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Microphotography of the lung biopsy. A – Acinar adenocarcinoma, with moderate pleomorphism (H&E, 200X); B – Positivity for TTF-1 (100X).
Source publication
Spontaneous regression (SR) of cancer, especially lung cancer, is a rare biological event with a mechanism that is not currently understood. Immunological mechanisms seem to be the stronger explanation in SR of a lung cancer. We report the rare case of SR of a lung adenocarcinoma stage IA, in a 75-year-old man, which was incidentally diagnosed and...
Context in source publication
Context 1
... pathology report revealed an adenocarcinoma with tubular pattern and same mucosecretory cells. The immunohistochemistry study with TTF1 was positive in neoplastic cells, to confirm the pulmonary origin of the adenocarcinoma (Figures 2A and 2B). A positron emission tomography (PET)-CT was performed and showed no other sites of radiotracer uptake, besides the pulmonary nodule ( Figure 3) rendering the cT1N0M0 as stage IA. ...
Citations
... Little is known about the detailed mechanism of SR in cancer; it is poorly understood due to multiple factors, such as immunological imbalance for cancer progression, hormonal changes, infections, or operative trauma (5)(6)(7). Recently, several researchers reported SR in NSCLC after biopsy (5,(8)(9)(10)(11). A possible explanation for this is that biopsy using endoscopic forceps may trigger the release of antigens with consequent activation of the immune system (5,(8)(9)(10)(11). ...
... Recently, several researchers reported SR in NSCLC after biopsy (5,(8)(9)(10)(11). A possible explanation for this is that biopsy using endoscopic forceps may trigger the release of antigens with consequent activation of the immune system (5,(8)(9)(10)(11). Furthermore, two recent reports have described the exacerbation of lymph node metastasis after SR of NSCLC. ...
... Fever, infection, injury, and medication have been clinically postulated to be among the mechanisms of SR (13); however, our patient did not have any reason except for injury by biopsy. Twenty-three cases of SR of lung cancer have been previously reported in the literature; these histological types included SCC in seven patients, small cell lung carcinoma (SCLC) in eight patients, NSCLC in two patients, adenocarcinoma in four patients, and large cell carcinoma in two patients (5,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Most SR of lung cancer were identified as SCC or SCLC without an underlying reason. ...
Background/aim:
Spontaneous regression (SR) of cancer, which indicates the natural disappearance of malignant tumors, is rare. Little is known about the mechanisms underlying SR; however, immunological reactions, infections, injuries, and medications have been presumed. Among previously reported cases of SR, lung cancer cases have been extremely limited.
Case report:
Here, we present a case of lymph node metastasis exacerbation after SR of a primary adenocarcinoma following a biopsy. After complete disappearance of the primary site tumor, metastatic lymph nodes in the mediastinum gradually increased in size as a single lesion. Local treatment with resection and radiotherapy was effective for this metastasis, without recurrence for >3 years.
Conclusion:
This is an interesting case of SR of pulmonary adenocarcinoma with inconsistent features in the primary and metastatic lesions. When physicians encounter exacerbation of metastatic sites with SR of the primary site in lung cancer, local intervention may be considered as a curative treatment.
... [7][8][9] The effects brought about by the biopsy may have contributed to regression of this tumor. Cases of tumor regression following biopsy have been reported in cancer at other sites 14 and is thought to be brought about by activation of the immune response due to the injury brought about by the biopsy or destruction or emboli of the feeding artery of the tumor by the core needle biopsy. ...
Usual type necrosis (UN) and infarct like necrosis (ILN) occur in CRLMs. ILN is a rare form of necrosis in colorectal liver metastases which is usually seen following chemotherapy. De novo occurrence of ILN is a very rare phenomenon. ILN in CRLM without adjuvant chemotherapy following colorectal resection was not described previously. We describe the presence of complete ILN in a solitary metachronous liver metastasis from right colonic adenocarcinoma without prior chemotherapy.
... [10] While the precise cause is still unclear, it can be postulated that the immune system infection, or inflammation. [11] In our case, the injury caused by the biopsy procedure could have led to an inflammatory response leading to activation of the immune system or it could also be an act of the immune system against EBV. Our finding and the previous similar case report throws a light on the fact that even high-grade lymphomas such as PBL could regress spontaneously and that the immune system may have a key role. ...
Plasmablastic lymphoma (PBL) is a rare, aggressive non-Hodgkin lymphoma which shows blastic morphology and an immunophenotype of plasma cell differentiation while chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma is an indolent B-cell lymphoma and has a variable clinical course. A CLL transforming into a PBL and the coexistence of CLL with PBL are both extremely rare findings. We report an unusual case of a 72-year-old HIV-negative male who presented with a gingival swelling which was diagnosed as PBL with simultaneous CLL in the blood and bone marrow. Further, in this case, the PBL spontaneously regressed postbiopsy adding to the peculiarity and rarity of this case. This could be due to immune system modulation and can open up a new window to the treatment strategies of PBL in the future.
... Cole y Everson informaron por primera vez sobre 47 casos de RE de cáncer, confirmados por biopsia, y propusieron el término y los criterios para RE en 1956 [1] . Aunque el neuroblastoma, el cáncer de vejiga y el linfoma han mostrado incidencias relativamente altas de RE [2] , la RE de cáncer de pulmón no-mi- 70 Kompass Neumol 2020;2:69-75 DOI: 10.1159/000506573 crocítico (CPNM) es rara, y solamente se han reportado unos pocos casos en todo el mundo [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] . En este trabajo presentamos el caso de una mujer de 74 años diagnosticada con CPNM avanzado, poco diferenciado, que remitió espontáneamente después del fracaso de múltiples líneas de quimioterapia. ...
b>Antecedentes: La remisión espontánea (RE) del cáncer es un fenómeno muy raro, cuyo mecanismo se desconoce. En particular, hay escasos reportes de RE de cáncer de pulmón no-microcítico (CPNM). Presentamos el caso de una mujer de 74 años con CPNM avanzado, poco diferenciado (con alta expresión del ligando 1 de muerte programada [PD-L1]), que progresó a pesar de administrar múltiples de líneas quimioterapia y posteriormente remitió de manera espontánea. Presentación del caso: La paciente presentaba hemoptisis y se le diagnosticó CPNM poco diferenciado en estadio IIIA mediante biopsia broncoscópica. No había características notables en su historial médico y su estado funcional era moderado. El plan inicial de tratamiento consistió en cirugía después de quimioterapia neoadyuvante. A pesar de la quimioterapia convencional, la tomografía computada (TC) de seguimiento mostró una progresión gradual del tumor, y la paciente decidió no continuar con el tratamiento después de la quimioterapia de quinta línea. Sin embargo, el tamaño de la masa tumoral disminuyó marcadamente en una TC torácica de seguimiento un año después de suspender la quimioterapia. Asimismo, imágenes de tomografía por emisión de positrones tomadas en el seguimiento mostraron una menor actividad metabólica en la masa tumoral, y una muestra de biopsia percutánea de la masa pulmonar reducida no reveló células tumorales viables. Se confirmó el diagnóstico de RE de CPNM, y la paciente no mostró progresión tumoral en el seguimiento, nueve meses después. Más tarde, la inmunotinción para PD-L1 mostró una alta positividad (>99%) en las células tumorales iniciales. Conclusión: Nuestro caso, que muestra la RE de CPNM avanzado, poco diferenciado y refractario a múltiples líneas de quimioterapia, sugiere una asociación entre la inmunidad y la regresión tumoral.
... Resolution after biopsy has been reported for other neoplasms ranging from eosinophilic granuloma to primary and metastatic carcinoma [39][40][41][42][43][44][45]. Spontaneous regression was defined by Everson as the complete or partial regression of a neoplasm without treatment or with treatment considered inadequate to produce tumor regression [45]. ...
... Best known cases of postbiopsy regression occur in neuroblastomas and lymphomas [47,48]. Other case reports of post-biopsy tumor resolution include merkel cell carcinomas, renal malignancies, squamous cell carcinomas (skin and lung), primary breast lymphoma, and pulmonary adenocarcinoma [40][41][42][43][44][45]49,50]. The exact mechanism of biopsy induced regression remains unclear with immunologic and tumor necrosis among many mechanisms suggested [45,[51][52][53]. ...
Desmoid-type fibromatosis (DF) is a rare neoplasm characterized by fibroblastic and myofibroblastic proliferation. While characterized as a benign lesion that does not metastasize, desmoid-type fibromatosis exhibits a wide range of behavior from aggressive local tissue invasion and post-surgical recurrence to spontaneous regression. Tumor regression can occur following systemic medical therapy or rarely may occur in the absence of therapy. We present a case of a 50-year-old female with a left thigh vastus medialis intramuscular mass which underwent imaging work-up and subsequent core needle ultrasound-guided biopsy showing results of desmoid-type fibromatosis. Following biopsy, the tumor showed prompt, complete regression with complete MRI resolution 2 months following biopsy. The patient showed no evidence of disease recurrence out to one year on MRI surveillance. This case report will discuss desmoid-type fibromatosis imaging features, treatment strategies, spectrum of disease behavior, and atypical behavior such as the spontaneous tumor regression as seen in this case report. To our knowledge there have been no reported cases of DF spontaneous regression 2 months following a core needle biopsy. Understanding the variable behavior of desmoid-type fibromatosis can assist the radiologist in guiding management of these lesions with the goal of optimizing clinical outcomes and preventing unnecessary aggressive treatments for stable or regressing disease.
... Concerted international academic effort will be required to collect cases of SR in NSCLC in order to unravel the underpinning biology. [29] • Immune response triggered by local inflammation [29] Immunological • NK activation [56] • Infection-related immune upregulation [57] • CD8 + cell infiltration [58] Hormonal ...
... Concerted international academic effort will be required to collect cases of SR in NSCLC in order to unravel the underpinning biology. [29] • Immune response triggered by local inflammation [29] Immunological • NK activation [56] • Infection-related immune upregulation [57] • CD8 + cell infiltration [58] Hormonal ...
Background:
ALK-rearrangement is observed in < 5% non-small cell lung cancer (NSCLC) cases and prior to the advent of oral tyrosine kinase inhibitors, the natural history of oncogenic NSCLC was typically poor. Literature relating to regression of treatment-naïve NSCLC is limited, and regression without treatment has not been noted in the ALK-rearranged sub-population.
Case presentation:
A 76 year old 'never smoker' female with an ALK-rearranged left upper lobe T2 N0 NSCLC experienced a stroke following elective DC cardioversion for new atrial fibrillation. Following a good recovery, updated imaging demonstrated complete regression of the left upper lobe lesion and a reduction of the previously documented mediastinal lymph node. Remaining atelectasis was non-avid on repeat PET-CT imaging, 8 months from the baseline PET-CT. When the patient developed new symptoms 6 months later a further PET-CT demonstrated FDG-avid local recurrence. She completed 55 Gy in 20 fractions but at 18 months post-radiotherapy there was radiological progression in the lungs with new pulmonary metastases and effusion and new bone metastases. Owing to poor performance status, she was not considered fit for targeted therapy and died 5 months later.
Conclusion:
All reported cases of spontaneous regression in lung cancer have been collated within. Documented precipitants of spontaneous regression across tumour types include biopsy and immune reconstitution; stroke has not been reported previously. The favourable response achieved with radical radiotherapy alone in this unusual case of indolent oncogenic NSCLC reinforces the applicability of radiotherapy in locally advanced ALK-rearranged tumours, in cases not behaving aggressively. As a common embolic event affecting the neurological and pulmonary vasculature is less likely, an immune-mediated mechanism may underpin the phenomenon described in this patient, implying that hitherto unharnessed principles of immuno-oncology may have relevance in oncogenic NSCLC. Alternatively, high electrical voltage applied percutaneously adjacent to the tumour during cardioversion in this patient may have induced local tumour cell lethality.
... The malignant diseases in which SR are most frequently reported include renal cell carcinoma, melanoma, and neuroblastoma [17]. SR of lung carcinoma is a particularly rare occurrence [19,20], with 18 cases reported in the English literature (11 with NSCLC and 7 with SCLC). Currently, only one case has been reported to involve SR of lung cancer in IPF [21]. ...
Background:
Lung cancer is one of the most common co-morbid conditions in patients with idiopathic pulmonary fibrosis (IPF) and negatively affects the prognosis of IPF; Current guidelines for the management of IPF do not give a clear statement on how to manage these patients, and traditional chemotherapy for lung cancer had a limited efficiency rate. Here, we present a rare case of primary lung squamous carcinoma in a patient with IPF whose tumor completely regressed following gemcitabine plus cisplatin therapy; the cancer was no longer detectable after 2 years upon follow-up.
Case presentation:
Sixty-seven year-old male patient with IPF was admitted to hospital due to acute onset hemoptysis. In addition to a definite usual interstitial pneumonia (UIP) pattern, a chest CT scan showed a non-enhancing nodular opacity in the right upper lobe and an enhancing nodule in the right lower lobe. Bronchoscopic biopsy of the nodule in the right lower lobe revealed squamous lung cancer. After 2 cycles of chemotherapy with gemcitabine and cisplatin, the tumor in the right lower lobe was no longer detectable after 2 years of follow-up; however, the nodule in the right upper lobe had increased significantly. Finally, Mycobacterium tuberculosis (MTB) was cultured from the bronchoalveolar (BAL) sample submitted at the last evaluation, and the patient was confirmed to have active pulmonary TB.
Conclusion:
We report the first documented case of complete pulmonary squamous carcinoma regression in IPF following gemcitabine plus cisplatin. Traditional chemotherapy is considered inadequate to cause the resulting regression of the tumor. The concomitant active pulmonary tuberculosis possibly underlies the mechanism.
... Cole and Everson first reported 47 cases of biopsy-confirmed SR of cancer, proposing the term and criteria for SR in 1956 [1]. Although neuroblastoma, bladder cancer, and lymphoma have shown relatively high incidences of SR [2], SR of non-small cell lung cancer (NSCLC) is rare, with only a few cases reported worldwide [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Here, we present a case of a 74-year-old woman diagnosed with advanced poorly differentiated NSCLC that spontaneously remitted after failure of multiple courses of chemotherapy. ...
Background:
Spontaneous remission (SR) of cancer is a very rare phenomenon of unknown mechanism. In particular, SR of non-small cell lung cancer (NSCLC) has been scarcely reported. We present the case of a 74-year-old woman with advanced, poorly differentiated NSCLC (highly expressing programmed death ligand-1 [PD-L1]) that progressed despite multiple lines of chemotherapy but then spontaneously remitted.
Case presentation:
The patient presented with hemoptysis and was diagnosed with stage IIIA poorly differentiated NSCLC via bronchoscopic biopsy. She had an unremarkable medical history and moderate performance status. The initial treatment plan was surgery after neoadjuvant chemotherapy. Despite conventional chemotherapy, follow-up chest computed tomography (CT) showed gradual tumor progression and she decided against further treatment after fifth-line chemotherapy. However, the size of lung mass was markedly decreased on follow-up chest CT one year after ceasing chemotherapy. Also, follow-up positron emission tomography images showed decreased metabolic activity in the lung mass and a percutaneous biopsy specimen from the diminished lung mass revealed no viable tumor cells. A diagnosis of SR of NSCLC was confirmed, and the patient was without tumor progression on follow-up nine months later. Later, PD-L1 immunostaining revealed high positivity (> 99%) in initial tumor cells.
Conclusion:
Our case showing SR of poorly advanced NSCLC refractory to multiple lines of chemotherapy suggested the association between immunity and tumor regression.
... Marques et al. [5] reviewed 17 cases of spontaneous regression in lung cancer, 10 of which involved non-small cell lung cancer. Spontaneous regression in non-small cell lung cancer has rarely been reported, with only 3 cases reported in Korean domestic journals. ...
Spontaneous regression of lung cancer is a very rare and poorly understood phenomenon. A 64-year-old man
presented to Dong-A University Hospital with a shrunken nodule in the right lower lobe. Although the nodule
showed a high likelihood of malignancy on needle aspiration biopsy, the patient refused surgery. The
nodule spontaneously regressed completely in the next 17 months. However, the subcarinal lymph node was
found to be enlarged 16 months after complete regression was observed. We pathologically confirmed metastasis
of squamous cell carcinoma and performed neoadjuvant chemotherapy, surgery, and adjuvant
chemoradiation. Regardless of tumor size reduction, it is preferable to perform surgery aggressively in cases
of operable lung cancer.
... Since Everson and Cole first reported the spontaneous tumor regression in 1967 [7], more than 1000 case reports of spontaneous tumor regression have been published, these articles reported on common associated tumors, including glioma [8][9][10], choriocarcinoma [11], neuroblastoma [12], renal cell carcinoma [13], melanoma [14], sarcoma [15], bladder carcinoma [16] and osteogenic sarcoma [17]. Recent studies have reported that almost all tumors can undergo spontaneous regression [18][19][20][21][22][23][24][25]. Spontaneous tumor regression may be triggered by immune regulation, induced differentiation, hormone mediation, elimination of carcinogens, psychological factors, apoptosis and epigenetic mechanisms [6].However, the underlying mechanism causeing a potentially lethal tumor strikingly shift course without any intervention remains unknown. ...
Spontaneous tumor regression can be observed in many tumors, however, studies related to the altered expression of lncRNA in spontaneous glioma regression are limited, and the potential contributions of lncRNAs to spontaneous glioma regression remain unknown. To investigate the biological roles of lncRNA-135528 in spontaneous glioma regression. The cDNA fragment of lncRNA-135528 was obtained by rapid-amplification of cDNA ends (RACE) technology and cloned into the plvx-mcmv-zsgreen-puro vector. Additionally, we stably silenced or overexpressed lncRNA-135528 in G422 cells by transfecting with siRNA against lncRNA-135528 or lncRNA-135528 overexpression plasmid. Then, we examined lncRNA-135528 overexpressing and lncRNA-135528 silencing on glioma cells and its effects on CXCL10 and JAK/STAT pathways. The main findings indicated that lncRNA-135528 promoted glioma cell apoptosis, inhibited cell proliferation and arrested cell cycle progression; the up-regulation of lncRNA135528 led to significantly increased CXCL10 levels and the differential expression of mRNA associated with JAK/STAT pathway in glioma cells. lncRNA-135528 can inhibit tumor progression by up-regulating CXCL10 through the JAK/STAT pathway.
