Spontaneous regression of hepatocellular carcinoma--a case report

We report a 72-year-old man with hepatocellular carcinoma, which showed spontaneous regression. He was diagnosed as having chronic hepatitis type C five years before admission. In January 1998, a liver mass was found by ultrasonography. In February, computed tomography showed a low-density mass, 3.5 cm in diameter in the S5 region. Although liver biopsy was not performed, findings obtained by computed tomography and ultrasonography indicated that the tumor was hepatocellular carcinoma. The levels of alpha-fetoprotein and PIVKA (protein induced by vitamin K antagonist)-II were increased to 1000 ng/mL and 2000 mAU/mL, respectively. The patient was admitted to our hospital in March 1998. At the time, the size of liver mass was reduced to 2.5 cm in diameter on computed tomography, and the tumor markers, alpha-fetoprotein and PIVKA-II, spontaneously decreased to the normal range. We considered that hepatocellular carcinoma of this patient regressed spontaneously. Because it was hard to exclude the possibility that the mass contained residual malignant cells, we resected the mass on April 28, 1998. Microscopically, the resected mass did not contain any malignant cells. The parenchyma surrounding tumor necrosis, which is reflected by severe inflammatory infiltration with lymphocytes, indicates spontaneous regression. Although the precise mechanism regarding spontaneous regression of hepatocellular carcinoma is not fully understood, either ischemia due to rapid growth of the tumor or some inflammatory mechanism may be involved in regression of hepatocellular carcinoma.