Potts D Alan, Fromm Jonathan R, Gopal Ajay K, Cassaday Ryan D
University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA.
Department of Laboratory Medicine, University of Washington School of Medicine, P.O. Box 357110, 1959 NE Pacific Street, Seattle, WA 98195, USA.
Case Rep Hematol. 2017;2017:2676254. doi: 10.1155/2017/2676254. Epub 2017 Feb 21.
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 F-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.
非霍奇金淋巴瘤（NHL）是一组异质性血液系统恶性肿瘤，通常采用多药化疗进行治疗。很少能观察到自发缓解的情况，尤其是在惰性更强的亚型中。侵袭性NHL的预后可通过临床和组织病理学因素进行预测。在侵袭性B细胞NHL中，MYC和BCL2原癌基因共表达（通过免疫组织化学评估）以及高级别组织学特征的重要性尤为值得关注。我们报告了一例侵袭性B细胞NHL患者自发缓解的独特病例，该患者具有高风险组织病理学特征，包括MYC蛋白表达率为70%-80%、BCL2蛋白表达以及提示高级别B细胞淋巴瘤（NOS，以前称为具有弥漫性大B细胞淋巴瘤和伯基特淋巴瘤[BCLU]之间特征的不可分类B细胞淋巴瘤）的形态学特征。在进行活检确诊后，他选择放弃根治性化疗。氟脱氧葡萄糖正电子发射断层扫描-计算机断层扫描显示的单一但相对较大的受累区域在随后的随访研究中逐渐消退。一年后，他仍无复发迹象，且从未接受过治疗。该病例强调了NHL自发缓解的可能性，并表明尽管存在当代高风险组织病理学特征，仍可观察到这种现象。
