Spontaneous Regression of an Oral Manifestation of Plasmablastic Lymphoma: Literature Review and Commentary about the Phenomena

Abstract

Plasmablastic Lymphoma (PBL) is a hematolymphoid malignant disease that has a predilection for the oral cavity and jaw. The aim of this paper is report a total resolution of oral manifestation of PBL without any oncological treatment; this process is extremely rare and we discuss the mechanism which can occur. We present a case of PBL in left maxilla and oral mucosa in a woman HIV-positive patient. After an incisional biopsy an unusual outcome of spontaneous regression of the disease occurred, we reported the diagnostic process, the management and the Daroit et al.; BJMMR, 21(11): 1-7, 2017; Article no.BJMMR.33683 2 follow up of case. We revised the similar cases reported in the literature and we will discuss the hypotheses how the phenomenon can occur. Although the PBLs are aggressive lesions, with questionable prognosis, the spontaneous regression can occur and the patient should be monitored for the risk of metastases and possible recurrence of the disease. Case Study

Spontaneous Regression of Epstein-Barr Virus-Positive Diffuse Large B-cell Lymphoma in an HIV-Positive Patient: A Case Report and Literature Review

“…Besides that, the use of herbal medicines has been postulated to contribute to the spontaneous regression of tumors as well due to their anti-inflammatory properties [18,19]. To our knowledge, the underpinning mechanism through which HIV-associated lymphomas experience spontaneous regression is most likely due to the immune reconstitution effects of cART [7][8][9][12][13][14][15][16][17]. All patients had markedly increased CD4 counts at remission and significantly reduced HIV viral load, which further strengthens this theory.…”

“…Other proposed mechanisms of spontaneous regression are also related to the immune system through action in different ways such as halting cell growth and proliferation, promoting apoptosis, and stimulating natural killer cells [8,18,19]. Some literature suggests that biopsy or ablation procedures may trigger a local healing response to resolve the tumor [16,18,19], although none was observed in our cohort. Besides that, the use of herbal medicines has been postulated to contribute to the spontaneous regression of tumors as well due to their anti-inflammatory properties [18,19].…”

“…In this case report, we describe a newly diagnosed HIV-positive patient with EBV-positive DLBCL of the colon who achieved remission after commencing cART only without any chemotherapy. From our literature review, we have also identified another six cases of biopsy-proven lymphomas that responded to cART alone and these are summarized in Table 1 [12][13][14][15][16][17]. Patients reported by Sindhu et al [7] and Griffin et al [8] have been excluded from our study cohort as well as those who received some form of conventional cancer therapy concurrently with the administration of cART.…”

“…The majority of reports suggested that an infectious etiology related to the pathogenesis of the lymphoma such as EBV and human herpesvirus- 8 (HHV-8) could explain the subsequent regression upon treatment with cART [ 8 , 17 ]. Similarly, EBV has also been implicated in lymphomagenesis in other immunodeficiency states including post-solid organ or stem cell transplant patients [ 8 , 16 ]. Immune function restoration is the main focus in the treatment of EBV-associated post-transplant lymphoproliferative disorders (PTLD).…”

“…cART functions by suppressing HIV replication and restoring CD4 T-lymphocyte counts, working alongside cellular and humoral immune responses [ 8 , 12 , 16 ]. Therefore, it has been postulated that patients who are diagnosed with HIV at the time of lymphoma detection can respond to immune reconstitution without typical cancer treatment regimens in a comparable manner to patients with PTLD.…”