Spontaneous regression of hepatocellular carcinoma: potential promise for the future.To the Editor: Worldwide there are approximately 1.2 million new cases of hepatocellular carcinoma hep·a·to·cel·lu·lar carcinoma n. A carcinoma derived from parenchymal cells of the liver. Also called hepatocarcinoma, malignant hepatoma. (HCC HCC Hepatocellular Carcinoma (liver cancer) HCC Hertfordshire County Council (administrative region of south eastern England UK) HCC Harford Community College (Maryland) ) that arise annually, making this one of the most prevalent malignancies in the world. (1) The incidence of HCC in the United States and Europe is on the rise with the increasing number of hepatitis B Hepatitis B Definition Hepatitis B is a potentially serious form of liver inflammation due to infection by the hepatitis B virus (HBV). It occurs in both rapidly developing (acute) and long-lasting (chronic) forms, and is one of the most common chronic and C cases. (2) Despite advances in detecting and managing malignant diseases, progress in the management of HCC has been minimal and the prognosis of advanced cases of HCC remains poor. Typically, survival time after onset of symptoms is less than six months. (3) There have been a few case reports describing the spontaneous regression of HCC; however, the exact pathophysiology pathophysiology /patho·phys·i·ol·o·gy/ (-fiz?e-ol´ah-je) the physiology of disordered function. path·o·phys·i·ol·o·gy n. 1. behind this phenomenon remains unknown. Spontaneous regression of malignancies in general, although rare, (around 1 per 60,000-100,000) has been documented. (4) [FIGURE 1 OMITTED] We report a patient who had radiological and biopsy-proven HCC that did not progress for a period of 6 months. On the contrary, the patient had spontaneous regression of multiple lesions without any treatment. (Fig. 1-2) Over the same period, the patients' elevated alpha fetoprotein alpha fetoprotein /al·pha fe·to·pro·tein/ (fe?to-pro´ten) a plasma protein produced by the fetal liver, yolk sac, and gastrointestinal tract and also by hepatocellular carcinoma, germ cell neoplasms, other cancers, and some benign (AFP (1) (AppleTalk Filing Protocol) The file sharing protocol used in an AppleTalk network. In order for non-Apple networks to access data in an AppleShare server, their protocols must translate into the AFP language. See file sharing protocol. ) level decreased, despite not receiving any known conventional or unconventional treatment for his malignancy. [FIGURE 2 OMITTED] [FIGURE 3 OMITTED] Because of the rarity of this phenomenon, possible mechanisms for regression discussed in the literature originate primarily from the analysis of individual case histories. Spontaneous regression of HCC has also been reported to occur after abstinence from alcohol, persistent fever, withdrawal of androgen, blood transfusion blood transfusion, transfer of blood from one person to another, or from one animal to another of the same species. Transfusions are performed to replace a substantial loss of blood and as supportive treatment in certain diseases and blood disorders. , massive bleeding, rapid tumor growth, angiography angiography or arteriography X-ray examination of arteries and veins with a contrast medium to differentiate them from surrounding organs. The contrast medium is introduced through a catheter to show the blood vessels and the structures they supply, including , surgical trauma and the use of herbal medicines. Among the proposed mechanisms of spontaneous regression of HCC, an immunologic response offers the most scientific explanation. (1) It is proposed that the immune response is toward the AFP, which is a weakly antigenic self-protein and has to be presented by an antigen presenting dendritic cells to initiate an immune response. Dendritic cell (Fig. 3) vaccinations have actually been effective in the treatment of HCC in animals and human trials are currently underway. The ultimate role of tumor vaccines is in the prevention of HCC in high-risk patients, such as those with cirrhosis. Further understanding of this phenomenon could help discover new strategies for the prevention, control and management of HCC. Acknowledgments The authors would like to acknowledge Dr. V. Bhatia and Dr. L. Schlabach for their assistance. Harsha Gadadhar Vardhana, MD Mukta Panda, MD Department of Internal Medicine University of Tennessee The University of Tennessee (UT), sometimes called the University of Tennessee at Knoxville (UT Knoxville or UTK), is the flagship institution of the statewide land-grant University of Tennessee public university system in the American state of Tennessee. , College of Medicine Chattanooga, TN References 1. O'Beirne JP Harrison PM. The role of immune system in the control of Hepatocellular carcinoma. Eur J Gastroenterology 2004;16:1257-1260. 2. El-Serag HB, Mason AC. Rising incidence of hepatocellular carcinoma in the United States. N Engl J Med 1999;340:745-750. 3. Okuda K, Ohtsuki T, Obata H, et al. Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study of 850 patients. Cancer 1985;56:918-928. 4. Cole WH. Efforts to explain spontaneous regression of cancer spontaneous regression of cancer Oncology The partial or complete disappearance of a histologically-confirmed malignancy in absence of treatment or with treatment deemed inadequate to sufficiently alter its natural course. See Melanoma. . J Surg Oncol 1981;17:201-209.Letters to the Editor |
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