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
Posterior cervical, left neck lymph nodes
Personal Characteristics
75 -year-old male september 2002
Clinical Characteristics
CT scan obtained showed posterior cervical lymphadenopathy measuring up to 1.4cm fine needle aspiration of the ln revealed a monoclonal b-cell population that expressed CD19, 20, and 5. CT scan of the chest, abdomen, and pelvis was performed for further evaluation but showed no evidence of adenopathy. Bone marrow exam performed showed no evidence of involvement. Fdg-PET in november 2002 revealed fdg uptake in the left neck (3.6) and upper abdomen in the periaortic region (2.8). A follow-up CT of the abdomen within 1 week showed a 1-cm ln in the retroperitoneum, corresponding to the PET findings. Excisional biopsy confirmed male cell lymphoma. Suggestion of stage 3a mantle cell lymphoma. The patient was asymptomatic thus no treatment and under observation follow fdg-PET in march 2003 revealed similar findings as before but less (uptake in left neck; suv of 2.2) a third PET in nov 2003 showed a mild to moderately increased fdg uptake (1.3) in the cervical region, while still less that previous scan, no other suggestive active regions, patient still asymptomatic
Remission Characteristics
Second fdg-PET scan showed decrease uptake in the left neck (3.6 to 2.2) but in the periaortic region there was no uptake follow-up CT also showed a decreased cervical ln size third PET found even less uptake of fdg in the cervical region than previous scans
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
Excisional biopsy
Non-Clinical Treatment
None reported