spontaneous regression of non-Hodgkin's lymphoma in the oral cavity after incisional biopsy

Abstract

We report a case of gingival T cell non-Hodgkin's lymphoma that responded initially to chemotherapy, recurred at another site a year later, but regressed spontaneously after incisional biopsy. We are not aware of any other reports about spontaneous regression of T cell lymphomas in the oral cavity.

Case Details

Disease Location

Oral cavity

Personal Characteristics

56 -year-old male

Clinical Characteristics

4 week history of swelling and ulceration in the right maxillary gingival area large irregular ulcer with sloughing and bone exposure in the edentulous space of upper right first permanent molar that extended from the palate into the buccal vestibule. Maximum diameter of 1.5cm there was also an area of ulceration on the lower labial and lingual incisal gingivae he was apyearsexial and there was neither cervical nor axillary lymphadenopathy a week later, both lesions had doubled in size, white cell count was within the reference range but there was mild neutrophilia (8.1 x 10^9/l), and lymphopenia (1.3 x 10^9/l). Antinuclear cytoplasmic antibodies were not found. Electrophoresis showed a monoclonal band. Paraprotein measured 1.8g/l and was identified as monoclonal IGG type kappa maxillary specimen was biopsied and consisted of ulcerated mucosa with sheets of large pleomorphic cells within the stroma, suggesting lymphoproliferative disease. Immunostaining confirmed lymphoma and was classified as an extranodal peripheral t cell lymphoma, unspecified of cd 4 type CT and physical exam localized lesion to the oral cavity 14 months after the end of chemo, patient developed ulceration of the gingiva in the upper left quadrant incisional biopsy confirmed recurrence of t cell nhl clinical examination and CT again showed no evidence of systemic disease, he was then listed for radiation treatment

Remission Characteristics

Patient responded well to the chemo, and patient was reported as in remission before radiation therapy was due to start there was no sign of active disease, 4 years after completion of chemo there is no evidence of the lymphoma

Treatment & Mechanisms

Proposed Remission Mechanisms

Bacterial or viral infection may stimulate the immune system to induce regression through humoral and cellular effector mechanisms discontinuation of immunosuppressive drugs

Clinical Treatment

Chemotherapy using the chop method (cyclophosphamide, doxorubicin, vincristine and prednisolone)

Non-Clinical Treatment

None reported