Complete Spontaneous Remission Of Diffuse Large B-cell Lymphoma Of The Maxillary Sinus After Concurrent Infections
Buckner, T. W., Dunphy, C., Fedoriw, Y. D., van Deventer, H. W., Foster, M. C., Richards, K. L., & Park, S. I. (2012). Complete spontaneous remission of diffuse large B-cell lymphoma of the maxillary sinus after concurrent infections. Clinical lymphoma, myeloma & leukemia, 12(6), 455–458. https://doi.org/10.1016/j.clml.2012.06.007
View Original Source →Case Details
Disease Location
Right maxillary sinus
Personal Characteristics
67 -year-old female
Clinical Characteristics
Presented to her dentist with a painless, right-sided facial swelling that had been slowly increasing for approx. 4 weeks. The swelling did not improve after a course of oral antibiotics one month after presentation, she was referred to an oral surgeon WHO extracted 2 teeth, during the procedure - soft tissue mass was noted in the right maxilla and biopsies were performed histological exam of the mass revealed sheets of monomorphic, large cells with vesicular chromatin and prominent nucleoli with admixed scattered small lymphocytes immunohistochemistry revealed positive CD20, CD10, bcl-2, bcl-6, and mum-1. Consistent with diffuse large b-cell lymphoma, activated b-cell subtype. Ki-67 proliferation index was 80% in the lymphoma cells clonality was confirmed PET-CT showed a 5.1x4.2cm soft-tissue mass in the right maxillary sinus with erosion of the anterior and inferior portions of the sinus. The mass was intensely fdg avid and extended into the soft tissues of the cheek. An additional 8mm fdg-avid ln of unclear clinical significance was noted adjacent to the thoracic aorta diagnosis of stage ie dlbcl eastern cooperative oncology group performance status was 1, international prognostic index score was 1, and she was scheduled to start chemo shortly after staging evaluation 2 days before the planned initiation of chemo, the patient presented to the emergency department. With fear that had started a day earlier that day. She started to have nausea, vomiting, and diarrhea 4 days before presentation, followed 2 day later by the onset of cough. Stool was positive for clostridium difficile toxin, and a chest radiograph revealed a left lower lobe opacity. She received pharmaceutical treatment notably, the swelling on the right side of her face started to decrease in size about the same time or just after the onset of these symptoms. CT with IV contrast showed a decrease in size to 3.8x3cm and no drainable fluid was seen. Chemo was canceled due to infection
Remission Characteristics
Face swelling decreased in size around the same time of infection symptoms the patients facial swelling resolved during the hospitalization a repeat PET-CT 1 month later showed the mass had further decreased in size (2x1cm) and was only mildly fdg-avid; the ln adjacent to the thoracic aorta was no visualized 7 months after initial presentation, a second PET-ct7 showed the facial mass was no longer present 1 year after initial presentation, the patient remains well with no evidence of disease
Treatment & Mechanisms
Proposed Remission Mechanisms
Stimulation of the immune system by bacterial infection might be responsible for tumor cell death regression maybe was also due to the biopsy aka physical disrupatiention might give the immune system the ability to recognize and attack the malignant clones
Clinical Treatment
Oral antibiotics as initial treatment for swelling she received metronidazole for colitis, as well as levofloxacin and clindamycin for empiric treatment of possible bacterial pneumonia
Non-Clinical Treatment
None reported