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Spontaneous regression of hepatocellular carcinoma (HCC) is an extremely rare phenomenon. We herein report the case of a 73-year-old man who showed the spontaneous regression of multiple pulmonary recurrences of HCC that had occurred after hepatectomy. The patient was undergoing dialysis due to diabetic renal failure when ultrasonography revealed a liver tumor (diameter ~ 10 cm). A preoperative diagnosis of HCC with hepatic vein thrombosis was made. The liver function was well preserved and then the right hepatic vein area was resected. Two months after hepatectomy the α-fetoprotein level increased, and multiple lung nodules were observed on follow-up computed tomography. A diagnosis of multiple lung metastases was made, but no therapy was started because of the patient's renal failure. Five months after hepatectomy the α-fetoprotein level normalized, and the metastases regressed completely. The patient is now doing well without any recurrence at 13 months after the surgery. The associated literature on spontaneous HCC regression is also reviewed.

Background: We aimed to study the early outcome of patients 80 years of age and older undergoing liver resection and to compare the results with the outcomes of patients younger than 80 years of age., Methods: All 350 consecutive patients undergoing hepatic resections from 2004 April to 2008 October were included. Patients were divided into two groups: 80 years of age and older (group I; n = 43) and less than 80 years of age (group II; n = 307). Preoperative clinicopathological features, intraoperative factors, in-hospital mortality, postoperative complications, length of hospital stay, operative mortality, morbidity, and prognosis after discharge were analyzed and compared between groups I and II., Results: There was no significant difference between the two groups regarding the indication for hepatic resection. Hepatitis viral status was significantly different between groups: patients without hepatitis B or C viral infection were more common in group I than in group II. Regarding preoperative liver function, serum levels of albumin were significantly lower in group I than in group II. Although the operative time was significantly shorter in group I than in group II, no difference was found between groups regarding such operative factors as type of hepatectomy, blood loss, and rate of blood transfusion. After elimination of 16 patients with extrahepatic bile duct resection and reconstruction, no difference existed between the two groups in operative time. There was no postoperative mortality nor in-hospital mortality in group I; in group II one postoperative death (0.3%) and two in-hospital deaths (0.6%) were recorded. There was no difference between groups in the incidence of morbidity and early prognosis after discharge., Conclusions: The results indicate that hepatic resection for elderly patients over 80 can be safely performed given careful patient selection.

We discuss a patient who had poorly differentiated HCC with pyrexia and high CRP in laboratory data, which are not commonly observed in the usual HCC. A 50-year-old man with a history of liver dysfunction was admitted with a chief complaint of a prolonged fever and general fatigue. Preoperative diagnosis was HCC with portal vein tumor thrombus. Posterior segmentectomy of the liver and thrombectomy was performed. Rapid tumor recurrence occurred after surgery, and he died 79 days after the operation. Immunohistochemical stain of HCC in this patient revealed the production of proinflammatory cytokine, interleukin-8 (IL-8). IL-8 production may have contributed to the high fever, high inflammatory reaction, and poor prognosis in this case.

Background/aims: The recurrence rate after hepatectomy of hepatocellular carcinoma (HCC) remains high. Although the cause of recurrence seems to be the multicentric occurrence and metastasis of cancer cells in the patients after curative resection of HCC, the mechanism of HCC recurrence in each case is still uncertain. The recurrence pattern may illuminate these mechanisms., Methodology: A data analysis of 152 patients who underwent HCC resection, and had observed for more than 5 years was conducted. These patients were divided into three groups; group I (n=32), the patients without HCC recurrence, group II (n=86), the patients with fewer than four recurrent nodules of HCC, group III (n=34), the patients with four or more recurrent nodules of HCC. We compared the clinicopathological data of groups I and II, and of groups I and III. The linkage of risk factors linked to recurrence patterns was clarified., Results: The risk factors linked to group II by comparison with group I were high serum levels of alanine aminotransferase, low serum levels of albumin, high values in the indocyanine green retention test at fifteen minutes, hepatitis C antibody positivity. low platelet counts, and high histological hepatitis activity. The risk factors linked to group III were large tumor size, histological presence of portal vein invasion by cancer cells, intrahepatic metastasis, and poor differentiation of cancer cells., Conclusions: The risk factors linked to recurrence with no more than three HCC nodules recurrence were related to host-related factors such as hepatic function, and hepatitis activity, but not tumor related. The risk factors linked to multiple recurrence were tumor related. The analysis of recurrence patterns revealed that completely different mechanisms exist in the patients with recurrence involving no more than four nodules, which may be related to multicentric occurrence, and patients with multiple recurrence, which may be related to the metastasis of cancer cells.

We experienced changes in ultrasonographic features of hepatic parenchyma in 156 patients treated with Tamoxifen (TAM) as an adjuvant hormonal therapy for breast cancer. After the treatment with TAM subsequent to the surgery for breast cancer, 36% of patients showed changes in ultrasonographic features of the liver more than Grade 2, despite no obvious hepatic involvement at the start of the medication. Forty-five percent of affected patients showed Grade 2 or 3 changes in hepatic parenchymal images within the first 6 months of TAM medication, while the average interval of change was 11.3 months. Abdominal ultrasound inspection should be undertaken within 6 months of surgery to aid the early detection of liver metastasis and fatty liver changes, which may play an important role in determining postoperative follow-up care for breast cancer patients.