Spontaneous regression of a large hepatocellular carcinoma with multiple lung metastases.

A 75-year-old Japanese man with chronic hepatitis C was found to have a large liver tumor and multiple nodules in the bilateral lungs. We diagnosed the tumor as hepatocellular carcinoma (HCC) with multiple lung metastases based on imaging studies and high titers of HCC tumor markers. Remarkably, without any anticancer treatment or medication, including herbal preparations, the liver tumor decreased in size, and the tumor makers diminished. Moreover, after 1 year, the multiple nodules in the bilateral lungs had disappeared. Fifteen months after the first medical examination, transcatheter arterial chemoembolization (TACE) was performed for the residual HCC. Because local relapse was observed on follow-up computed tomography, a second TACE was performed 13 months after the first one. At 4 years after the second TACE (7 years after the initial medical examination), there was no recurrence of primary or metastatic lesions. Spontaneous regression of HCC is very rare, and its mechanism remains unclear. Understanding the underlying mechanism of this rare phenomenon may offer some hope of finding new therapies, even in advanced metastatic cases.

Diuretics aggravate zinc deficiency in patients with liver cirrhosis by increasing zinc excretion in urine.

AIM: Liver cirrhosis is often accompanied by zinc deficiency. The exact mechanisms underlying zinc deficiency remain unclear. This study was undertaken to clarify the influence of diuretics on blood zinc levels and zinc excretion in urine in liver cirrhosis. METHODS: Seventy-nine outpatients with liver cirrhosis were divided into four groups: (i) patients receiving no zinc preparations or diuretics (LC group); (ii) those receiving zinc preparations only (LCZ group); (iii) those receiving diuretics only (LCD group); and (iv) those receiving both zinc preparations and diuretics (LCDZ group). Among these groups, the effects of the administrated drugs on blood zinc levels and urinary zinc excretion were analyzed. RESULTS: Blood zinc levels were significantly lower in the LCD group (47.8 ± 10.5 µg/dL) than in the other groups (LC: 68.8 ± 17.1 µg/dL, P = 0.0056, post-hoc test; LCZ: 78.4 ± 18.1, P < 0.0001; LCDZ: 70.3 ± 21.4, P = 0.0008). The creatinine-adjusted urinary zinc excretion was significantly higher in the LCDZ group (548.1 ± 407.6 µg/mg creatinine) than in the other groups (LC, 58.5 ± 43.7; LCZ, 208.1 ± 227.8; LCD, 105.2 ± 154.4; each P < 0.0001). The fraction of urinary zinc excretion was also significantly higher in the LCDZ group (5.6 ± 2.9%) than in the other groups (LC, 0.6 ± 0.5; LCD, 1.7 ± 1.5; LCZ, 1.6 ± 1.2; each P < 0.0001). CONCLUSION: In patients with liver cirrhosis, treatment with diuretics can increase zinc excretion by suppressing the reabsorption of zinc through renal tubules, which might lead to zinc deficiency.