Transient spontaneous regression of an anterior mediastinal mass

Abstract

A case of spontaneous regression of lymphoma is presented. Regression of the tumor occurred during an episode of mechanical small bowel obstruction. Elevated circulating endogenous corticosteroids are thought to have acted against the tumor cells.

Case Details

Disease Location

Anterior mediastinal mass

Personal Characteristics

69 -year-old female

Clinical Characteristics

Presented with shortness of breath and cough chest roentgenogram revealed an anterior mediastinal mass, this was confirmed on chest CT percutaneous aspiration of the mass suggested lymphoma during the next two days, the patient developed abdominal distention, pain, and an elevated wbc count. The focus shifted to her abdomen and laparotomy 7 days after admission occured. Small bowel obstruction was relieved with lysis of adhesions and resection of 59cm of small intestine after recovering from surgery, the medistinal mass resumed. Repeat reontgenogram of the chest on the 17th day of hospitalization occured 3 weeks (27 days) after discharge, the patient returned with reaccumulation of pleural effusion and reappearance of the anterior mediastinal mass. Thoracotomy and biopsy revealed lymphoblastic lymphoma

Remission Characteristics

The repeat roentgenogram no longer could detect the mass, which was also confirmed by a repeat CT, left pleural effusion decreased in size

Treatment & Mechanisms

Proposed Remission Mechanisms

Hormonal factors may be the predominant mechanism, with the stress associated with small bowel obstruction and laparotomy, the patient probably had elevated levels of circulating endogenous corticosteroids wbc count may also be related to an increased host immune response against the tumor

Clinical Treatment

Laparotomy thoracotomy

Non-Clinical Treatment

None reported