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SPONTANEOUS REGRESSION OF HEPATO-CELLULAR CARCINOMA (HCC) IN A 62 YEAR OLD MALE PRESENTING WITH PORTAL VEIN THROMBUS
S Gauthier, MC Champion
Division of Gastroenterology, University of Ottawa
A 62 year old male, with known cirrhosis, presented to hospital with nausea, vomiting and 30lbs weight loss in December 2005. Abdominal U/S and CT scan demonstrated near occlusive portal vein thrombus,cirrhosis, splenomegaly and ascites but no evidence of any tumor. With increasing LFTs [Alk Phos 388, GGT 271] and an alpha fetoprotein [AFP] of 92ug/l an MRI in April 2006 revealed chronic liver disease and extensive arterialized tumor thrombus within the intra and extrahepatic portal venous radicals. There was diffuse arterial phase enhancement indicative of diffuse HCC throughout the liver also with the possibility of two lesions in the right hepatic lobe. Liver FNAB in May 2006 revealed HCC (positive for HepPar1 and negative for AE1/3 and AFP, inconclusive CEAp). After discussion with an oncologist, and accounting for numerous other comorbidities, the patient elected not to undergo any treatment for HCC. Repeat AFP has since normalized, LFTs have also improved [AFP 2.6, Alk Phos 208, GGT 125] and the previous portal vein thrombus has recanalized. Follow up MRI shows resolution of the two previously seen lesions. The ascites and esophageal varices have also resolved. Radiologically and biochemically biopsy proven HCC has spontaneously regressed and he remains asymptomatic.
Review of the literature demonstrates more than 60 cases of spontaneous remission of HCC of which five cases are related to obstructive thrombus and eight cases are related to other ischemic insults. Although the mechanisms of spontaneous HCC regression have yet to be fully understood, ischemic injury resulting from thrombus, rapid tumor growth, gastrointestinal bleeding or aberrant blood flow is thought to play a role.