Spontaneous Remission Of Acute Lymphoblastic Leukemia With Mediastinal Mass
Yoruk, A., Erguven, M., Celiker, E., Aki, H., Timur, C., Yuksel, E., & Ozkan, H. (2008). spontaneous remission of acute lymphoblastic leukemia with mediastinal mass. Pediatric hematology and oncology, 25(3), 181–186. https://doi.org/10.1080/08880010801938132
View Original Source →Abstract
Spontaneous remission/regression of cancer is defined as partial or complete disappearance of malignant disease temporarily or permanently in the absence of medical treatment. This event is named as spontaneous regression for solid tumors and spontaneous remission for leukemia. The authors report the case of a girl aged 4 years and 3 months, who presented with mediastinal mass and leukemic findings in the bone marrow both of which reappeared after spontaneous regression and remission, respectively.
Case Details
Disease Location
Blood
Personal Characteristics
4 -year-old female
Clinical Characteristics
Patient was admitted with cough and dyspnea, there was a 20 day history of these complaints physical revealed mild dyspnea, and respiratory sounds were bilaterally coarse chest roentgenogram revealed a mediastinal mass complete blood count revealed a wbc of 21.8x10^9/l with 66% neutrophils, and a platelet count of 461x10^9/l other blood counts glucose 81mg/dl, bun 24mg/dl, creatinine 0.6mg/dl, uric acid 12.6mg/dl, ast 49iu/l, alt 33iu/l, na 137 meq/l, k 4.5 meq/l, ca 9.8mg/dl, p 6.2mg/dl, and ldh 3790 iu/l marrow revealed 63% blasts flow cytometry found a high granulocyte percentage hydration, alkalinization or urine, and allopurinol therapy were started and ceftriaxone was added as the chest roentgenogram suggested pneumonia fibrinogen was 615mg/dl, cu 155ug/dl, alpha-fetoprotein 1.77 iu/ml, ferritin 862ng/ml, beta-hcg <1 miu/ml, and haptoglobulin 280mg/dl chest CT revealed a 11x8x4.5cm mediastinal mass on the 5th day of her admission she had a fever for 24 hours and postnasal secretion was observed with was interpreted as a sign of viral upper respiratory infection two days later an itching urticarial rash appeared on her arms and trunk, and symptomatic treatment was given 3rd week of admission, client was discharged 2 weeks after her discharge, she was admitted again with cough and dyspnea, heart rate was 120/min, blood work found wbc count of 11.9x10^9/l, glucose was 87mg/dl, urea 20mg/dl, creatinine 0.4mg/dl, uric acid 9.2mg/dl, na 138 meq/l, k 4.7 meq/l, ca 10mg/dl, p 9.2mg/dl, and ldh 1950 iu/l chest roentgenogram revealed reappearance of the mediastinal mass. Treatment with hydration, urine alkalinization and allopurinol were started again immunophenotyping revealed t-all in the 2nd day of admission she had severe dyspnea, heart rate of 110/min and respiratory rate of 44/min, subcostal retraction and venous congestion were observed, suggesting vena cava superior syndrome prednisolone and vincristine were given via IV complaints disappeared in 1 day, she was enrolled on the bfm trall 200 chemo protocol
Remission Characteristics
On the 10th day routine chemistry studies were normal and hydration, urine alkalinization and allopurinol were stopped in the second week of admission, mediastinal mass disappeared radiologically at that time, marrow aspiration revealed 9% blasts and immunophenotyping was nondiagnostic in the 3rd week, no blasts were seen in marrow and she was discharged
Treatment & Mechanisms
Proposed Remission Mechanisms
Sr was possibly due to viral infection and/or fever in the patient
Clinical Treatment
Hydration, urine alkalinization, allopurinol and ceftriaxone IV prednisolone, vincristine bfm trall 2000 chemo
Non-Clinical Treatment
None reported