Spontaneous remission in diffuse large cell lymphoma

Secondary vitreoretinal lymphoma with spontaneous regression

Purpose

To report a patient with vitreoretinal lymphoma (VRL) secondary to systemic diffuse large B-cell lymphoma, who had two episodes of spontaneous regression.

Observations

An 80-year-old Nicaraguan male with a history of treated systemic diffuse large B-cell lymphoma presented with decreased vision in his right eye over one year. The patient was found to have subretinal lesions and moderate vitreous opacities in his right eye. Cytological analysis of vitreous confirmed B-cell lymphoma. Following his systemic work-up, spontaneous clinical improvement was noted. There were no vitreoretinal or systemic lymphoma recurrences during one year of follow-up until the patient had new onset decreased vision in the left eye. He was presumed to have a recurrence of VRL supported by optical coherence tomography findings. Repeat systemic workup was negative for reoccurrence and the ocular lesions resolved spontaneously over 4 weeks.

Conclusions

Spontaneous regression of intraocular lymphoma can rarely occur. Multimodal imaging has an essential role in diagnosing and monitoring recurrence of this disease.

Case Report: Spontaneous Remission of an Infraorbital Follicular B-Cell Lymphoma: Case Report and Review of the Literature

Non-Hodgkin lymphomas comprise a heterogeneous group of malignancies, with a wide scope of clinical, radiological and histological presentations. In this paper, a case is presented of a 59-year-old white male with an infraorbital follicular B-cell lymphoma, which appeared as a painless mass in the left cheek. The lymphoma achieved spontaneous remission five and a half months after his diagnostic incision biopsy. The literature is reviewed, focusing on this rare site of presentation and spontaneous remission. In literature, only four cases have been reported with a follicular B-cell lymphoma of the cheek or infraorbital region, and only 26 cases of spontaneous remission of an extracranial non-Hodgkin lymphoma in the head and neck region have been described. To the authors’ best knowledge, this is the first time spontaneous remission of an infraorbital follicular lymphoma could be observed. The nature of the processes inducing spontaneous remission remains obscure. It is important to recognize this phenomenon as this might prevent unnecessary treatment.

[Unmittelbare Remission eines mit großzelligem B-Non-Hodgkin-Lymphom befallenen inguinalen Lymphknotens unter alleiniger homöopathischer Behandlung mit Conium: Wann ist eine alleinige adjuvant-homöopathische Tumortherapie zulässig und sinnvoll?]

Bei einer 63-jährigen Patientin wird mittels Biopsie eines linksinguinalen Lymphknotens ein großzelliges B-Non-Hodgkin-Lymphom diagnostiziert. Unmittelbar nach Beginn einer homöopathischen Therapie mit Conium C 30 beginnt sich der Lymphknoten in der linken Leiste zurückzubilden. Bei Exzision des Lymphknotens vierzehn Tage nach Therapiebeginn können histologisch keine Residuen des Tumors mehr nachgewiesen werden und es darf von einer vollständigen Remission ausgegangen werden. Die Patientin bleibt in der Folge rezidivfrei. Das homöopathische Mittel Conium (Schierling) kommt in der adjuvanten homöopathischen Tumortherapie und bei vergrößerten Lymphknoten als häufig indiziertes Mittel zur Anwendung.

A large-cell B-cell non-Hodgkin Lymphoma (LCBCL) was diagnosed bioptically in a female patient (age 63 years) in one left inguinal lymph node. Immediately after beginning homeopathic treatment with Conium C 30, the lymph node started to show a reduction in size. Two weeks after starting homeopathic therapy, histological examination of the excised lymph node showed no evidence of a residual tumor – suggestive of a complete remission. The patient remains disease free until now. The homeopathic remedy Conium (hemlock) is frequently applied for adjuvant homeopathic tumor therapy as well as for the treatment of enlarged lymph nodes.

Spontaneous Remission of an Untreated, MYC and BCL2 Coexpressing, High-Grade B-Cell Lymphoma: A Case Report and Literature Review

Non-Hodgkin lymphomas (NHL) are a heterogeneous group of hematologic malignancies typically treated with multiagent chemotherapy. Rarely, spontaneous remissions can be observed, particularly in more indolent subtypes. The prognosis of aggressive NHL can be predicted using clinical and histopathologic factors. In aggressive B-cell NHL, the importance of MYC and BCL2 proto-oncogene coexpression (as assessed by immunohistochemistry) and high-grade histologic features are particularly noteworthy. We report a unique case of spontaneous remission in a patient with an aggressive B-cell NHL which harbored high-risk histopathologic features, including MYC protein expression at 70-80%, BCL2 protein expression, and morphologic features suggestive of high-grade B-cell lymphoma, NOS (formerly B-cell lymphoma unclassifiable with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma [BCLU]). After undergoing a biopsy to confirm this diagnosis, he opted to forego curative-intent chemotherapy. The single, yet relatively large area of involvement noted on ¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography steadily resolved on subsequent follow-up studies. He remained without evidence of recurrence one year later, having never received treatment. This case emphasizes the potential for spontaneous remission in NHL and demonstrates that this phenomenon can be observed despite contemporary high-risk histopathologic features.

Apparent spontaneous regression of malignant neoplasms after radiography: Report of four cases

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On rare occasions, apparently spontaneous regression of unknown etiology is observed in a neoplasm.

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We report a series of 4 patients with apparent spontaneous regression of malignant neoplasms after radiography.

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Apparently spontaneous regression of these malignant lymphomas and cancers was caused by the small radiation doses received in the radiographic examinations.

Introduction

On rare occasions, an apparently spontaneous regression of unknown etiology is observed in a neoplasm. We report a series of 4 patients with apparent spontaneous regression of malignant lymphomas after radiography.

Presentation of case

All four of the tumors were malignant lymphomas. The regressions occurred between 1 and 2 months after the radiographic examinations. All four patients later underwent relapse and needed additional treatments: surgery, chemotherapy and/or radiation.

Discusssion

Four cases had the following features in common: (1) the neoplasms were radiosensitive, (2) the regression occurred after radiography, (3) none of the neoplasms was in the advanced stage, and (4) the doses received through radiographic exposure were a little higher than usual because CT was included for most of the patients.

Conclusion

We suspect that the apparently spontaneous regression of malignant lymphomas was caused by the small radiation doses received in the radiographic examinations.

Long-term complete regression of nodal marginal zone lymphoma transformed into diffuse large B-cell lymphoma with highly active antiretroviral therapy alone in human immunodeficiency virus infection

Since the introduction of combination antiretroviral therapy (cART), there has been a decrease in the incidence of non-Hodgkin lymphoma among the HIV-infected population and also significantly improved survival rates. We describe a remarkable case of a HIV-infected patient whose large B-cell lymphoma, most likely arising by transformation of a nodal marginal zone lymphoma, completely regressed with the use of cART alone. He remained disease-free for almost 3 years and he finally died from presumed flare up of his lymphoma. There are very few cases of spontaneous regression of lymphomas with cART alone in the HIV population. This is an extreme example of the significance of cART in improving survival in HIV-non-Hodgkin lymphoma and changing the face of the HIV epidemic in general.

Primary bladder lymphoma: management and outcome of 12 patients with a review of the literature

Primary bladder non-Hodgkin's lymphoma (NHL) is rare. Optimal management remains controversial. Using the Scotland and Newcastle lymphoma group database, 12 patients with primary bladder lymphoma were identified between 1980 and 2001, the largest single group of patients available to date. Histology and immunocytochemistry was reviewed in 9 of the 12 cases. Six cases were low-grade extranodal marginal zone lymphoma, 4 diffuse large B-cell lymphoma, one an ALK 1 positive anaplastic large cell lymphoma (ALKoma) and one a low-grade lymphoma unspecified. Two patients (low-grade NHL) were treated with oral antibiotics (n=1) or diathermy (n=1) alone with complete resolution of disease. One patient with high-grade NHL gained complete remission without conventional therapy. Nine patients were treated with single or combined modality surgery, chemotherapy and/or radiotherapy. Overall survival was 75%, mean follow up of 4.8 (range 1-10) years. A review of 88 additional cases in the literature support the findings that primary bladder lymphoma is associated with a good prognosis. Patients with low-grade extranodal marginal zone lymphoma may respond well to simple therapies. Patients with diffuse large B-cell lymphoma respond well to first-line chemotherapy regimens. Ureteric obstruction and acute renal failure are serious complications. Repeat cystoscopy is mandatory for follow-up.

Sudden appearance and spontaneous regression of diffuse large B cell lymphoma in a man with a broken arm

An elderly, demented man with stable κ bi-clonal gammopathy of unknown significance suffered a severe displaced right humeral fracture in a fall. One week later a rapidly enlarging head, neck and axillary adenopathy first appeared, including a 2 cm tonsillar node that partially obstructed the oropharynx. A left cervical node biopsy demonstrated diffuse large B cell lymphoma with CD20+, bcl-2+, κ+, CD3-, Epstein-Barr virus negative malignant cells. During the next month lymphadenopathy regressed more than 90% in the absence of treatment with chemotherapeutic agents, radiation or glucocorticoids. Following 2 months of clinical improvement, he died of pneumonia 95 days after the injury. An autopsy demonstrated residual right hilar and mediastinal malignant lymphadenopathy. These unusual events may be related to immunosuppressive and other systemic effects of acute injury on tumour behaviour.

Spontaneous Regression of Diffuse Large B-Cell Lymphoma Harbouring Epstein-Barr Virus: A Case Report and Review of the Literature

We report an elderly patient with diffuse large B cell lymphoma harbouring Epstein-Barr virus that showed spontaneous regressions with subsequent relapses three times. The patient died of aspiration pneumonia without any anti-neoplastic treatment 5 years 10 months after the initial onset of lymph node swelling. In the literature, there are several reports of aggressive non-Hodgkin's lymphoma cases that showed spontaneous regressions without relapse till the last observation. Over half of the cases were the extra-nodal type. The tendency toward regression of swollen lymph nodes detected by clinicians occurs within 2 weeks after biopsy. If the remaining lymph nodes show a tendency to decrease in size after biopsy without any anti-tumor therapies, the patient may develop spontaneous regression.

Spontaneous regression of malignant lymphoma of the breast

A complete spontaneous regression of diffuse large B cell lymphoma involving the right breast, confirmed by aspiration cytology, is reported. The patient visited a hospital due to the rapid growth of a tumor in the right breast. Five years previously she underwent a craniotomy for a brain tumor, diagnosed as B-cell malignant lymphoma, and received several courses of irradiation to the brain. Analysis of the breast tumor cells obtained by aspiration revealed lymphoma cells morphologically, which were similar to the tumor cells in the brain expressing CD20. While waiting for further examination, the tumor regressed rapidly and was not palpable after 20 days. An excisional biopsy of the breast exhibited no definite malignant lymphoma cells among a diffuse population of CD45RO and CD8-positive small lymphocytes. Nucleotide sequencing of HCDR3s of the brain tumor and breast tumor cells showed a completely matched sequence, revealing the breast mass to be a metastatic lesion from the tumor of the brain. Although there was no tumorous lesion, the patient received additional chemotherapy and has shown no sign of recurrence in the breast for 7 years. We were able to confirm that the breast lymphoma shown in the aspiration cytology was a metastatic one, which was not proven histologically prior to chemotherapy, and regard the present case as a malignant lymphoma of the breast showing spontaneous regression. The present case shows a rare occurrence of spontaneous regression of diffuse large B cell malignant lymphoma after aspiration and suggests that CD8-positive T cells might be related to the regression.

Spontaneous Regression of a Large-Cell Lymphoma in the Conjunctiva and Orbit

Spontaneous and complete regression of malignant neoplasms is extremely unusual. To our knowledge, this case report is the first description of spontaneous regression of an extranodal malignant lymphoma occurring in the conjunctiva and orbit. A 40-year-old woman noticed a pink conjunctival mass at the medial aspect of her left eye that had been present for 3 weeks. She presented on May 5, 2003. Ophthalmologic examination showed a salmon-colored mass along the lateral side of the caruncle. CT revealed a mass in the medial orbit. Surgical biopsy exhibited a malignant lymphoma, diffuse large B-cell type. After biopsy, the tumor spontaneously decreased in size and completely disappeared in 5 weeks. At 6 months' follow-up, the tumor had not recurred.

Spontaneous Regression of Follicular, Mantle Cell, and Diffuse Large B-Cell Non-Hodgkinʼs Lymphomas Detected by FDG–PET Imaging

Spontaneous regression of non-Hodgkin lymphoma (NHL) has been reported in low-grade tumors but is an extremely rare event in intermediate- and high-grade disease. Documentation of spontaneous regression by serial fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging has not been reported in the literature. We present 3 cases of spontaneous regression, 1 each of follicular lymphoma (FL), mantle cell lymphoma (MCL), and diffuse large B-cell lymphoma (DLBCL), which showed spontaneous regression on serial FDG-PET imaging. All patients underwent serial whole-body FDG-PET scans 60 minutes after intravenous injection of 9-11 mCi of this radiotracer. None of them had any chemotherapy, radiotherapy, or surgery after the baseline PET scan. Spontaneous regression of disease in all 3 cases was correlated with conventional imaging and clinical course. All 3 patients had positive FDG-PET results on their baseline scan. There was complete disappearance of FDG uptake on a follow-up PET scan for the patient with follicular lymphoma. These results suggest complete regression. The patients with MCL and DLBCL both showed a significant reduction in FDG uptake on serial whole-body PET scans, suggesting partial regression in both cases. Although spontaneous regression of lymphoma is uncommon, this phenomenon can be successfully demonstrated by FDG-PET imaging. Therefore, serial PET imaging may play an important role in detecting this unusual event and may further enhance our understanding of the biologic behavior of this malignancy.

Spontaneous regression of Hodgkin's disease: two case reports and a review of the literature

We present two cases of patients with Hodgkin's lymphoma who experienced spontaneous regressions of their disease. The first case was a 31-year-old man diagnosed with stage IIIA lymphocyte predominant Hodgkin's disease in 1994, who elected to be followed without any treatment. Over the subsequent 3 years, he experienced significant regression in his lymphadenopathy, and still remains asymptomatic of his disease 70 months after diagnosis. The second case was a 47-year-old man with a bulky anterior mediastinal mass found on a thoracic CT scan, ultimately diagnosed with stage IIB Nodular Sclerosing Hodgkin's Lymphoma. Repeat imaging of the chest performed two months later, just prior to initiating treatment, revealed that the mass had spontaneously decreased by >75% of its original size. Spontaneous regressions of Hodgkin's lymphoma are exceedingly rare. A review of the literature regarding spontaneous regressions of lymphoma and cancer in general is discussed.

Spontaneous regression of extranodal malignant lymphoma occurred in the gingiva

The spontaneous regression of malignant neoplasm is an extremely rare event. Here we report a case of extranodal malignant lymphoma occurring in the upper gingiva, which regressed spontaneously. A 78-year-old female had noticed a diffuse bucco-lingual swelling of the left maxillary gingiva in the incisor regions for a month, and she visited our department on 20 January 1999. Intraoral examination revealed diffuse swelling and redness in the maxillary gingiva of the incisor regions. Cervical and underarm lymphadenopathy was not detected. Surgical biopsy of the swollen gingiva revealed a malignant lymphoma, with diffuse large cells, B cell type. She was clinically staged as IE. After biopsy, the tumor spontaneously decreased in size; finally, the mass completely disappeared after 3 weeks. After regression, the lesions were externally irradiated with 30 Gy total dose. The patient has been free from disease for 36 months after regression.

Resolution of oral non-Hodgkin's lymphoma by reduction of immunosuppressive therapy in a renal allograft recipient: a case report and review of the literature

A case of oral non-Hodgkin's lymphoma arising in a patient with insulin-dependent diabetes who had undergone renal allograft transplantation is described. The resolution of the disease was achieved by a reduction in her immunosuppressive therapy. The differential diagnosis is discussed, and the management of posttransplantation lymphoproliferative disorders is reviewed.

Regression and clonally distinct recurrence of human immunodeficiency virus related Burkitt-like lymphoma during antiretroviral therapy

An increased incidence of intermediate to high-grade Non Hodgkin's Lymphoma is found in individuals with AIDS. Although immune function in AIDS patients can be improved through the use of antiretroviral therapy, the contribution of these drugs to lymphoma regression is not known. Here we describe the complete regression and subsequent recurrence of high grade, Burkitt-like lymphoma during antiretroviral therapy in a patient with AIDS. Antiretroviral therapy resulted in diminished viral load and modest improvement in CD4+ T cell counts. Lymphoma regressed initially, but relapsed 3 months later. Tissue taken from the initial and recurrent tumor demonstrated different clonal rearrangements. The recurrent lymphoma did not respond to continued antiretroviral therapy. In Conclusion, antiretroviral therapy may contribute to lymphoma regression in AIDS lymphoma. Clinically recurrent disease may be clonally distinct.

Anti-lymphoma effect of naproxen and indomethacin in a patient with relapsed diffuse large B-cell lymphoma

A 77-year-old man with relapsed non-Hodgkin's lymphoma, diffuse large B-cell type, was treated with naproxen, a nonsteroidal anti-inflammatory drug (NSAID), for paraneoplastic fever. A dramatic disappearance of not only the fever but also generalized lymphadenopathy was observed. Naproxen was continued, and he maintained remission for 10 months. When relapse of lymphoma occurred in spite of continuous naproxen administration, indomethacin, another type of NSAID, was tried. Surprisingly, rapid regression of lymphoma occurred again and was maintained for almost 1 year. These results indicate that NSAIDs are effective in some patients with non-Hodgkin's lymphoma.

Spontaneous regression of an anaplastic large cell lymphoma in the oral cavity: first reported case and review of the literature

Lymphomas account for 2-5% of all oral malignancies and are the third most common in this site. This case report appears to be the first in the world literature describing spontaneous regression in the oral cavity of a subset of non-Hodgkins lymphomas known as Ki-1 anaplastic large cell lymphomas (ALCL). Ki-1 ALCL account for 2-7% of all non-Hodgkins lymphomas and the clinical presentation is variable; they may arise de novo or in the setting of a separate primary lymphoma and commonly present in the extra-nodal location. Disease severity is also variable with waxing and waning lesions at one extreme which may spontaneously regress to bone marrow involvement in around 12% of cases. This case is especially interesting since the patient is a farmer, given the recent evidence that there may be a link between non-Hodgkins lymphoma and this occupation.

Spontaneous remission of primary central nervous system lymphoma: report of 3 cases and discussion of pathophysiology

Primary central nervous system lymphoma (PCNSL) is a relatively uncommon disease in which spontaneous remission is exceedingly rare. We are reporting three cases of primary CNS lymphoma with spontaneous regression in two to eight weeks, from the time of the initial diagnosis. The remission lasted for four years in the first case, two years in the second, and one year in the third case. Tissue diagnosis was made in the first two cases after relapse, and in the third case a biopsy was done at the initial presentation. The literature and the possible pathophysiological mechanisms of this interesting phenomenon are discussed.

Natural killing activity in patients with spontaneous regression of malignant lymphoma

Previously, we proposed a new analysis of natural killing activity, for comparison, employing an "individual effector/target cell ratio" according to the number of effector cells in blood. The activity could be measured in four patients with spontaneous regression of malignant lymphoma. Despite the absence of episodes suggesting viral infections, patients with spontaneous regression had significantly higher activities prior to their regressions than either controls or patients without regression. In one patient who had a spontaneous regression accompanied by a high level of natural killing activity, subsequent exacerbation of the disease with a reduced activity was never followed by a regression and became life-threatening. In another patient, a spontaneous regression was accelerated after greater augmentation of natural killing activity was induced by a superimposed viral infection. These facts suggest that highly elevated natural killing activity may be one of the possible mechanisms responsible for spontaneous regression of malignant lymphoma.

Spontaneous regression of chemotherapy-refractory non-Hodgkin's lymphoma preceding the development of secondary leukaemia

In this report a rare case of spontaneous regression of a long-standing chemotherapy resistant low grade non-Hodgkin's lymphoma (NHL) of follicular small cleaved cell type is described. Extensive bulky lymphadenopathy substantially resolved, 7 months before the diagnosis of acute myelomonocytic leukaemia was established, in the absence of further treatment. It is possible that in this case the mutagenic effects of alkylating agents given during the course of the NHL reprogrammed lineage commitment in an early progenitor cell, deviating potential B-lineage cells along the myelomonocytic pathway.

Spontaneous complete regression of high grade non-Hodgkin's lymphoma. Morphologic, immunohistochemical, and gene amplification analyses

BACKGROUND

Spontaneous regression of non-Hodgkin's lymphoma, occasionally reported in low grade groups, is a rare phenomenon in high grade groups. Clonal proliferation has not been confirmed in the majority of reported cases. In this woman, age 58 years, who had been diagnosed as having high grade immunoblastic lymphoma after excision of a single cervical lymph node, the remaining bilateral cervical, inguinal, and axillary adenopathy regressed completely without any cytotoxic treatments 22 days after biopsy. At the time of this writing, the patient has been free of disease for 24 months.

METHODS

Clonality of the lymphoproliferation in the case was examined by immunohistochemistry and polymerase chain reaction (PCR) amplification using paraffin embedded biopsy material. Possible implications of Epstein-Barr virus in the pathogenesis of this process was examined also by PCR amplification and in situ hybridization.

RESULTS

The proliferating lymphoid cells showed restricted expression of immunoglobulin (Ig) light chain and amplification of clonally rearranged V-D-J regions of Ig heavy chain gene. Epstein-Barr virus did not appear to be involved in the process.

CONCLUSION

The present study shows that spontaneous complete regression of clonal lymphoproliferation that is morphologically a high grade lymphoma can occur.

Spontaneous remission of multilobated non-Hodgkin lymphoma

A 67-year-old previously well man was admitted with hypercalcemia after a 7-day history of fever, night sweats, and back pain. The blood showed 5% multilobated lymphoid cells. A multilobated non-Hodgkin lymphoma associated with marked reticulin fibrosis was diagnosed on a bone marrow biopsy. During the next 7 days, in the absence of specific therapy, his symptoms disappeared. Three weeks after admission his biochemical abnormalities had resolved and after 9 weeks his bone marrow examination was normal. He remains in clinical and laboratory remission 16 months after presentation.

Spontaneous regression of a small non-cleaved cell malignant lymphoma (non-Burkitt's lymphoblastic lymphoma). Morphologic, immunohistological, and immunoglobulin gene analysis

Complete spontaneous regression of high-grade malignant non-Hodgkin's lymphoma is extremely unusual. In this report the authors describe a complete spontaneous remission after surgical excisional biopsy of a small noncleaved cell malignant lymphoma (non-Burkitt's lymphoblastic lymphoma) of the tonsil in a 12-year-old boy. The diagnosis was confirmed by immunohistologic and immunoglobulin gene analysis. Similar studies were performed on the cervical lymph node excised 2 weeks later when spontaneous remission had occurred. The patient has remained in good health for over 3 years.

Spontaneous regression of gastric lymphoma

Two cases of spontaneous regression of histologically diagnosed large cell lymphoma of the stomach are reported. Regressions occurred after nonspecific therapy including the H-2 antagonist cimetidine and were documented surgically. Spontaneous regression of intermediate and high-grade non-Hodgkin's lymphoma is distinctly uncommon. The possible role of cimetidine in these cases is discussed.