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Spontaneous Regression Of Diffuse Large B-cell Lymphoma In A Patient With Ataxia-telangiectasia

Sherkat, R. 2022Lymphoma

Sherkat, R., Afshar Moghaddam, N., Reisi, N., & Rezaei, M. (2022). Spontaneous Regression of Diffuse Large B-cell Lymphoma in a Patient with Ataxia-Telangiectasia. Advanced biomedical research, 11, 31. https://doi.org/10.4103/abr.abr_169_21

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Abstract

Ataxia-telangiectasia (AT) is a type of primary immunodeficiency characterized by an autosomal recessive mode of inheritance and usually presents with progressive cerebellar ataxia in early life. This complex disease is associated with humoral and cellular immune dysfunction and other features including characteristic oculocutaneous telangiectasia and increased predisposition to cancers, particularly lymphoma and leukemia. An 11-year-old Iranian girl presented with primary immunodeficiency and was diagnosed as having AT according to her clinical manifestations and molecular findings. She had a history of two types of non-Hodgkin's lymphoma and showed spontaneous regression of her diffuse large B-cell lymphoma without any specific treatment. Gene mutations and dysfunction in patients with AT result in different manifestations including abnormal development of the thymus, immunodeficiency, increased susceptibility to malignancies, and increased radiosensitivity. No standard treatment is available for these patients. The use of immunotherapeutic strategies in patients with primary immune deficiency disease-associated tumors is potentially important.

Case Details

Disease Location

Lymph nodes

Personal Characteristics

11‐year‐old iranian girl from a consanguineous family with a diagnosis of ataxia–telangiectasia, hypothyroidism.

Clinical Characteristics

History of recurrent fever, ataxia, failure to thrive, speech delay, congenital fistula in front of her right ear, nail clubbing, recurrent bacterial and viral infections, mucocutaneous candidiasis, mouth ulcers and tooth caries, recurrent sinusitis, rhinitis and upper respiratory tract infections, persistent conjunctivitis‐otitis media, and recurrent chronic diarrhea. Antibiotics and intravenous immunoglobulin (ivig) were used at both therapeutic and prophylactic doses. She had received monthly infusions of ivig beginning at the age of 3 years at 3 years and 2 months, nasal lymph node swellings were seen, and she developed a mass in her left nose. Magnetic resonance imaging revealed a tumor measuring 3 cm × 2 cm × 1 cm in the left nasal cavity. Microscopic examination of the tumor biopsy was consistent with a diagnosis of non‐hodgkin’s lymphoma (nhl), probably, burkitt’s lymphoma (bl). She was started on chemotherapy consisting of cyclophosphamide, vincristine, methotrexate, and adriamycin. After two cycles of treatment, the mass completely disappeared. At 7 years old, the patient complained of a mass in her neck at a regular follow‐up visit. Abdominal us disclosed massive splenomegaly, mild hepatomegaly, and multiple small mesenteric and left para‐aortic lymphadenopathy images. Tumor resection was carried out, and the diagnosis of diffuse large b‐cell lymphoma (dlbcl) was made by microscopic and pathologic examination.

Remission Characteristics

Several months after tumor resection, the swollen lymph nodes and spleen decreased in size spontaneously

Treatment & Mechanisms

Proposed Remission Mechanisms

Recurrent systemic inflammation during sinopulmonary infections, together with the traumatic effects of several biopsies, is hypothetical mechanisms that may explain dlbcl regression in this young girl

Clinical Treatment

Ivig, antibiotics. Biopsy cyclophosphamide, vincristine, methotrexate, and adriamycin excitional biopsy

Non-Clinical Treatment

None reported