spontaneous regression of diffuse large B-cell lymphoma harbouring Epstein-Barr virus: a case report and review of the literature

Abstract

We report an elderly patient with diffuse large B cell lymphoma harbouring Epstein-Barr virus that showed spontaneous regressions with subsequent relapses three times. The patient died of aspiration pneumonia without any anti-neoplastic treatment 5 years 10 months after the initial onset of lymph node swelling. In the literature, there are several reports of aggressive non-Hodgkin's lymphoma cases that showed spontaneous regressions without relapse till the last observation. Over half of the cases were the extra-nodal type. The tendency toward regression of swollen lymph nodes detected by clinicians occurs within 2 weeks after biopsy. If the remaining lymph nodes show a tendency to decrease in size after biopsy without any anti-tumor therapies, the patient may develop spontaneous regression.

Case Details

Disease Location

Left inguinal ln, supraclavicular ln

Personal Characteristics

89 -year-old male advanced senile dementia repeated aspiration pneumonias 5 years 10 months later died of severe aspiration pneumonia with disseminated intravascular coagulation syndrome

Clinical Characteristics

Diffuse large b cell lymphoma harboring epstein-barr virus swollen left inguinal lymph node measuring 40 mm in diameter, and was slightly tender physical exam didn't detect any other swollen ln or hepatosplenomegaly. Hematologocial and biochemical studies were unremarkable, initial diagnosis was granulomatous lymphadenitis. Postmorighten immunostains of first biopsy were postive for CD20 and anti ig x antibody, but negative for CD3, CD5, CD10 and anti-ebv antibody. Anti-ig lama was negative. Gl was then corrected to lymphoplasmacytoid lymphoma. The swollen ln was removed and there were no palpable ln for about 34 months. 34 months later, painful left inguinal and supraclavicular ln swellings were found and measured 20x40mm & 40x40mm respectively serum m-protein appeared and the serum γ-globulin level was about 30% 3 years and 2 months later serum gamma-globulin level increased to 45%. Extreme elevation of serum IGA (3,800 mg/dl) and normal levels of IGG and IGM were found. Thrombocytopenia (70,000/µl) was seen. Bone marrow smears showed increased plasma cells percent (11%) and hypoplastic megakaryocytes without adhesions of platelets. No anemia was found. No abnormal x-rays. 3 years 8 months later, m-protein disappeared. Second biopsy of inguinal ln demonstrated dlbcl with severe pleomorphism. Lymphoma cells did not show a tendency of a differentiation to plasma cells. Immunohistochemical markers of ln cells were positive for CD20, CD30, mum-1, oct-2, bob-1 and ebv-encoded latent membrane protein-1 and negative for CD3, CD5, CD10, CD15, bcl-6 and ebv nuclear antigen 2. RNA in situ hybridization with the ebv-encoded small nuclear early region-1 probe demonstrated that the lymphoma cells harbored to ebv

Remission Characteristics

55 days after 2nd biopsy, the swollen lymph nodes decreased in size, after another 5 days, ln swelling disappeared completely. Then the right and left cervical and right inguinal lymph nodes became swollen for 2-3 months then disappeared respectively. During the 31- months course from initial dlbcl diagnosis, there was absence of ln swelling for 20 of those months

Treatment & Mechanisms

Proposed Remission Mechanisms

(general for nhl) modulation of the host immune system to viral or bacterial infection and/or traumatic effects including biopsy (this case) fluctuating increase and decrease of the patient's immunocompetence affected the remission, i.e. The ebv

Clinical Treatment

2 biopsies

Non-Clinical Treatment

None reported