title: Complete spontaneous necrosis of hepatocellular carcinoma confirmed on resection: A case report.
abstract: BACKGROUND
  Complete spontaneous necrosis of hepatocellular carcinoma (HCC) without any pretreatment or angiography is rare. We present a rare case of spontaneous complete necrosis of HCC, as confirmed after hepatectomy.
  
  
  METHODS
  The patient, a 74-year-old man with a history of alcoholic hepatitis, was referred to our hospital for confirmation of suspected HCC. In March 2015, abdominal ultrasonography detected a low echoic mass in segment 8 (S8) of the liver. Contrast-enhanced computed tomography (CT) imaging revealed interval growth of this tumor and showed that the tumor was well enhanced in the arterial phase and washed out in the portal and delayed phases. The serum alpha-fetoprotein level was elevated at 30.8ng/mL and the percentage of the L3 isoform was 25.5%. Two months later, CT imaging showed that the tumor was of low density and had decreased in size; no contrast enhancement of the tumor was seen. Spontaneous necrosis of the HCC was considered; however, as we could not exclude viable malignant cells in the tumor, we performed S8 segmentectomy of the liver. The resected tumor specimen had a thick fibrous capsule. Histopathological findings showed only granulation and necrotic tissue accompanied by bleeding and hemosiderosis. No viable tumor cells were observed. The serum alpha-fetoprotein level returned to the normal range one month after surgery.
  
  
  CONCLUSIONS
  If spontaneous regression has occurred, there is a possibility of HCC recurrence and of remnant viable tumor cells.
  
  
  CONCLUSIONS
  We present a rare case of complete spontaneous necrosis of HCC and strongly recommended surgical intervention.
authors.affiliation: Department of Surgery, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, Hiroshima 722-8508, Japan. Electronic address: ryusuke009009@gmail.com.
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Saito
authors.affiliation: Department of Surgery, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, Hiroshima 722-8508, Japan; Department of Gastroenterological and Transplant Surgery, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima 734-8551, Japan.
authors.forename: Hironobu
authors.initials: H
authors.lastname: Amano
authors.affiliation: Department of Surgery, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, Hiroshima 722-8508, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Abe
authors.affiliation: Department of Surgery, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, Hiroshima 722-8508, Japan.
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Fujikuni
authors.affiliation: Department of Surgery, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, Hiroshima 722-8508, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Nakahara
authors.affiliation: Department of Pathology, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, Hiroshima 722-8508, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Yonehara
authors.affiliation: Department of Gastroenterology, Mitsubishi Mihara Hospital, 3-3-1, Itozaki, Mihara, Hiroshima 729-0324, Japan.
authors.forename: Kazushi
authors.initials: K
authors.lastname: Teramen
authors.affiliation: Department of Surgery, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, Hiroshima 722-8508, Japan; Department of Gastroenterological and Transplant Surgery, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima 734-8551, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Noriyuki
keywords: Alcoholic hepatitis; Case report; Complete spontaneous necrosis; Hepatocellular carcinoma