Complete remission of advanced hepatocellular carcinoma by sorafenib: A case report

Hepatocellular carcinoma (HCC) is the fifth most common malignant disease worldwide, and curative treatment remains difficult because the majority of cases are diagnosed in the advanced stage. Sorafenib is the only known effective systemic treatment, but patients rarely achieve complete remission (CR). A 66-year-old man with a history of alcoholic liver cirrhosis with a diagnosis of advanced HCC, was initially treated with transarterial chemoembolization on four occasions. However, the disease progressed with portal vein thrombosis. Therefore, sorafenib was started, and 4 mo later, the patient achieved CR. The treatment was continued for 12 mo, and CR was maintained up to 4 mo after sorafenib discontinuation.     

Irinotecan as second-line chemotherapy for 5-FU-resistant gastric cancer with disseminated intravascular coagulation: a case report

A 60-year-old female was diagnosed as advanced gastric cancer with multiple bone, neck and mediastinal lymph node metastases. As a primary chemotherapy, she was treated with S-1(50 m g/body, twice daily for 4 weeks, followed by a 2- week rest). After 3 courses of S-1, she developed a disease progression with pulmonary lymphangitic carcinomatosis and disseminated intravascular coagulation(DIC). Therefore, she received second-line chemotherapy of irinotecan(CPT-11 150 mg/m2, biweekly). Within 3 weeks of starting the treatment, the clinical and laboratory signs of DIC were dramatically resolved. There have been no previous reports of irinotecan alone showing such remarkable effectiveness in a patient with 5- FU-resistant gastric cancer with DIC.     

Complete remission of unresectable hepatocellular carcinoma treated with reduced dose of sorafenib: a case report

Hepatocellular carcinoma (HCC) is a highly aggressive cancer. For patients who are diagnosed with advanced stage disease that are not surgical candidates, the disease is universally lethal. Advance has been made to extend survival with molecular target therapy, but durable complete responses are extremely rare. We report an unusual case where a 74-year-old patient with unresectable HCC received eight months of reduced-dose of sorafenib, a tyrosine kinase inhibitor, and achieved a durable complete remission. At the most recent follow up, he remains in remission 16 months after cessation of treatment, without clinical or imaging evidence of disease recurrence.     

Spontaneous regression of hepatocellular carcinoma: a case report

We report a hepatocellular carcinoma that appeared to undergo spontaneous regression twice. On June 5, 1995, two hepatocellular carcinomas were detected by ultrasonography in a 72-year-old woman. On July 1, 1995, the tumor in the lateral segment had increased in size from 2.0 cm to 3.2 cm in 27 days, and the level of alpha-fetoprotein (AFP) had increased from 743 to 1300 ng/ml. On September 22, 1995, one tumor appeared as a typical hypervascular lesion on contrast-enhanced computed tomography. It was 3.9 cm in size and located in the posterior segment. The other was a 3.9-cm cystic mass located in the lateral segment. The tumor in the posterior segment was treated with an emulsion of epirubicin and lipiodol administered via the posterior branch of the right hepatic artery and percutaneous ethanol injection. The tumor in the lateral segment was kept under observation because it was avascular, had regressed to 2.0 cm in size, and the patient's AFP level had decreased to 237 ng/ml by December 5, 1995. By February 21, 1996, the AFP level had increased again to 105,340 ng/ml, and by March 22, 1996, the latter tumor had increased in size to 3.8 cm. However, it later regressed again to 1.6 cm, and the AFP level decreased spontaneously to 7 ng/ml. From the changes in the contrast-enhanced computed tomographic images, and the level of AFP, we cannot rule out the possibility that the spontaneous regression might have been caused by the tumor's rapid growth.      

Complete response of advanced hepatocellular carcinoma with multiple lung metastases treated with sorafenib: a case report

Sorafenib, an oral multikinase inhibitor, has demonstrated clinical efficacy in patients with advanced hepatocellular carcinoma (HCC). However, in the SHARP trial (Sorafenib HCC Assessment Randomized Protocol trial) and the Asia-Pacific trial (conducted in the Asia-Pacific region), no cases of complete response (CR) were reported. Thereafter, only a relatively small number of CR cases were reported worldwide for sorafenib therapy. We herein report a case of CR in a patient treated with sorafenib for 4 months. The patient had advanced HCC with multiple lung metastases, and there has been no recurrence after 8 months following cessation of administration. To our knowledge, this is the first time a female treated with sorafenib alone for HCC has had a CR.     

Giant pedunculated sarcomatoid hepatocellular carcinoma: a case report

We report a case who was a 74-year-old female with hepatitis B virus (HBV) carrier for more than 30 years. The serum levels of AFP, CEA and CA199 were within normal range. CT scan demonstrated that a huge pedunculated mass of the right hepatic lobe presenting as lobulated and cystic-solid appearance and heterogeneous density of the solid portion composed of multiple nodules. The patient was performed surgery, and the tumor was removed. Sarcomatoid hepatocellular carcinoma (SHC) was diagnosed by pathological and immunohistochemical test. The patient has been living for 4 months without tumor recurrence, which indicates that pedunculated SHC might have a high probability for resection and acquire better survival.     

Changes in mode of response to chemotherapy for hepatocellular carcinoma induced by transarterial embolization. A case report.

A 61-year-old man received systemic mitoxantrone chemotherapy following transarterial embolization of a large hepatocellular carcinoma with extensive intrahepatic, lung and bone metastases. His serum alpha-fetroprotein levels were 199,000 ng/ml prior to chemotherapy. He was given 10 mg mitoxantrone/m2 (14 mg/dose) intravenously every three weeks, and showed a rapid decrease in his serum levels of alpha-fetoprotein. There was almost complete resolution of the multiple bilateral metastatic lung nodules at five weeks and a marked decrease in the size of the intrahepatic metastatic nodules by seven weeks. The primary tumor, however, which had been previously treated by transarterial embolization, only underwent a 33% reduction in size according to WHO criteria. This occurred despite the disappearance, demonstrated by contrast enhanced computed tomography, of all viable tumor tissue. Ultrasonography also revealed only a minor regression, and could demonstrate no changes in the tumor echo pattern. The response pattern observed in this patient indicates the response to chemotherapy for hepatocellular carcinoma to be modified by prior transarterial embolization.     

Complete remission of poorly differentiated squamous liver carcinoma after systemic chemotherapy and surgery. A case report

We report the case of a 64-year-old male patient diagnosed as having inoperable poorly differentiated liver carcinoma that could be completely resected after systemic chemotherapy with cisplatin and 5-fluorouracil.     

Oxaliplatin induced disseminated intravascular coagulation: A case report and review of literature

Oxaliplatin in combination with a fluoropyrimide is a treatment option for colorectal cancer patients in the adjuvant and metastatic settings. Very few hematological emergencies have been reported associated with Oxaliplatin. These include autoimmune hemolytic anemia, thrombocytopenia and pancytopenia. We present a case report of a patient who developed hematuria and disseminated intravascular coagulation while receiving the second cycle of FOLFOX and bevacizumab for metastatic colon cancer.     

肝癌伴上下牙龈多发转移1例

<正>1病例资料川北医学院附属医院收治1例伴有上下牙龈多发且连续转移的肝癌患者,报告如下。患者为女性,83岁,因“发现上下颌牙龈肿物3月余”入院。入院查体：上前牙及磨牙区唇舌侧牙龈可见多处粉红色菜花状新生物,下颌牙唇舌侧牙龈可见连续粉红色新生物,触之质韧,易出血,活动度差,边界较清,无触压痛,口腔卫生差,闻及恶臭。     

Complete response after chemoradiation in ampullary carcinoma: a case report

AIMS AND BACKGROUND: The case of a 70-year-old patient with resectable, poorly differentiated adenocarcinoma of the ampulla of Vater is presented. PATIENT AND METHODS: Due to intraoperative hemorrhagic complications, surgical resection was not feasible. The patient was treated with radiochemotherapy consisting of external beam radiotherapy (50.4 Gy; 1.8 Gy/fraction; 5 fractions/week) plus 5-FU (1000 mg/m2/day, continuous i.v. infusion, days 2-5, week 1 and 5 of radiotherapy) and mitomycin C (10 mg/m2 i.v., day 2, week 1 of radiotherapy). RESULTS: At five years' follow-up the patient was in good general condition, without any signs of disease according to CT scan, endoscopic retrograde cholangiopancreatography and tumor marker determination. Multiple random biopsies performed in the ampullary region were negative for tumor growth. CONCLUSIONS: In patients with ampullary carcinoma the use of concurrent chemoradiation should be considered, particularly when surgical resection is unfeasible due to medical contraindications or locally advanced disease.     

A case of cerebral infarction caused by disseminated intravascular coagulation during hepatic arterial infusion chemotherapy

A 73-year-old woman with liver metastasis underwent implantation of an infusion catheter-port system for hepatic arterial infusion chemotherapy. She developed multiple infarctions caused by disseminated intravascular coagulation (DIC) due to liver metastases. The hypercoagulability syndrome associated with cancer (known as Trousseau's syndrome) is considered a cause of cerebral infarction. Among the complications of the implantation of an infusion catheter-port system, Trousseau's syndrome may be one of the causes.     

Spontaneous regression of hepatocellular carcinoma with multiple lung metastases: a case report.

Spontaneous regression of hepatocellular carcinoma is an extraordinarily unusual phenomenon. We present here a case of a 75-year-old man in whom multiple lung metastases of hepatocellular carcinoma regressed spontaneously. He underwent systemic chemotherapy for hepatocellular carcinoma with multiple lung metastases. However, the chemotherapy was not effective and he was therefore followed up without any anticancer treatments in an outpatient clinic. Four months later, multiple lung nodules regressed dramatically and the serum alpha-fetoprotein level decreased markedly. After an 8-month period of the regression, however, intrahepatic lesions gradually enlarged, although multiple lung metastatic lesions remained regressed. The mechanisms underlying this intriguing phenomenon remain unknown.     

Retroperitoneal metastasis of hepatocellular carcinoma - a case report

The patient was a 54-year-old man. He was an HBV carrier, and hepatocellular carcinoma (HCC) was detected for the first time in 2000. An operation was performed, but HCC recurred. After repeating the operation and transarterial chemo-embolization (TACE) for the recurrent HCC, a tumor was found in January 2009 on the ventral side of the right kidney, and we thought it was a retroperitoneal metastasis of HCC or peritoneal dissemination. He was enrolled in a trial of systemic chemotherapy, called "S-1 monotherapy for extrahepatic metastasis of HCC", but the tumor seemed progressive. Since he showed no other lesion, he was indicated for surgical resection. Intraoperatively, the tumor was localized between the duodenum and the right kidney, and was covered by the retroperitoneum. Pathological examination of the resected specimen revealed retroperitoneal metastasis of HCC. Intrahepatic recurrence was detected 6 months after the resection. Therefore, he underwent TACE, and he is currently (1 year after surgery) alive without any extrahepatic metastasis. We describe herein this case because retroperitoneal metastasis of HCC is very rare.     

Resection of solitary metachronous lymph node metastasis from hepatocellular carcinoma following transarterial chemotherapy with cisplatin: a case report

A 74-year-old female was found to have a 40-mm liver tumor (in segment VIII) by ultrasonography and was diagnosed with hepatocellular carcinoma (HCC). She underwent liver resection and was stably treated without recurrence for 19 months. A 45-mm extrahepatic tumor was then found during follow-up with enhanced computed tomography and was diagnosed as being a metachronous lymph node (LN) metastasis. Angiography revealed that the metastasis LN was fed by both the right and left gastric arteries. Transarterial chemotherapy with cisplatin was scheduled to control LN metastasis and to prevent intrahepatic metastasis, simultaneously. Blood alteration using coil embolization was performed to isolate the feeding arteries before transarterial chemotherapy with cisplatin powder. The patient was stably treated for 6 months (3 times) and no new intra- or extrahepatic metastatic lesions appeared during the chemotherapy. The patient subsequently underwent systematic LN dissection of the porta hepatis. She was successfully treated, and has remained recurrence-free for almost 5 years.     

Complete pathological remission is possible with systemic combination chemotherapy for inoperable hepatocellular carcinoma.

The purpose of this Phase II study was to determine the response rate, the toxicity, and the effect on survival of the combination of cisplatin, doxorubicin, 5-fluorouracil, and alpha-IFN (PIAF) in advanced unresectable hepatocellular carcinoma. Fifty patients with either unresectable or metastatic disease were treated with PIAF: cisplatin (20 mg/m2 i.v., days 1-4), doxorubicin (40 mg/m2 i.v., day 1), 5-fluorouracil (400 mg/m2 i.v., days 1-4), and alpha-IFN (5 MU/m2 s.c., days 1-4). Treatment was repeated every 3 weeks to a maximum of six cycles. All patients were evaluable for response, toxicity, and survival. As assessed by conventional imaging criteria, there were no complete responses, but 13 patients (26%) had a partial response. Among the 36 patients who had an initially high alpha-fetoprotein level (>500 ng/ml), 15 (42%) had a >50% fall after therapy. Nine patients underwent surgical resection after achieving partial response and, in 4 of these patients, histological examination of the resected specimens revealed no viable tumor cells. All these nine patients are alive, and eight patients remain in complete remission at between 7.6 and 25.8 months at the time of analysis. The overall median survival was 8.9 months. Toxicity was mainly myelosuppression and mucositis. There were two treatment-related deaths due to neutropenic sepsis. PIAF is active in hepatocellular carcinoma despite considerable hematological toxicity. Complete pathological remission is possible with this systemic combination. Apparently, persistent radiological lesions may still represent complete pathological resolution of active disease.     

A case of hepatocellular carcinoma associated with ossification. A case report

A 54-year-old man with hepatocellular carcinoma (HCC) of the typical trabecular pattern exhibiting unusual histologic features, both osteoid and bone formations, is reported. The tumor was associated with well-developed cirrhosis; thus, this may be different from mixed hepatic tumors of adults with bone formations because the latter are characterized by their prevalence in noncirrhotic livers and by the formation of myxoid connective tissue. Computed tomography of the current case revealed calcification within HCC.     

An apparent danazol-induced primary hepatocellular carcinoma: case report

This paper presents an apparent case of danazol-induced primary hepatocellular carcinoma in a 49-year-old patient, following two years of continuous therapy with this inhibitor of pituitary gonadotrophin. Discontinuation of the drug failed to cause regression of the tumour.     

Resected hepatocellular carcinoma with macroglobulinemia--a case report

A 54-year-old man had been diagnosed as having macroglobulinemia 10 years earlier; Ultrasonography and liver scintigraphy showed a space-occupying lesion in the right lobe of the liver; CT scan showed abnormal density in the same region. IgG was more than 7,000 mg/dl. The tumor was isolated, and liver function was good. On laparotomy, biopsy of the tumor and one of the enlarged lymph nodes in the hepatoduodenal ligament was undertaken. The diagnosis the from frozen tumor section was hepatocellular carcinoma; malignancy was not found in the lymph node. Right lobectomy was done. The patient left the hospital two months later after an uneventful recovery.     

Complete pathological response of colorectal liver metastases after chemotherapy and bevacizumab treatment: a case report

The vast majority of colorectal cancer patients who present with liver metastases are not initially candidates for hepatic resection. Although the combination of systemic chemotherapy and liver surgery can convert a significant proportion of patients from a palliative situation to a potentially curative situation, the majority of initially unresectable liver metastases do not respond sufficiently to initial chemotherapy to become resectable. More recently the addition of biologic agents (bevacizumab or cetuximab) to cytotoxic chemotherapy has increased the rate of tumor response, suggesting that the addition of these agents could improve resectability rate. Here we report the clinical case of a complete pathological response (pCR) in a 67-year-old male affected by metastatic colorectal cancer, with initially unresectable liver metastases, after treatment with chemotherapy and bevacizumab.