spontaneous regression of classical Hodgkin lymphoma: a case report and review of the literature

Abstract

Thomas Hodgkin first described Hodgkin lymphoma in 1832. Classical Hodgkin lymphoma (cHL) is a potentially curable hematologic malignancy with distinct histology, biologic behavior, and clinical characteristics. cHL is further divided into different subgroups, based on the appearance and immunophenotype of the tumor cells as well as the composition of the reactive background. Mixed-cellularity cHL represents 15–30% of cHL cases. The incidence rate of cHL is 2.8 per 100,000 men and women per year. It accounts for approximately 10% of all lymphomas and approximately 0.6% of all cancers diagnosed in the developed world annually.1,2 The improvement in 5-year survival is unmatched in the United States by any other cancer throughout the past 40 years. The overall 5-year relative survival rate is 84.7%. cHL has a bimodal age distribution, with one peak in the 20s and 30s and a second peak after the age of 50.3 cHL of the elderly is defined as that occurring in patients older than 60 years.4 It is an uncommon disease. Older patients usually present with mixed cellularity histology and B symptoms. Progression-free and overall survival rates for elderly cHL patients are disproportionately inferior to those of younger patients. Survival rates for elderly patients with cHL are inferior to those achieved by younger populations. The 5-year overall survival rates for elderly cHL patients range from 40–55%, as compared to overall survival rates exceeding 80–90% for patients younger than 40 years.5-7 Spontaneous regression (SR) of cancer is the complete or partial disappearance of a malignant tumor without treatment or in the presence of therapy that is

Case Details

Disease Location

Lymph nodes classical hodgkin lymphoma

Personal Characteristics

86 -year-old female no significant medical history

Clinical Characteristics

Patient was originally evaluationuated for diffuse myalgia, proximal muscle weakness, skin rash, dry cough, and anemia the physical exam found multiple small cervical and inguinal lymph nodes bilaterally, there was an indurated, non-tender 3x3cm ln in her left axilla lab work showed wgc 2.9x10^3ul, hemoglobin 11.8xg/dl, hematocrit of 33.9%, platelet count 99x10^3ul chest x-ray showed a new hilar fullness, CT scan showed extensive lymphadenopathy in the chest, abdomen, and pelvis involving celiac, porighta hepatis, splenic hilar, retroperitoneal, inguinal, plevic, mesenteric, and peripancreatic nodes; the CT also showed classic hl of mixed cellularity type. Diagnosis of chl of mixed cellularity type (stage IV b) and a plan for treatment was given 7 weeks later PET-CT was performed for staging prior to chemo

Remission Characteristics

Staging PET-CT marked decrease size and degree of lymphadenopathy in the chest, abdomen, and pelvis; there was resolution of splenomegaly and pleural effusions, along with a marked decrease in number of pulmonary nodules there was no medication received and no lifestyle changes subsequent follow ups showed complete resolution of lymphadenopathy she continues her sr 8 months after intital diagnosis there were no other identifiable triggers for sr, i.e. Infection or inflammation

Treatment & Mechanisms

Proposed Remission Mechanisms

Immunological factors, concomitant infections, hormonal factors, elimination of carcinogens, surgical trauma of the primary tumor, in duction of differentiation, and genetic factors. Sr pheno monthson is most often attributed to immunological mechanisms as in this case. The combo of other "systemic symptoms" i.e. Severe myalgias, anemia, and weightless may be explained by an undiagnosed concomitant immunologic disease that could have intensive cellular and humoral immunity, leading to sr

Non-Clinical Treatment

None reported