Prolonged spontaneous Remission of Case of Malignant Lymphoma

Abstract

A case is reported of malignant lymphoma which appeared in eight different locations during seven years following initial diagnosis, and subsequently has been followed by 22 years of complete remission. The literature on regressions or remissions of malignant lymphomas is reviewed, and various implications of the present case are discussed.

Case Details

Disease Location

Left axilla right groin bilateral epitrochlear left inguinal

Personal Characteristics

56 -year-old female she had been examined once previously in 1951 when she was found to have mild hypertension.

Clinical Characteristics

Admitted in may 1959 after she noted a lump in her left axilla a few days earlier. She had previously been in excellent health the lump was removed surgical and the pathologic diagnosis was lymphosarcoma there was a focus of malignant lymphoma that was noted on examination of the bone marrow after the recovery from the surgery, she received a course of radiation therapy to the ln-bearing area of the left axilla the patient received an "ominous prognosis" and left washington dc (place of admission) to return to kansas city, mo to her 5 sisters where she felt that she was coming home to die the patient consulted the writer (wolf) on september 15, 1959, and she was scheduled for monthly check-ups because of the lymphoma diagnosis the patient's exam results continued to be normal except for hypertension until january 1961 when a right inguinal gland became enlarged and was resected the specimen consists of spherical ln which measures 3x2x2cm, it was rather firm. Cut sections revealed that the usual architecture is not present and appears to be replaced by a bulging, rather homogenous glistening, fleshy appearing tissue the ln was very cellular, nodal architecture diffusely effaced. The node was diffusely replaced by small to medium sized and occasionally large cells with rounded to ovoid nuclei, relatively small amounts of cytoplasm, indistinct cell outlines, abundant mitoses. The cell type was relatively uniform. Diagnosis was malignant lymphoma, predominantly poorly differentiated lymphocytic, lymph node right groin. A course of localized radiation was given to the right groin area post-op in june 1961, she experienced a stubborn left middle ear infection for about two weeks, after which there was a small mass observed in the left posterior pharynx, which apparently obstructed the eustachian tube. Biopsy performed resulted in a diagnosis of malignant lymphoma she received a course of 20 radiation treatments to the eustachian tube area. In november 1961, enlargement of a right epitrochlear ln was noted, this was excised november 28, 1961. Pathology again was malignant lymphoma a course of 10 radiation treatments was given on february 11, 1962, a left epitrochlear node, enlarged to the size of a small olive was noted. Again, a course of 10 radiation treatments was given with no excision. On march 31, 1966, an olive-sized gland was noted in the left inguinal area a course of local radiation was given in early may 1966, the patient began complaining of severe pain down the left arm and on may 10 the typical erupatientions of herpes zoster were noted over her left shoulder and upper arm on may 17, the erupatiention became somewhat generalized withabout a dozed scattered lesions of the right side of her face and trunk prostaphlin therapy was started on july 22, 1966, a swelling of the left sternomastoid muscle was noted, exam indicated the enlargement was due to a gland the size of a large olive under the lower part of the muscle. A course of 10 radiation treatments was given to the local area. On october 21, 1969, the patient had a typical lesion of herpes zoster in the right lumbar area. She was given injections of medroxyprogesterone in june 1981 she had her third herpes zoster attack, this time over her right scapular area with considerable pain, prostaphlin was prescribed again.

Remission Characteristics

Excisions were all successful in removing ln masses the ear infection subsided and the mass disappeared the left epitrochlear enlarged gland disappeared after radiation the left inguinal enlargement disappeared after radiation after prostaphlin, the herpes zoster lesions began to recede and dry up then gradually disappeared the left sternomastoid mass disappeared after radiation herpes zoster reced without complications after medroxyprogesterone after the medroxyprogesterone injections, she was continued to be seen at intervals of about 3 months. She had no further troubles until june 1981 after prostaphlin, the lesions improved quickly and gradually disappeared there have been no further developments of malignant lymphoma in the patient since 1966, and at the time of writing she appears to be in excellent health at 85 years old.

Treatment & Mechanisms

Proposed Remission Mechanisms

The viral infection of herpes zoster could be responsible for the remission of the malignant lymphoma

Clinical Treatment

Excisions radiation therapy post-op prostaphlin medroxyprogesterone "excision of four lesions followed by local radiation terapy and local radiation therapy without excision to four additional lesions"

Non-Clinical Treatment

None reported