spontaneous, temporary regression in a lymphosarcoma: can procaine produce this effect?

Case Details

Disease Location

Mediastinal mass and cervical lymph nodes

Personal Characteristics

16 -year-old male

Clinical Characteristics

Patients chief complaints were of bilateral, enlarged, cervical lymph nodes and difficulty in breathing and was admitted according to the patient, he had been well until three months prior to the admission, when a single, firm painless nodule appeared on the right side of his neck at that time, an unknown drug, given by injection was prescribed by a physician without benefit since then, more cervical nodules were noticed and during the previous weeks they had become somewhat tender. At this time, the patient started to experience difficulty in breathing and in swallowing solid foods physical exam found bilateral, hyperightrophoid, hyperemic tonsils and there were several nodules, slightly tender on palpation. These nodules were bilateral, unattached to the skin and ranging in diameter from 1-5cm. Slight generalized tenderness was found in the abdomen. Chest xrays showed a large upper mediastinal mass sediment contained occasional white cells per high power field. Hemoglobin was 12.05 at first, decreasing to 10gm 10 days later. Wbc was 14,600 with 74% neutrophils, 21% lymphocytes, 4% eosinophils and 1% monocytes. Total proteins were 7gm/100ml, albumin 4.3/100ml, globulin 2.7/100ml, non-protein nitrogen was 15.5mg/100ml, bilirubin 0.4/100ml, thymol was 1.4u, and bood sugar 84/100ml. Heterophil antibodies were twice found positive at 1/28. Throat culture yielded alpha hemolytic stepatientococci and neisseria in a 24 hours urine specimen, the 17 ketosteroids were 4.1ml and the 17 hydroxycorighticoid 9.8mg. On repetition these were found to be 3.1mg and 9.7mg respectively biospy was taken of the left cervical nodules on the 3rd day of hospitalization. On the 4th, the nodules decreased in size. That 4th day, mild diarrhea was also noted, and the patient received 800k daily units of penicillin procaine was started biopsy revealed lymphosarcoma type lymphoma until the tenth day after admission, the cervcial nodules remained the same but thereafter, there was a gradual increase in size. On the 12th day, chest xray showed the same upper mediastinal mass. On the 17th day, a repeated biopsy revealed chronic lymphocytic leukemia due to invasion of the vascular structure. Later gi tests were performed and found several filling defects all of different size in the ileum and colon. The mucosal pattern was distorighted in some places, and from those findings the radiologist suggested lymphoma. Repeated wbc counts were between 9,400 and 6600 with normal differentials, eosinophilia was 1-5%.

Remission Characteristics

On the 4th day of hospitalization, a day after biopsies, the left cervical nodules had very much decreased in size and number, and an immediate chest xray was taken and showed that the mediastinal mass had also regressed. A repeat xray the same day verified that finding.

Treatment & Mechanisms

Proposed Remission Mechanisms

Sr followed a biopsy, so it could have be the surgical exploration also mention of procaine having a role in the regression the role of the thymus gland on the lymphocytes and the lymphoid tissues, i.e. Interplay between the thymic hormones and the substances containing procaine ln biopsies are regularly perfromed using local anestehtic, which procaine is the most universal

Clinical Treatment

Unknown IV drug penicillin procaine

Non-Clinical Treatment

None reported