TNF and neoplasm: The possible causes of spontaneous necrosis of HCC include hepatic circulation impairment due to massive bleeding or shock (6,19), damage to the lining fibrous capsule of the artery supplying the tumor due to catheterization (20), a sudden enlargement of the tumor (7), a reduced blood supply to the cancer nodule due to the formation of a fibrous capsule (7), damage to the cancer nodule due to inflammatory cells, such as lymphocytes, and cytokines, such as TNF-α (7,9,21), abstinence from drinking (18), and the use of herbal medicines (18).