Spontaneous Regression Of Diffuse Large B-cell Lymphoma In The Small Intestine With Multiple Lymphadenopathy
Tanaka, Y., Ishihara, M., Miyoshi, H., Hashimoto, A., Shinzato, I., & Ohshima, K. (2019). Spontaneous regression of diffuse large B-cell lymphoma in the small intestine with multiple lymphadenopathy. Journal of clinical and experimental hematopathology : JCEH, 59(1), 17–21. https://doi.org/10.3960/jslrt.18020
View Original Source →Abstract
Diffuse large B cell lymphoma (DLBCL) is classified as an aggressive lymphoma due to its poor prognosis regardless of the treatment. Almost all cases of DLBCL are treated using rituximab-combination chemotherapy, but spontaneous regression without any therapeutic modalities may rarely occur. A 35-year-old man complained of abdominal pain and discomfort. Positron emission tomography-computed tomography (PET-CT) demonstrated abnormal accumulation of fluorodeoxyglucose in the thickened wall of the small intestine and multiple lymphadenopathy. Laparoscopic lymph node biopsy was performed, and the diagnosis of DLBCL was made based on the biopsy findings. Soon after the laparoscopic biopsy, the patient felt free from any symptoms. Approximately three months later, no abnormal accumulation of fluorodeoxyglucose in the entire body was found on PET-CT. He has remained in complete metabolic remission for over three years according to PET-CT. We discuss the mechanism of this rare phenomenon.
Case Details
Disease Location
Small intestine
Personal Characteristics
35-year-old man
Clinical Characteristics
Admitted for evaluation of an intra-abdominal mass discovered in us as a large mass on the right side of the umbilical region. CT demonstrated thickening of the entire circumference of the wall of the small intestine on the right side of the umbilical region and multiple soft tissue density nodules in the mesentery. On PET/CT an abnormal accumulation of 18 fdg was localized in the small intestine and multiple nodules. Total double-balloon endoscopy revealed multiple areas with small raised reddish mucosa in the lumen of the entire circumference of the small intestine. Laparoscopic lymph node biopsy was performed. Multiple lymph nodules were found in the mesentery, and a tumor was also found in the small intestine. One lymph node in the mesentery was removed. On histopathological examination, diffuse proliferation of large-sized abnormal cells with irregular nuclei and scant cytoplasm in the biopsied lymph node were observed. These findigns and the inmunohistochemestry led to the diagnosis of diffuse large b cell lymphoma (dlbcl)
Remission Characteristics
After the laparoscopic biopsy, the patient felt that his abdominal discomfort gradually improved, and approximately one month later, he felt free from any symptoms. There was no abnormal accumulation of 18-fdg on PET-CT three months later
Treatment & Mechanisms
Proposed Remission Mechanisms
Apoptosis of lymphoma cells may have been induced through the pd-l1/pd-1 axis.
Clinical Treatment
Biopsy
Non-Clinical Treatment
None reported