Follicular Lymphoma With Full Remission Of Leukemic Phase
ANDAY, G. J., SCHMITZ, H. L., & LIMARZI, L. R. (1956). Follicular lymphoma with full remission of leukemic phase. A.M.A. archives of internal medicine, 97(5), 631–638. https://doi.org/10.1001/archinte.1956.00250230125014
View Original Source →Abstract
TWO OF us (G. J. A. and H. L. S.), in 1952, published a report in the A. M. A.Archives of Internal Medicineof an unusual case of follicular lymphoma.<sup>1</sup>For a short time this patient had presented the clinical and laboratory findings of acute leukemia, and then these findings had spontaneously disappeared. Repeated lymph node biopsies proved that this patient had follicular lymphoma with sarcomatous changes. Subsequently we have been searching for the explanation of the peculiar cells ("notched nucleus cells" of Isaacs<sup>2</sup>) which were typically present in the leukemic phase of that case. From a large number of leukemia cases we have studied a few in which "notched nucleus cells" were characteristically present. The results of these studies were briefly presented in the form of a lecture in May, 1953<sup>3</sup>; a more detailed presentation of the subject is now being published elsewhere.<sup>4</sup>The
Case Details
Disease Location
Lymph nodes, liver
Personal Characteristics
68 -year-old male caucasian left kidney was removed in 1938 because of a tumor, he recovered satisfactorily in december 1951 he noticed his lymph nodes were enlarged, he was seen locally in dec 1951 and april 1952 farmer from michigan
Clinical Characteristics
First seen on may 14, 1952 and complained of tiredness, shortness of breath, and a sensation of fullness in the abdomen physical exam found the patient was very pale, all superficial lymph nodes were enlarged, the posterior and anterior lymph nodes of the neck were navy-bean to cherry size. The axillary inguinal and femeroal nodes were cherry to walnut size. The lips, gums, and soft palate were pale. The chest, a few rales were present at the left base where the respiratory excursions of the diaphragm were limited the aortic second sound was accentuated, blood pressure was 140/80 and the pulse rate was 118/minute the spleen was greatly enlarged, its lower pole could be palpated 10cm below the left costal margin, the liver could be palpated 5cm below the right costal margin lab findings: on first exam (may 14th) rbc was 3,350,000; hemoglobin was 10gm; wbc was 65,000; in the differential count there were 6% segmented cells, 2% band cells, 4% lymphocytes, and 8% "notched nucleus cells". There were 1 or 2 nucleated rbc per 100 wbcs (figure 1 in article) an iliac puncture was performed in may and a sternal puncture in july showed almost complete replacement of the normal bone marrow cells by the notched nucleus cells. Platelet count was 120,000. X-ray of the chest showed some torightuosity and calcification of the aorta, ekg showed a left axis deviation the diagnosis at that time was chronic lymphatic leukemia, except for the notched nucleus cells, the bone marrow aspiration biopsies were compatible with lymphatic leukemia, however the presence of large numbers of notched nucleus cells in the blood was often associated with follicular lymphoma, plus the enlargement of the spleen made it more suspicious a supraclavicular ln biopsy was examined on july 16, 1952 the sections were densely infiltrated with lymphocytes, the follicular structure was outline though, some of the cells showed the notched nucleus. The walls of the blood vessels were densely infiltrated with the same cell type the patient came to chicago for exam in may, june, july and august 1952. He postponed treatment until late fall, there was no change in his condition on november 1952 and refused treatment again
Remission Characteristics
In march 1952, he came for another exam and apparently gained weight and had a better color. He stated he was enjoying better health and was no longer tired or short-winded and resumed working on the farm on physical, almost all of the superficial lymph nodes had become smaller, some were not even palpable, the liver was no longer enlarged, the lower pole of the spleen could be felt only on deep inspiration lab exam revealed 4,140,000 rbc, 12gm. Of hemoglobin/100cc, 6,200 wbc, differential showed 73% segmented cells, 1% band cells, 22% lymphocytes, and 4% monocytes iliac punctures showed a normal bone marrow with a mild increase in the red-cell forming elements other ln biopsies were performed in 1953 and 1954 and showed the structure of follicular lymphoma without the superimposed leukemic infiltrations, the cells of the follicles as well as of the interfollicular zones were identical, argentophilic fibrils were to extending into the follicles, some of the fibrils were small and broken up, the interfollicular fibrils were densely packed the blood vessels were free from infiltrations the notched nucleus cells have been completely absent from the peripheral blood as well as from the marrow since march 1952, however, these cells could be found in large numbers in the lymph nodes the patient is now 72 and in good general condition and living a normal life, performed regular daily work
Treatment & Mechanisms
Proposed Remission Mechanisms
The spontaneous termination of the leukemic features seems to point to humoral influences
Clinical Treatment
None reported
Non-Clinical Treatment
None reported