Indian Journal of Cancer
Home  ICS  Feedback Subscribe Top cited articles Login 
Users Online :818
Small font sizeDefault font sizeIncrease font size
Navigate here
  Search
 
  
Resource links
   Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
   Article in PDF (1,052 KB)
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
   References
   Article Figures

 Article Access Statistics
    Viewed2047    
    Printed25    
    Emailed0    
    PDF Downloaded237    
    Comments [Add]    

Recommend this journal

 


 
  Table of Contents  
LETTER TO THE EDITOR
Year : 2016  |  Volume : 53  |  Issue : 1  |  Page : 11-12
 

Spontaneous regression of orbital lymphoma


1 Department of Hematology, Sir Ganga Ram Hospital, New Delhi, India
2 Department of Histopathology, Sir Ganga Ram Hospital, New Delhi, India
3 Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India

Date of Web Publication28-Apr-2016

Correspondence Address:
A A Khan
Department of Hematology, Sir Ganga Ram Hospital, New Delhi
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.180841

Rights and Permissions



How to cite this article:
Khan A A, Jain D, Siraj F, Aggarwal S. Spontaneous regression of orbital lymphoma. Indian J Cancer 2016;53:11-2

How to cite this URL:
Khan A A, Jain D, Siraj F, Aggarwal S. Spontaneous regression of orbital lymphoma. Indian J Cancer [serial online] 2016 [cited 2019 Aug 22];53:11-2. Available from: http://www.indianjcancer.com/text.asp?2016/53/1/11/180841


Sir,

Spontaneous regression of malignant neoplasms is extremely unusual. We encountered one such patient who presented with right orbital mass, histologically diffuse large B cell type lymphoma, who showed spontaneous regression within a span of 3 weeks after the diagnosis, and at 1-year follow-up, the tumor had not recurred.

An 84-years-old female who had right pthisisbulbi from childhood had been complaining of mild intermittent pain right orbit for last 4 years. Her physical examination was unremarkable except for the right pthisisbulbi. Complete blood counts, liver function tests, kidney function tests, chest X-ray were all within normal limits. However, non-contrast CT scan head revealed small right retro-orbital mass without proptosis. This lesion was biopsied. Histopathological examination showed fibrofattytissue infiltrated by mononuclear cells (chronic inflammatory changes). With impression of pseudotumor orbit, patient received steroids (prednisolone 60 mg/day) for only 1 month. Five months later, she developed proptosis, which was progressive and associated with mild discomfort. Repeat computed tomography (CT) scan head showed right orbital mass occupying whole of the orbit [Figure 1]. On biopsying this lesion, it revealed diffusely invasive tumor, composed of sheets of large atypical lymphoid cells, immunohistochemically positive for CD20 [Figure 2]. An impression of non-Hodgkin lymphoma, diffuse large B cell type was given. Patient was planned for staging workup and treatment; however, patient turned up after 3 weeks with complete disappearance of the orbital swelling without any treatment [Figure 3]. She denied any further investigations and treatment. Patient is doing well at 1-year follow-up without any recurrence.
Figure 1: Non-contrast CT scan head showing right orbital mass

Click here to view
Figure 2: Photomicrograph showing a tumor composed of sheets of large atypical lymphoid cells, positive for CD20 (IHC CD20, ×20)

Click here to view
Figure 3: (a) Right orbital mass with proptosis. (b) Spontaneous regression of the mass

Click here to view


Complete regression of high-grade non-Hodgkin lymphoma (NHL) is an extremely rare phenomenon. Abe et al., in 2007 reviewed 15 cases of spontaneous regression (SR) in NHL and reported that 3 cases involved were diffuse large B cell Lymphoma (DLBCL) type.[1] Most of the SR cases are localized tumors stage I or IE that has undergone an intervention like excisional biopsy and have been associated with a massive infiltration of T cells in the residual tissue.[1] The leading hypothesis regarding complete SR involves modulation of the host immune system in response to viral or bacterial infection or traumatic intervention.[1] Chang et al., in 2004 reported a 40-years-old female with diffuse large B cell lymphoma of the orbit who showed spontaneous regression at 5 weeks of surgical biopsy and at 6 months follow-up, patient had not shown any sign of relapse.[2]

Information regarding the duration of SR is limited. Wiernik concluded that duration of SR of different hematological malignancies varies and may be triggered by different agents. Spontaneous regression of lymphoma is often of substantial duration, months, or years, and frequently is associated with viral infections. It was documented that one patient with complete SR of DLBCL died of recurrent disease after 13 years.[3]

Treatment of SR cases remains controversial. Some DLBCL cases survive for years [4] and some relapse early. Because complete SR is an extremely rare phenomenon, there is insufficient evidence that anti-tumor therapy can be omitted. Whichever management plan is decided on, such patients require cautious and long-term follow-up for a long duration.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

 
  References Top

1.
Abe R, Ogawa K, Maruyama Y, Nakamura N, Abe M. Spontaneous regression of diffuse large B-cell lymphoma harbouring Epstein-Barr virus: A case report and review of the literature. J Clin Exp Hematop 2007;47:23-6.  Back to cited text no. 1
    
2.
Chang YC, Chang CH, Liu YT, Tsai KB, Liu TC, Lin YN. Spontaneous regression of a large-cell lymphoma in the conjunctiva and orbit. Ophthal Plast Reconstr Surg 2004;20:461-3.  Back to cited text no. 2
    
3.
Wiernik PH. Spontaneous regression of hematologic cancers. Natl Cancer Inst Monogr 1976;44:35-8.  Back to cited text no. 3
[PUBMED]    
4.
Grem JL, Hafez GR, Brandenburg JH, Carbone PP. Spontaneous remission in diffuse large cell lymphoma. Cancer 1986;57:2042-4.  Back to cited text no. 4
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
Print this article  Email this article
 

    

  Site Map | What's new | Copyright and Disclaimer
  Online since 1st April '07
  2007 - Indian Journal of Cancer | Published by Wolters Kluwer - Medknow