A Case Of Spontaneous Regression Of Pulmonary Small Cell Carcinoma
Ugajin, M., & Kani, H. (2019). A Case of Spontaneous Regression of Pulmonary Small Cell Carcinoma. European journal of case reports in internal medicine, 6(8), 001203. https://doi.org/10.12890/2019_001203
View Original Source →Abstract
An 82-year-old man was examined using chest computed tomography after treatment for pneumonia. Imaging showed a nodular shadow in the left lower lobe with associated enlarged lymph nodes. A polypoid tumour was observed on bronchoscopic examination, and the histological findings showed pulmonary small cell carcinoma with infiltration of CD3-positive and CD8-positive lymphocytes. The patient declined any antitumoural therapy and experienced an exacerbation of heart failure treated with atrial natriuretic peptide. Eighteen months after the diagnosis, the polypoid tumour had disappeared. T lymphocyte-mediated immunity and the antitumoural effects of atrial natriuretic peptide may have influenced the observed spontaneous regression. LEARNING POINTS: Spontaneous regression of pulmonary small cell carcinoma is an exceptional phenomenon.T lymphocyte-mediated immunity and the administration of atrial natriuretic peptide may have affected the observed spontaneous regression of pulmonary small cell carcinoma.
Case Details
Disease Location
Lung, lymph nodes
Personal Characteristics
82-year-old man. He routinely took vildagliptin for diabetes mellitus, aspirin and carvedilol for ischaemic heart disease, which had required percutaneous coronary intervention at age 74, and received a leuprorelin injection every 3 months for prostate adenocarcinoma diagnosed at age 79.
Clinical Characteristics
Complaining of cough and dyspnoea. CT imaging of the chest revealed a left-sided pleural effusion and infiltration in the left lower lobe. The patient was diagnosed with pneumonia accompanying congestive heart failure, and his symptoms disappeared after administration of antibacterial agents and diuretics. A chest CT scan 3 months after initial presentation showed a nodular shadow in the left lower lobe with enlarged mediastinal and hilar lymph nodes. Plasma pro-gastrin-releasing peptide (pro-grp) level was elevated. Bronchoscopic examination revealed a polypoid tumour which occluded the left lower b6 b+c bronchus. Biopsy showed small cell carcinoma. During follow-up, the patient was hospitalized due to exacerbation of chronic heart failure, which occurred 7 months after the diagnosis of pulmonary small cell carcinoma. Diuretics, including carperitide, were administered. 2 months later, admitted for hyperosmolar hyperglycaemic state, which occurred 9 months after the diagnosis of pulmonary small cell carcinoma. The patient’s blood glucose level was 818 mg/dl on admission; insulin therapy was administered
Remission Characteristics
Eighteen months after the diagnosis of pulmonary small cell carcinoma, the patient’s chest CT showed disappearance of the nodular shadow in the left lower lobe and a marked decrease in the size of the mediastinal and hilar lymph nodes. Bronchoscopic examination showed disappearance of the polypoid tumour
Treatment & Mechanisms
Proposed Remission Mechanisms
T lymphocyte-mediated immunity and the antitumoural effect of atrial natriuretic peptide may have induced the observed spontaneous regression.
Clinical Treatment
Biopsy, diuretics, insulin therpay
Non-Clinical Treatment
None reported