Spontaneous Remission of an Untreated, MYC and BCL2 Coexpressing, High-Grade B-Cell Lymphoma: A Case Report and Literature Review

Abstract

Non-Hodgkin lymphomas (NHL) are a heterogeneous group of hematologic malignancies typically treated with multiagent chemotherapy. Rarely, spontaneous remissions can be observed, particularly in more indolent subtypes. The prognosis of aggressive NHL can be predicted using clinical and histopathologic factors. In aggressive B-cell NHL, the importance of MYC and BCL2 proto-oncogene coexpression (as assessed by immunohistochemistry) and high-grade histologic features are particularly noteworthy. We report a unique case of spontaneous remission in a patient with an aggressive B-cell NHL which harbored high-risk histopathologic features, including MYC protein expression at 70–80%, BCL2 protein expression, and morphologic features suggestive of high-grade B-cell lymphoma, NOS (formerly B-cell lymphoma unclassifiable with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma [BCLU]). After undergoing a biopsy to confirm this diagnosis, he opted to forego curative-intent chemotherapy. The single, yet relatively large area of involvement noted on 18F-fluorodeoxyglucose positron emission tomography-computed tomography steadily resolved on subsequent follow-up studies. He remained without evidence of recurrence one year later, having never received treatment. This case emphasizes the potential for spontaneous remission in NHL and demonstrates that this phenomenon can be observed despite contemporary high-risk histopathologic features.

Spontaneous Regression of Primary Cutaneous Diffuse Large B-Cell Lymphoma on Sequential FDG PET

“…Spontaneous regression of tumors in the absence of treatment, especially with aggressive tumors, is rare. 8 Regression of PCDLBCL-LT in the absence of therapy is extremely rare, with limited reported cases in the medical literature. 9–13 Graham et al 9 reported a patient with histologically confirmed PCDLBCL-LT with a large, reticulated, erythematous-to-violaceous plaque of the leg that subsequently underwent spontaneous regression of the disease but recurred over a year after the initial presentation.…”

Case Report: Spontaneous Remission of an Infraorbital Follicular B-Cell Lymphoma: Case Report and Review of the Literature

“…The underlying mechanism is still poorly understood and appears to be multifactorial [ 2 ]. Several hypotheses might explain the spontaneous remission of cancer, unified by the idea that the innate immune system is triggered and increases its ability to recognize and react on malignant cells [ 21 ]. Spontaneous remission occurs mostly in melanomas, hypernephromas and neuroblastomas, and might occasionally take place in lymphomas [ 22 , 23 ].…”

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“…Another report found 6 out of 44 cases of low grade lymphomas (13.6%) without previous treatment showed spontaneous remission [27]. There are some reports in the literature trying to provide explanations for this fascinating phenomenon [28,29], yet the mechanism for which is still largely not well understood. Two mechanisms have been proposed in the literature: The systemic immune response and the genetic mechanism.…”