spontaneous regression of high grade primary gastric Lymphoma in an untreated viral hepatitis infection

Case Details

Disease Location

Gastric

Personal Characteristics

57 -year-old male history of polysubstance abuse long qt syndrome secondary to methadone abue with a dual-chamber implantable cardioverighter-defibrillator suffered from untreated chronic hepatitis c infection with a child-pugh clss a cirrhosis he quit alcohol and IV drug abuse more than 2 decades previously

Clinical Characteristics

Presented with a 2 month history of epigastric pain barium swallow test demonstrated narrowing at the gastroesophageal junction. Upper endoscopy was performed. PET/CT showed focal fdg activity along the gastric greater curvature biopsies taken in an area of ulceration showed a diffuse infiltrate of atypical lymphocytes, medium to large in size ihc revealed these to be CD20 positive b cells, these extrafollicular b cells aberrantly expressed germinal center-associated antigens CD10 and bcl6, and ki-67 staining showed a markedly elevated proliferative fraction that approached 100% approx. 40% of the of the lymphocytes were positive for myc by ihc, by myc was negative by fish pcr analysis for clonal igh rearrangements revealed an oligoclonal pattern, with three prominent peaks diagnosis was dlbcl not otherwise specified there was a slight macrocytosis and thrombocytopenia, and an increase in ldh the patient was non-compliant and did not obtain therapy during the next 13 months, interval review revealed resolution of his epigastric pain lab work-up was similar to previous studies, showing mcv 100fl, platelet count 75x10^9/l and ldh 257u/l repeat egd showed a pale gastric mucosa with areas of edema, patchy erythema and diffuse nodularity

Remission Characteristics

Multiple random biopsies taken in the antrum, body and greater curvature after the second egd showed only mild chronic gastritis with no evidence of lymphoma a recent 2 year re-staging work-up including PET/CT and an egd did not have any evidence of lymphoma recurrence

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

None reported

Non-Clinical Treatment

None reported