Spontaneous Regression Of Follicular, Mantle Cell, And Diffuse Large B-cell Non-hodgkin's Lymphomas Detected By Fdg-pet Imaging
Kumar, R., Bhargava, P., Zhuang, H., Yu, J. Q., Schuster, S. J., & Alavi, A. (2004). spontaneous regression of follicular, mantle cell, and diffuse large B-cell non-Hodgkin's lymphomas detected by FDG-PET imaging. Clinical nuclear medicine, 29(11), 685–688. https://doi.org/10.1097/00003072-200411000-00002
View Original Source →Abstract
Spontaneous regression of non-Hodgkin lymphoma (NHL) has been reported in low-grade tumors but is an extremely rare event in intermediate- and high-grade disease. Documentation of spontaneous regression by serial fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging has not been reported in the literature. We present 3 cases of spontaneous regression, 1 each of follicular lymphoma (FL), mantle cell lymphoma (MCL), and diffuse large B-cell lymphoma (DLBCL), which showed spontaneous regression on serial FDG-PET imaging. All patients underwent serial whole-body FDG-PET scans 60 minutes after intravenous injection of 9-11 mCi of this radiotracer. None of them had any chemotherapy, radiotherapy, or surgery after the baseline PET scan. Spontaneous regression of disease in all 3 cases was correlated with conventional imaging and clinical course. All 3 patients had positive FDG-PET results on their baseline scan. There was complete disappearance of FDG uptake on a follow-up PET scan for the patient with follicular lymphoma. These results suggest complete regression. The patients with MCL and DLBCL both showed a significant reduction in FDG uptake on serial whole-body PET scans, suggesting partial regression in both cases. Although spontaneous regression of lymphoma is uncommon, this phenomenon can be successfully demonstrated by FDG-PET imaging. Therefore, serial PET imaging may play an important role in detecting this unusual event and may further enhance our understanding of the biologic behavior of this malignancy.
Case Details
Disease Location
Left parotid inguinal lymph nodes
Personal Characteristics
59 -year-old female 1998
Clinical Characteristics
Biopsy on the left parotid found a low-grade follicular nhl. Surgical excision occurring in 1998, bone marrow biopsy in 2000 reveal marrow involvement, and fdg-PET was also performed the whole body fdg-PET showed areas of focal increased radiotracer uptake in the inguinal lymph nodes bilaterally with a standardized uptake value of 2.6, this was interpreted as active disease. There was also mild diffuse increased fdg uptake in the spleen and bone marrow. Because of low grade malignancy, there was no treatment at that time CT scan in march 2002 revealed no abnormality in july 2003, a follow-up fdg-PET was performed, during the interim--the patient remained asymptomatic. The follow-up scan demonstrated normal fdg distribution in the entire body, although the mild diffuse increased fdg uptake in the spleen appeared unchanged when the inguinal regions had resolved
Remission Characteristics
CT scan in 2002, no abnormalities a follow-up fdg-PET found the fdg distribution normal in the body, with resolution of the uptake in inguinal regions. Spleen appeared unchanged however
Treatment & Mechanisms
Proposed Remission Mechanisms
Modulation of the host immune system, possibly by concurrent bacterial or viral infection or traumatic effects including reduction of tumor burden by biopsy immunomodulatory effect
Clinical Treatment
Excision in 1998
Non-Clinical Treatment
None reported