Vanishing Act: Spontaneous Regression of Hepatocellular Carcinoma After Hepatitis C Virus Treatment and Emergent Transjugular Intrahepatic Portosystemic Shunt Placement.

We describe the case of a 71-year-old man with hepatitis C virus/alcohol-associated cirrhosis and a liver mass consistent with hepatocellular carcinoma (HCC) who experienced tumor regression after the initiation of direct acting antivirals and undergoing an emergent transjugular intrahepatic portosystemic shunt placement for variceal bleeding. Repeat imaging showed nonviable HCC despite no locoregional therapy, and liver explant pathology revealed <5% residual tumor. This is a rare instance of HCC regression potentially linked to viral eradication and portal pressure reduction. Understanding how direct acting antiviral therapy and transjugular intrahepatic portosystemic shunt influence tumor biology may offer insights into HCC management in decompensated cirrhosis.