention from smoking might have improved his immunological function.

Aggressive Intrasegmental Recurrence of Hepatocellular Carcinoma after Radiofrequency Ablation: Risk Factors and Clinical Significance

“…During surgical resection, it is possible to perform systematic removal of the corresponding hepatic segment fed by portal tributaries, including potential microvascular invasion as well as the tumor itself (3); however, RF ablation is limited to destruction of the tumor, allowing for some ablative margin, and there is no direct way to treat the remaining segment (4). This restriction is a substantial difference between the two treatment methods because intrahepatic recurrences could arise by means of vascular invasion and subsequent transportal spread along intrasegmental branches or untreated micrometastases around the tumor, which are related to poor prognosis after hepatic resection (5)(6)(7)(8)(9). We recently observed an interesting pattern of delayed aggressive recurrence confined to the peripheral portion of treated segments after RF ablation for HCC.…”

Intrahepatic recurrence of single nodular hepatocellular carcinoma after surgical resection: an analysis by segmental distribution

“…Two underlying modes of intrahepatic recurrence have been suggested, that is, de novo or multicentric occurrence and intrahepatic metastasis. Multicentric occurrence is by definition a newly formed tumour, and tends to be associated with a few nodules, recur late, host‐factor related, and thus, metachronous in nature . On the other hand, intrahepatic metastasis involves tumour dissemination through pre‐existing intrahepatic channels, such as the portal or hepatic veins, and tends to be multiple, recur early, tumour biology‐related, and synchronous in origin .…”

Pathological complete response after percutaneous isolated hepatic perfusion in hepatocellular carcinoma with portal vein tumor thrombosis: a case report

“…To the best of our knowledge, this is the first report of a case with pathological complete response after preoperative chemotherapy with PIHP in advanced HCC involving PVTT. Although there were several reports of spontaneous regression of PVTT [ 25 , 26 ], in the present case, we judged PIHP was effective based on the pathohistological assessment.…”