Spontaneous Remission Of Follicular Lymphoma
Morigi, A., Casadei, B., Argnani, L., Cavo, M., & Zinzani, P. L. (2019). Spontaneous remission of follicular lymphoma. Hematological oncology, 37(5), 626–627. https://doi.org/10.1002/hon.2653
View Original Source →Abstract
Follicular lymphoma is an indolent B cells proliferative disorder that represents approximately 35% of all non-Hodgkin lymphomas. Although spontaneous remission is uncommon in patients with low grade non-Hodgkin lymphomas, some cases have been reported. We present a case of follicular lymphoma for which we have documented a spontaneous remission both with serial instrumental investigations and through histological biopsy of the bone marrow. The patient is still in remission after 2 years of follow-up. The causes for a spontaneous remission are not known, and we can only hypothesize a possible reawakening of the host's immune response against the tumour.
Case Details
Disease Location
Lymph nodes, bone marrow, spleen, stomach
Personal Characteristics
47-year-old caucasian man
Clinical Characteristics
Presented with enlarged inguinal bilateral lymph nodes, splenomegaly, and lymphocytosis. Laboratory evaluation showed lymphocytosis and mild thrombocytopenia. Blood smear showed some large lymphocytes with an elevated cytoplasmic nucleus ratio, compatible with peripheral blood involvement by follicular lymphoma (fl). These lymphocytes were CD20+, CD19+, cd 23−, and cd 5−. Ldh was elevated (439 u/l). CT scan demonstrated widespread lymphadenopathy above and under the diaphragm of maximum 50 × 33 mm in hilum pulmonary site associated with splenomegaly of 23 cm of bipolar diameter. Whole body positron emission tomography (PET) scan with fluorodeoxyglucose (fdg) revealed hypermetabolic adenopathies and a diffuse splenic and gastric uptake. Biopsy of a mediastinal lymph node was compatible with the diagnosis of non-hodgkin fl with a nodular infiltration of small and medium-sized lymphoid cells. Bone marrow biopsy was consistent with these findings. Urea breath test that resulted positive for the presence of helicobacter pylori infection. Patient started h. Pylori eradication therapy, suspended after 48 hours for allergic skin rash.
Remission Characteristics
After 3 months, wbc was normal without lymphocytosis (400/mmc), with normal value of hemoglobin, platelet, and ldh. The CT scan showed the regression of all the lymphadenopathies and of the splenomegaly, the PET scan did not show hypermetabolic adenopathies, and the bone marrow biopsy showed a cellularity of 60% without any lymphoid infiltration
Treatment & Mechanisms
Proposed Remission Mechanisms
Possible reawakening of the host's immune response against the tumour
Clinical Treatment
Biopsy, h. Pylori eradication therapy
Non-Clinical Treatment
None reported