spontaneous Remission in Localized Diffuse Large B-cell Lymphoma

Case Details

Disease Location

Tongue (left vallecula and root of the tongue)

Personal Characteristics

66 -year-old female 2003 history of hysterectomy due to leiom-year-old malea as well as total adnexectomy also endometrioid neoplasia in the ovaries no medicine on a regular basis

Clinical Characteristics

She was in general good health and presented with a 3-week history of dysphonia and a pharyngeal globus perception physical exam revealed a swelling between the left vallecula and and the root of the tongue measuring 2x1cm but no lymphadenopathy in the region of the head and neck or anywhere else was detected. Hepatosplenomegaly was not present lab results showed a moderate elevation of the red blood cell sedimentation rate with normal peripheral cell numbers histological assessment of the biopsy material taken from the swelling showed lymphatic tissue with regular germinal centers and malignant tumor tissue the tumor cells had prominent eosinophilic nucleoli and their nuclei were light, variously shaped and surrounded by narrow rims of eosinophilic cytoplasm. Several mainly atypical cell divisions were visible immunohistochemistry showed tumor cells to be negative with cytokeratin-, kappa-, lambda-, CD15-, s100-, cytokeratin ae1-ae3, melan-a, CD30 antibodies, however the tumor cells were positive with b-cell markers and negative with t-cell markers diagnosis of high grade b-cell lymphoma was made staging exams including chest, abdominal and pelvic cts were used to gain info about the lymph nodes and penetration of tumor into other organs, no bone marrow biopsy occured and she did not present herself to the follow-up within the next 6 months. The cts did not show any pathologic-sized lymph nodes, only a mild hepatosplenomegaly; 6 months later, a control CT of neck, chest, abdomen and pelvis couldn't detect any lymphadenopathy one year after diagnosis, in 2004, she was still asymptomatic and physical exam didnt reveal any morbidity. Lab results including cbc and ldh were within normal and control CT of neck and chest didnt reveal lymphadenopathy. The negative status was confirmed by an otorhinolaryngological exam and there were no signs of local progression samples from the original biopsy from the root of the tongue went into further histological review due to indolent behavior not typical for dlbcl the second histological exam defined the disease as an immunoblastic variant of the dlbcl with activated b-cell like immunophenotype. The tumor cells showed a weak focal positivity for CD20 and 38, a relatively homogeneous cytoplasmic positivity for cd79a and an extensive positivity for mum-1, bcl-2 and cytoplasmic immunoglobulin light chain kappa, but negativity for CD5, ebv-lmp1, bcl-6 and CD10 the patient didnt show up for further hematological control exams. In april 2010, at the otorhinolaryngological control exam, she was complaint-free and had negative lab parameters (normal ldh and beta-2-microglobuline level), and negative orl status control neck CT revealed a fine contrast agent concentrating mass in the root of the tongue and a pathological-sized ln in the mediastinum PET-CT was performed to determine whether the mass was residuum of the former operation or a local recurrence there was no fdg accumulation at the root of the tongue while the mediastinal nodes were found to be reactive due to two independent prognostic markers (aaipi and bcl-2 + mum-1 positivity), the risk status of the patient corresponded to the high risk ipi-score

Remission Characteristics

"all the article mentions was the ""we became passive witnesses of the sr of an activated b-cell type dlbcl"" occurred along 7 years, untreated"

Treatment & Mechanisms

Proposed Remission Mechanisms

Immunological mechanisms, endocrine mechanisms, elimination of the carcinogenic factor, apoptosis, epigenetical, and psychological factors no major mechanism proposed for this case

Clinical Treatment

None reported

Non-Clinical Treatment

None reported