Spontaneous regression of hepatocellular carcinoma in S4 after another tumor in S1 was chemoembolized

An HCV-infected 77 year-old female with a history of blood transfusion when operated for disk herniation in 1960 developed multiple hepatocellular carcinoma in 2003: one in S1 and another in S4. Considering the impaired function of her cirrhotic liver, we planned to undertake transarterial chemoembolization (TAE) first for only the S1 tumor and later for the S4 tumor. One day, about 4 weeks after TAE was done successfully for her S1 tumor, she suddenly suffered from high fever and a sharp increase in transaminases. On the following day, we performed dynamic CT scanning and found that the S4 tumor had lost its tumor-specific enhancement, suggesting an extensive spontaneous necrosis of this tumor. The S4 tumor continued to regress thereafter. This was a rare event with almost no report in literature to our knowledge, particularly in that we could trace the time course of tumor-regression.