SPONTANEOUS REMISSION OF A HEPATOCELLULAR-CARCINOMA

Background: The prognosis of advanced hepatocellular carcinoma is poor with a median survival time of approximately 4-8 months. However, few patients live several years due to an unusual growth behaviour of the tumour which in rare cases regresses spontaneously. Material and Meth ods: We report about a 74-year-old patient who was referred to our hos pital in September 1994 because of right epigastric pain and a tumorou s mass in his liver. The initial alpha-1-fetoprotein (alpha 1-FP) conc entration in the serum was 21,700 IU/ml. The CT scan revealed two tumo urs in the right lobe and the central part of his liver. While one nod ule was quite small the other measured 9x7.5x6 cm and showed a central necrosis. Biopsy proved the diagnosis of a moderately differentiated, trabecular hepatocellular carcinoma. Due to its huge size, the tumour could not be resected and the patient was sent home without a specifi c treatment. Result and Conclusions: In the following months the tumou r slowly regressed. Three months after the initial diagnosis the alpha 1-FP concentration declined to 150 IU/ml and was completely normalise d after 6 months. Nine months after the initial evaluation the size of the carcinoma was 3.5 cm. In September 1995 the tumour had regressed to a size of 2 cm. Half a year later no tumor-could be detected anymor e. At his last follow-up visit in June 1997 the patient is still free of tumour and feels well. The phenomenon of a spontaneous tumour regre ssion is rare, and the mechanisms involved remain to be characterised.