Spontaneous Regression Of Non-small Cell Lung Cancer: A Case Report And Literature Review
Shatola, A., Nguyen, K. N., Kamangar, E., & Daly, M. E. (2020). Spontaneous Regression of Non-small Cell Lung Cancer: A Case Report and Literature Review. Cureus, 12(1), e6639. https://doi.org/10.7759/cureus.6639
View Original Source →Abstract
Spontaneous cancer regression is rare, and particularly rare for non-small cell lung cancer (NSCLC). The pathogenesis of spontaneous regressions is poorly understood, but of interest to many patients and providers. The infrequency of spontaneous regression makes it a challenging phenomenon to understand and study. We present a case of biopsy-proven NSCLC in a 73-year-old man that regressed without treatment.
Case Details
Disease Location
Lung, lymph nodes
Personal Characteristics
73-year-old caucasian man. 50 pack-year smoking history and a history of low grade, non-invasive bladder cancer treated with intravesicular bacillus calmette-guerin (bcg)
Clinical Characteristics
Presented with worsening shortness of breath and dyspnea on exertion. CT was obtained for further evaluation, which revealed a 3.2 x 2.5 cm spiculated solid mass in the left lower lobe of the lung. (PET)/CT completed three weeks later, confirmed a hypermetabolic solid nodule measuring 3.2 x 2.2 cm. Several borderline-enlarged mediastinal nodes were also noted. Paratracheal level 2 and 4 nodes measured up to 1.2 cm, with a right hilar level 10 node measuring up to 1.3 cm. CT-guided fine needle aspirate of the left lower lobe mass was performed. Cytology revealed large and small groups of neoplastic cells with enlarged and hyperchromatic nuclei, irregular nuclear membranes, some with small nucleoli, and a small amount of cytoplasm. On immunohistochemistry, cells were cytokeratin (ck)5/6 positive, epithelial membrane antigen (ema) focally positive, ber-ep4 very focally positive, and p63 positive. The results were consistent with keratinizing squamous cell carcinoma. He completed a six-week course of weekly bcg installations for non-invasive bladder cancer, approximately one month prior to lung biopsy.
Remission Characteristics
The follow-up CT chest was obtained for re-staging purposes, 10 weeks post-biopsy. The repeat CT chest revealed a marked decrease in the size of the left lower lobe lung mass from the most recent 3.2 cm to 2.2 cm. CT performed at a three-month interval revealed a further reduction in the size of the left lower lobe lung mass from 2.2 cm to 1.6 cm
Treatment & Mechanisms
Proposed Remission Mechanisms
Possible association with intravascular bacillus calmette-guerin (bcg) treatment
Clinical Treatment
Intravascular bacillus calmette-guerin (bcg). Biopsy
Non-Clinical Treatment
None reported