Spontaneous Regression Of A Small Non-cleaved Cell Malignant Lymphoma (non-burkitt's Lymphoblastic Lymphoma). Morphologic, Immunohistological, And Immunoglobulin Gene Analysis
Poppema, S., Postma, L., Brinker, M., & de Jong, B. (1988). spontaneous regression of a small non-cleaved cell malignant lymphoma (non-Burkitt's lymphoblastic lymphoma). Morphologic, immunohistological, and immunoglobulin gene analysis. Cancer, 62(4), 791–794. https://doi.org/10.1002/1097-0142(19880815)62:4<791::aid-cncr2820620425>3.0.co;2-m
View Original Source →Abstract
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.
Case Details
Disease Location
Tonsil (left submandibular region) cervical ln
Personal Characteristics
12 -year-old male dutch at 4 -year-old, he underwent adenotomy
Clinical Characteristics
Admitted because of a mass in the left submandiublar region that had been present for 6 weeks 4 months before admission, he was seen by a physician because of sinusitis. Despite antibiotic therapy, general weakness persisted physical exam confirmed presence of a left-sided oropharyngeal tumor behind an enlarged necrotizing tonsil. Also, a cervical ln with firm consistency and a diameter of 5cm was palpable in the left neck region hemoglobin was 135g/l; leukocyte count 6.6x10^9/l with 7% eosinophils, 66% neutrophils, 20% lymphocytes and 7% monocytes; platelet count was 212x10^9/l an axial CT of the base of the skull confirmed the presence of a large left-sided oropharyngeal soft tissue mass witho bony involvement a biopsy specimen of the tumor was taken and diagnosed as malignant lymphoma, small noncleaved cell (non-burkitt's lymphoblastic) during the next days, the tumor size diminished rapidly, and the ln in the left side of the neck was also excised the ln was diagnosed as showing only reactive changes, including fibrohyalinosis the boy was discharged after two weeks and antitumor treatment was refrained tonsil biopsy showed a diffuse proliferation of large lymphoid cells with round or oval nuclei and multiple nucleoli. The cytoplasm was strongly basophilic and showed no fat granules in imprints morphologic features suggest a non-burkitt's lymphoblastic lymphoma, or as a small noncleaved cell lymphoma the ln specimen showed reactive changes including extensive fibrohyalinosis, but no viable tumor cells ihc staining showed positivity for CD19, 20, 22, 24, anti-IGG and anti-lambda (table 1 in article) findings indicated an abnormal population of large b-cells with monoclonal membranous expression of gamma heavy chain and lambda light chain in the fibrohyalinosis areas, a predominance of CD8+ lymphocytes could be seen with an admixture of small number of leu 7+ cells tonsil tissue: jh probe showed one band in germinal line position and second band at a different location, indicating a rearranged clonal population. The c-kappa probe showed a germinal line band only. The c-lambda probe showed a rearranged band at a position clearly different from the germ line bands. The results indicate a clonal b-cell population with rearranged heavy and lambda light chain genes. The ln tissue showed germ lines only there was a high content of viable tumor cells and the presence of many mitotic figures in the tissue slides suggest the neoplastic origin of the metaphases
Remission Characteristics
After the initial biopsy, the tumor size diminished rapidly since his discharge, he has been examined at regular intervals and has now remained in good health for 3 years complete remission
Treatment & Mechanisms
Proposed Remission Mechanisms
A cytotoxic reaction of the host against the clonal transformed b-cells
Clinical Treatment
Excisional biopsy on the ln
Non-Clinical Treatment
None reported