SPONTANEOUS REGRESSION OF HEPATOCELLULAR CARCINOMA: FOCUSING IN THE ASSOCIATED RISK FACTORS.

BACKGROUND: Spontaneous regression (SR) is defined as the partial or complete disappearance of a tumor, in the absence of a specific treatment. Evidence of the SR in hepatocellular carcinoma (HCC) is rare. OBJECTIVE: The authors aimed to review all the cases of SR of HCC in two reference centers of Southern Brazil, highlighting the main characteristics. METHODS: Data of all patients with HCC were retrospectively reviewed looking for the occurrence of SR in patients from two tertiary centers in Southern Brazil, in the last five years. The diagnosis of cirrhosis was established according to clinical, laboratory and imaging data, as well as upper endoscopy or histopathological examination when necessary. The diagnosis of HCC was based on typical findings according to radiologic criteria (LIRADS) or histopathological examination. Spontaneous regression was defined as a partial or complete involution of a HCC in the absence of a specific therapy. RESULTS: From all cases of HCC in the last 5 years (n=433), there were five cases of SR. Three (60%) were men, the mean age was 62.6 (50.0-76.0) years, and the etiology was HCV in 3 (60%). Complete regression was observed in three patients (60%), one patient (20%) presented partial regression, and one (20%) relapesed and died. The time of follow-up varied between 12 and 21 months. In this presentation, it was highlighted one case of SR observed after COVID-19 infection in a patient with cirrhosis. The possible mechanisms involved in this situation were reviewed, emphasizing the most common like hypoxia and immunological. There were also one patient submitted to a surgical procedure as a possible fator involved and three patients without obvious risk factors. CONCLUSION: This phenomenon will possibly contribute to a better understanding of the pathophysiological mechanisms of HCC.

Regressão espontânea do carcinoma hepatocelular: foco nos fatores de risco associados / Spontaneous regression of hepatocellular carcinoma: focusing in the associated risk factors

ABSTRACT Background: Spontaneous regression (SR) is defined as the partial or complete disappearance of a tumor, in the absence of a specific treatment. Evidence of the SR in hepatocellular carcinoma (HCC) is rare. Objective: The authors aimed to review all the cases of SR of HCC in two reference centers of Southern Brazil, highlighting the main characteristics. Methods: Data of all patients with HCC were retrospectively reviewed looking for the occurrence of SR in patients from two tertiary centers in Southern Brazil, in the last five years. The diagnosis of cirrhosis was established according to clinical, laboratory and imaging data, as well as upper endoscopy or histopathological examination when necessary. The diagnosis of HCC was based on typical findings according to radiologic criteria (LIRADS) or histopathological examination. Spontaneous regression was defined as a partial or complete involution of a HCC in the absence of a specific therapy. Results: From all cases of HCC in the last 5 years (n=433), there were five cases of SR. Three (60%) were men, the mean age was 62.6 (50.0-76.0) years, and the etiology was HCV in 3 (60%). Complete regression was observed in three patients (60%), one patient (20%) presented partial regression, and one (20%) relapesed and died. The time of follow-up varied between 12 and 21 months. In this presentation, it was highlighted one case of SR observed after COVID-19 infection in a patient with cirrhosis. The possible mechanisms involved in this situation were reviewed, emphasizing the most common like hypoxia and immunological. There were also one patient submitted to a surgical procedure as a possible fator involved and three patients without obvious risk factors. Conclusion: This phenomenon will possibly contribute to a better understanding of the pathophysiological mechanisms of HCC.

RESUMO Contexto: A evidência da regressão espontânea (RE) no carcinoma hepatocelular (CHC) é rara. Objetivo: Revisar todos os casos de RE de CHC em dois centros de referência do Sul do Brasil, destacando as principais características. Métodos: Os dados de todos os pacientes com CHC foram revisados retrospectivamente buscando a ocorrência de RE em pacientes de dois centros terciários do Sul do Brasil, nos últimos 5 anos. O diagnóstico de cirrose foi estabelecido de acordo com dados clínicos, laboratoriais e de imagem, além de endoscopia digestiva alta ou exame histopatológico quando necessário. O diagnóstico de CHC foi baseado em achados típicos de acordo com critérios radiológicos (LIRADS) ou exame histopatológico. A RE foi definida como uma involução parcial ou completa de um CHC na ausência de terapia específica. Resultados: Do total de casos de CHC nos últimos 5 anos (n=433), houve cinco casos de RE. Três (60%) eram homens, a média de idade foi de 62,6 (50,0-76,0) anos, a etiologia foi virus da hepatite C em 3 (60%). A regressão completa foi observada em três pacientes (60%), um paciente (20%) apresentou regressão parcial e um (20%) apresentou recidiva e evoluiu a óbito. O tempo de seguimento variou entre 12 e 21 meses. Nesta apresentação foi destacado um caso (20%) de RE observado após infecção por COVID-19 em paciente com cirrose. Foram revisados os possíveis mecanismos envolvidos nesta situação, enfatizando os mais comuns como hipóxia e imunológicos. Houve também um paciente submetido a procedimento cirúrgico como possível fator envolvido e três pacientes sem fatores de risco evidentes. Conclusão: Este fenômeno possivelmente contribuirá para uma melhor compreensão dos mecanismos fisiopatológicos do CHC.

Acesso vascular para hemodiálise / Hemodialysis vascular hemodialysis vascular access

Introdução: A Doença Renal Crônica (DRC) acomete um grande número de pacientes em todo o mundo, sendo a hemodiálise um dos recursos terapêuticos mais frequentes para as fases mais avançadas de falência renal. Uma vez que o acesso vascular é essencial para a terapia, o presente artigo tem como objetivo revisar a literatura relacionada às indicações, técnica e complicações dos acessos temporários e permanentes. Métodos: A busca nas bases de dados Pubmed e LILACS foi realizada através da combinação de termos relacionados à hemodiálise ou diálise renal, acesso vascular e vasos sanguíneos. Foram selecionados 20 artigos conforme os critérios de inclusão e de exclusão e adequação ao tema proposto. Resultados: Os acessos temporários são o cateter de Shilley e o permcath. O primeiro se destina a situações agudas, inserido preferencialmente na veia jugular direita e tem a infecção como principal complicação. O permcath proporciona um período mais longo de utilização, com implante subcutâneo preferencialmente em veia jugular interna direita, tendo como principal complicação a punção arterial inadvertida. A fístula representa o acesso vascular definitivo, sendo o acesso de primeira escolha para pacientes que serão submetidos à hemodiálise por longo prazo. Suas maiores complicações são infecção, sangramento e alteração de fluxo sanguíneo arterial. Conclusão: Acesso vascular para hemodiálise é fundamental para instituição e manutenção da terapia. Dentre as opções atuais, o tempo de permanência, as potenciais complicações e as condições do pacientes guiarão a escolha.

Introduction: Chronic Kidney Disease (CKD) affects a large number of patients worldwide, with hemodialysis being one of the most frequent therapeutic resources for the more advanced phases of renal failure. As vascular access is paramount for this therapy, we aimed reviewing the literature regarding indications, technique and complications of temporary and permanent vascular accesses for hemodialysis. Methods: Pubmed and LILACS databases were searched combining terms refered to hemodialysis or renal dialysis, vascular access and blood vessels. It were selected 20 articles according inclusion and exclusion criteria as well as related to the proposed theme. Results: Temporary accesses are Shilley catheter and permcath. Shilley is indicated for acute situations, inserted preferably in the right jugular vein and the main complication is infection. Permcath allows a longer period of use, subcutaneously implanted preferably in the right internal jugular vein. The main complication is arterial puncture. Arteriovenous fistula represents the definitive vascular access, constituing the first choice for patients needing long term hemodialysis. The technique is based on the anastomosis between the artery and vein walls or between its extremities and the main complication is related to infection, bleeding and decreased artery blood flow. Conclusion: Hemodialysis vascular access is paramount in order to start and maintain the therapy. The option will be guided by therapy length, complications and clinical conditions.