Spontaneous Regression Of Metastatic Lesions Of Adenocarcinoma Of The Gastro-esophageal Junction
Mitchell, R., Kaur, A., Munoh Kenne, F., Khan, A., & Zafar, W. (2021). Spontaneous Regression of Metastatic Lesions of Adenocarcinoma of the Gastro-Esophageal Junction. Cureus, 13(10), e18784. https://doi.org/10.7759/cureus.18784
View Original Source →Abstract
Spontaneous regression of cancer is a rarely recognized entity in modern medicine. Historically, this was recognized and hypothesized that an infection causes immune activation, indirectly stimulating the body to destroy tumor cells. Similarly, immune-oncology has now become a major modality in the treatment of solid and some liquid malignancies. However, now with improved therapeutic modalities in the oncology world, one does not get to appreciate our own immune system's ability to fight cancer. We present a patient who had spontaneous regression of metastatic adenocarcinoma of the gastroesophageal junction (GEJ). The patient is a 58-year-old female who had presented with early satiety and dysphagia for which she underwent esophagogastroduodenoscopy which showed an esophageal mass and endoscopic ultrasounds (EUSs) confirmed adenocarcinoma of the GEJ with metastasis to the regional lymph nodes and left supraclavicular lymph nodes. The patient had refused to undergo any surgical, medical oncological, or holistic treatments. Interim disease monitoring positron emission tomography-computed tomography (PET-CT) showed resolution of the metastatic sites of gastroesophageal cancer with clinical improvement of her symptoms. She continues to have this distant regression of metastatic gastroesophageal cancer six months after the initial diagnosis. In literature, spontaneous cancer regression has been reported in melanoma, renal cell carcinoma, and basal cell carcinoma. To our knowledge, this is the first case reported of spontaneous regression of metastatic lesions involving adenocarcinoma of the GEJ with no medical or surgical intervention.
Case Details
Disease Location
Lymph nodes
Personal Characteristics
58-year-old female, gastric bypass done at age 39, multiple ventral hernia repairs, b12 deficiency, and depression.
Clinical Characteristics
Initially presented with a history of dysphagia and early satiety. Egd revealed a one-centimeter polyp in the distal esophagus. Biopsy of this polyp revealed a poorly differentiated adenocarcinoma of the gastroesophageal junction (gej). It was her-2 positive. Initial PET-CT showed 1.6 cm fluorodeoxyglucose (fdg) avid lateral wall thickening of the distal end of the esophagus with suv 3.1, with another focus at the gej suv 2.4, also noted were 2 cm x 1.6 cm left supraclavicular lymph node suv 7.2, 1 cm precarinal lymph nodes, and other nodes included retrocrural, gastrohepatic, periaortic, and aortocaval lymph nodes. Endoscopic ultrasound showed a medium-sized ulcerating mass measuring two centimeters at gej extending to the gastric pouch. There was also invasion of the muscularis propria. Five malignant-appearing lymph nodes were visualized in the lower para-esophageal mediastinum, celiac, and peri-aortic regions. Fine needle aspiration of the para-aortic lymph node was positive for metastatic adenocarcinoma.
Remission Characteristics
PET-CT was repeated four months later, which showed findings consistent with known primary malignancy but anatomic and metabolic resolution of metastasis to the left supraclavicular lymph node, the intraabdominal lymph nodes, and a hypermetabolic focus of gej that was previously seen. The size of the supraclavicular lymph node and the other gastric and para-aortic lymph nodes significantly decreased in size and were no longer metabolically active although the primary lesion had increased in size.
Treatment & Mechanisms
Clinical Treatment
Biopsy