spontaneous remission of multilobated non-Hodgkin lymphoma

Abstract

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.

Case Details

Disease Location

Lymph nodes

Personal Characteristics

67 -year-old male

Clinical Characteristics

Admitted for investigation of a 7 day history of night sweats, fatigue, anorexia, dry cough, and bone pain. There was a low grade fever (37.6c), moderate dehydration, and slight hepatomegaly. (hematologic and biochemical results are in table 1 of article), he was hypercalcemic, hyperruicemic, and had grossly elevated ldh, consistent with rapidly proliferating aggressive lymphoma approx 5% of circulating wbc were large, abnormal lymphoid cells with polylobated nuclei and lush agranular cytoplasm. Chest x-ray revealed a small right pleural effusion. Most of the marrow in the posterior iliac biopsy was replaced by a diffuse abnormal lymphoid-appearing infiltrate which did not show any evidence of differentiation. Cells varied fom small to large, but most were intermediate in saize and showed polylobated nuclei mitotic activity was increased, and the infiltrate was associated with marked reticulin fibrosis multilobated cells showed strong membrane positivity for a b-cell marker ln-2 (CD43) and a t-cell marker mt-1 (CD43)

Remission Characteristics

In the following 7 days after immunophenotyping, symptoms disappeared, ldh fell rapidly, he became normocalcemic, his thrombocytopenia resolved and the circulating polylobated lymphoid cells disappeared form the peripheral blood 3 weeks after admission, biochemical abnormalities completley resolved, although he became neutropenic during this period, his granulocyte count gradually increased over the next 6 weeks. Eventually a bone marrow aspirate was obtained and showed a regenerating marrow with no abnormal infiltrates and no excessive fibrosis chest x-ray showed resolution of the pleural effusion 16 months after presentation, he remains in clinical and biochemical remission

Treatment & Mechanisms

Proposed Remission Mechanisms

The evolution of neutropenia coincident with the subclinical myelosuppressive viral infection exerighted a cytotoxic effect against the malignant marrow population in this case, it would suggest that non-viral factors were instrumental in achieving and sustain a remission

Clinical Treatment

None reported

Non-Clinical Treatment

None reported