Spontaneous Regression Of Metastatic Cancer Cells In The Lymph Node: A Case Report
Choi, N., Cho, J. K., Baek, C. H., Ko, Y. H., & Jeong, H. S. (2014). spontaneous regression of metastatic cancer cells in the lymph node: a case report. BMC research notes, 7, 293. https://doi.org/10.1186/1756-0500-7-293
View Original Source →Abstract
BACKGROUND: Spontaneous regression of a malignant tumor is the phenomenon of disappearance of cancer cells without any treatments and it can be induced by an enhanced tumor-targeting immune response. However, there has not been a comprehensive immunological overview to compare the tumor-regressed lymph nodes and metastatic lymph nodes in the same patient. CASE PRESENTATION: We conducted a histologic analysis of various immune cells in an Asian female patient with buccal cancer (squamous cell carcinomas), in which the spontaneous regression of metastatic lymphadenopathy was confirmed by surgical pathology. The immune cell profiles between the metastatic nodes and the tumor-regressed nodes were compared. Tumor regression was confirmed by hematoxylin & eosin and cytokeratin/Ki-67 staining. Distinct differences were observed in Foxp3(+) regulatory T (Treg) cells and CD56(+) natural killer (NK) cells; a higher density of Foxp3(+) Treg cells was found in metastatic lymph nodes and more infiltration of CD56(+) NK cells in tumor regressed lymph nodes. Other immune cell populations (CD4, CD8, CD20, CD68, CD86, CD123, CD11c, and mannose receptor) showed no discernible differences in marker expression in the nodes examined. CONCLUSION: Less recruitment of Treg and high infiltration of NK cells were key features in tumor-regressed lymph nodes. Modulation of Treg or NK cells may be a good therapeutic method to control lymph node metastasis.
Case Details
Disease Location
Right buccal area
Personal Characteristics
52 -year-old female asian
Clinical Characteristics
Admitted with complaints of right cheek pain and an ulcerative protruding mass lesion in the right buccal area. Punch biopsy was conducted the biopsy revealed well-differentiated squamous cell carcinoma CT, MRI, and PET delineated a 2.9x2x1.4cm buccal mass in the right lower cheek with right ln metastasis (level ib, iia, and iii) - no evidence of distant metastasis she underwent wide surgical resection of the malignant tumor in the right buccal area, right comprehensive neck dissection (level i to v) and left selective neck dissection (level i to iii) pathologic TNM staging system diagnosed patient2n1 (right ln metastasis) post-op adjuvant radiotherapy was administered, covering the primary sites and regional nodes after therapy, regular CT, MRI, and PET/CT were scheduled. During the follow-up period, intermittent swelling of the neck lymph nodes was observed. Ultrasonography guided fine needle aspiration cytology was performed to exclude recurrence. There was no evidence of malignancy at 4 years and 6 months post-treatment, there was a markedly enlarged ln in the contralateral lower neck (left level v) CT and ultrasonography guided aspiration cytology showed regional ln recurrence, suggesting a metastatic squamous cell carcinoma, based on necrotic features of the enlarged ln on the CT and the keratin debris on cytology salvage neck dissection was performed most cells were CD86 positive with a clump of CD68+ or cd11c+ distribution of CD4+, 8+ and 20+ were similar or relatively homogenous in the area around the metastatic and regressed nodes
Remission Characteristics
Aspiration found no malignancy and she has remained in a disease-free state for 4 years total regression was revealed after salvage neck dissection and surgical pathology of recurrence that occurred 4 years and 6 months after treatment. I.e. Total regression of metastatic squamous cell carcinoma cell sin the left level v ln and there was no malignancy of other lymph nodes *** the left level v lymph nodes were not involved in pervious surgeries or radiation *** complete tumor regression was confirmed by cytokeratin and ki-67 staining, high levels of cytokeratin and ki-67 were observed in the tumor cells cytokeratin was noted in the keratin debris marked differences between the metastatic node and tumor-regressed node were in the incidence of foxp3+ regulatory t cells and CD56+ natural killer cells. There was nearly 2-fold in the metastatic node a noticeable infiltration of CD56+ NK cells was found in the keratin debris in the tumor-regressed ln
Treatment & Mechanisms
Proposed Remission Mechanisms
Immunological events or unknown etiology the interaction between treg and NK cells may be an imporightant phenomenon in sr
Clinical Treatment
Surgical resection & neck dissections post-op radiotherapy
Non-Clinical Treatment
None reported