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Kaira K, Imai H, Mouri A, Yamaguchi OU, Kagamu H. Progression to Lymph Node Metastasis After Spontaneous Regression of Pulmonary Adenocarcinoma Following Biopsy. In Vivo 2024; 38:1498-1502. [PMID: 38688648 PMCID: PMC11059875 DOI: 10.21873/invivo.13597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 05/02/2024]
Abstract
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.
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Affiliation(s)
- Kyoichi Kaira
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Hisao Imai
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Atsuto Mouri
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Saitama, Japan
| | - O U Yamaguchi
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Hiroshi Kagamu
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Saitama, Japan
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2
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Samhouri BF, Dimou A, Boland JM, Edell ES. Spontaneous Regression of Metastatic Lung Adenocarcinoma Following a Core Biopsy. J Bronchology Interv Pulmonol 2023; 30:181-184. [PMID: 35959896 DOI: 10.1097/lbr.0000000000000867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | - Eric S Edell
- Departments of Pulmonary and Critical Care Medicine
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3
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Chen Y, Guan W, Zhong C, Deng J, Hu M, Mo W, Xie X, Li S, Zhou C, Lin X. Case report: Spontaneous remission in lung carcinoma with a late relapse after adjuvant immunotherapy: Exceptional tumor micro-environment. Front Immunol 2023; 14:1106090. [PMID: 36923412 PMCID: PMC10008903 DOI: 10.3389/fimmu.2023.1106090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/06/2023] [Indexed: 03/01/2023] Open
Abstract
Spontaneous remission (SR) of local recurrence after adjuvant immunotherapy has rarely been reported, and the underlying mechanism is poorly understood. Herein, we reported a patient with stage cT2aN2M0 squamous cell lung carcinoma who received neoadjuvant and adjuvant treatment with nivolumab plus chemotherapy. The patient experienced a late relapse in the subcarinal lymph node seven months after the last dosage of treatment but achieved SR in the next three months without additional antitumor therapy. The complete response lasted for eleven months and counting. Notably, high copies of pathogenic microorganisms were detected in the patient's bronchoalveolar lavage fluid along with the recurrence but disappeared after SR. The patient also experienced a lymph node puncture-induced fever but had no other symptoms. A longitudinal analysis of infiltrated immune cells in the recurrent lymph node was performed by multiplex immunofluorescence and whole transcriptome sequencing, which revealed that CD8+ T cells were recruited during the initial relapse, specifically in the stromal area, then migrated into the tumor tissue, and continued to increase after elimination of tumor cells. Meanwhile, the initial recruitment of CD8+ T cells was coupled with a higher proportion of B cells, and the abundant neutrophil population was synchronous with the infiltration of CD8+ T cells into tumor cells. This is the first report on an Non-small cell lung cancer (NSCLC) patient with a late relapse after adjuvant immune checkpoint inhibitor (ICI) therapy who achieved SR. Our case highlights the complexity and plasticity of antitumor immunity and is expected to help find efficient strategies against the resistance of ICI treatment.
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Affiliation(s)
- Yan Chen
- Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenhui Guan
- Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Changhao Zhong
- Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiaxi Deng
- Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Minjuan Hu
- Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenwei Mo
- Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaohong Xie
- Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shiyue Li
- Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chengzhi Zhou
- Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xinqing Lin
- Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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4
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Sekine A, Oda T, Shintani R, Ikeda S, Baba T, Iwasawa T, Komatsu S, Hagiwara E, Ogura T. Spontaneous regression following endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer patients. Respir Investig 2021; 59:691-694. [PMID: 34147461 DOI: 10.1016/j.resinv.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/18/2021] [Accepted: 05/16/2021] [Indexed: 06/12/2023]
Abstract
Spontaneous regression (SR) is defined as a complete or partial, temporary or permanent disappearance of a tumor without anticancer treatment, which potentially develops after surgery or biopsy for primary and metastatic tumors despite unknown incidence rate. Here, we report the incidence rate of SR after endobronchial ultrasound-guided transbronchial nodal needle aspiration (EBUS-TBNA) in lung cancer patients. Among 96 patients evaluable with chest CT before and after EBUS-TBNA, SR was found in three patients (3.1%). With regards to patient characteristics, two patients had small cell lung cancer (SCLC), and one patient had adenocarcinoma. All patients had stage 3 disease with a bulky N2 stage and a history of smoking. Two patients also had interstitial lung disease. Notably, SR was observed not only at the biopsied site, but also at the non-biopsied site. Our results indicate that SR can develop following EBUS-TBNA in a substantial proportion of lung cancer patients.
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Affiliation(s)
- Akimasa Sekine
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan.
| | - Tsuneyuki Oda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Ryota Shintani
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Satoshi Ikeda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Tomohisa Baba
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Shigeru Komatsu
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Eri Hagiwara
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
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Katano K, Yoshimitsu Y, Kyuno T, Haba Y, Maeda T, Kitamura S. Temporary spontaneous regression of male breast cancer: a case report. Surg Case Rep 2020; 6:311. [PMID: 33284403 PMCID: PMC7721852 DOI: 10.1186/s40792-020-01088-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background Spontaneous regression (SR) of a malignant tumor is the partial or complete disappearance of primary or metastatic tumor tissue in the absence of treatment, which can be temporary or permanent. Here, we report an extremely rare case of male breast cancer that exhibited temporary SR followed by reappearance 8 months after tumor disappearance. Case presentation A 70-year-old man presented at our hospital with a primary complaint of pain and a lump in his left breast. Ultrasonography revealed a hypoechoic lesion measuring 12 mm × 10 mm × 8 mm. Fine-needle aspiration cytology revealed numerous necrotic and degenerated cells and few sheet-like clusters of atypical ductal epithelial cells. The atypical cells had mildly enlarged nuclei with nucleoli, were focally overlapped and formed tubular patterns. The cytological diagnosis indicated a suspicion of malignancy. Core needle biopsy (CNB) revealed necrotic and degenerated cells with microcalcification. The pathological diagnosis was indeterminate because there was no area of viable atypical cells. An excisional biopsy of the left breast lesion was scheduled one month later. However, it was difficult to detect the tumor during physical examination and ultrasonography performed 1 month after the patient’s first visit. The operation was canceled, and the patient received follow-up observation. After 8 months of follow-up, ultrasonography and computed tomography (CT) revealed reappearance of a 0.6-cm-diameter breast tumor in the same place. CNB was performed again and revealed invasive ductal carcinoma. A total mastectomy with sentinel lymph node biopsy was performed 13 months after the first tumor disappeared. Histopathological examination revealed invasive cribriform carcinoma without sentinel lymph node metastasis. The patient did not have any complications, and adjuvant therapy with tamoxifen was started. The patient was alive without recurrence 7 months after surgery. Conclusions Temporary SR followed by tumor reappearance can occur in breast cancer cases, and it is important to follow patients even if their breast tumor has seemingly disappeared. When breast tumors disappear without treatment, clinicians must be aware of the possibility of SR of cancer and should follow the patient for early detection of tumor reappearance.
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Affiliation(s)
- Kaoru Katano
- Department of Surgery, Houju Memorial Hospital, 11-71 Midorigaoka, Nomi, Ishikawa, 923-1226, Japan.
| | - Yutaka Yoshimitsu
- Department of Surgery, Houju Memorial Hospital, 11-71 Midorigaoka, Nomi, Ishikawa, 923-1226, Japan
| | - Takahiro Kyuno
- Department of Surgery, Houju Memorial Hospital, 11-71 Midorigaoka, Nomi, Ishikawa, 923-1226, Japan
| | - Yusuke Haba
- Department of Surgery, Houju Memorial Hospital, 11-71 Midorigaoka, Nomi, Ishikawa, 923-1226, Japan
| | - Tsutomu Maeda
- Department of Surgery, Houju Memorial Hospital, 11-71 Midorigaoka, Nomi, Ishikawa, 923-1226, Japan
| | - Seiko Kitamura
- Department of Pathology, Houju Memorial Hospital, 11-71 Midorigaoka, Nomi, Ishikawa, 923-1226, Japan
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Walls M, Walls GM, James JA, Crawford KT, Abdulkhalek H, Lynch TB, Peace AJ, McManus TE, Evans OR. Spontaneous regression of ALK fusion protein-positive non-small cell lung carcinoma: a case report and review of the literature. BMC Pulm Med 2020; 20:209. [PMID: 32762670 PMCID: PMC7409640 DOI: 10.1186/s12890-020-01249-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/28/2020] [Indexed: 01/03/2023] Open
Abstract
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.
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Affiliation(s)
- Maria Walls
- Centre for Medical Education, Queen’s University Belfast, Belfast, Northern Ireland
| | - Gerard M. Walls
- Clinical Oncology Department, Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, Northern Ireland
- Patrick G Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast, Northern Ireland
| | - Jacqueline A. James
- Patrick G Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast, Northern Ireland
- Cellular Pathology Department, Belfast Health & Social Care Trust, Belfast, Northern Ireland
- Precision Medicine Centre of Excellence, Health Sciences Building, Queen’s University Belfast, Belfast, Northern Ireland
| | - Kyle T. Crawford
- Clinical Oncology Department, Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, Northern Ireland
| | - Hossam Abdulkhalek
- Medical Oncology Department, North West Cancer Centre, Western Health & Social Care Trust, Derry, Northern Ireland
| | - Tom B. Lynch
- Clinical Oncology Department, Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, Northern Ireland
| | - Aaron J. Peace
- Cardiology Department, Altnagelvin Hospital, Western Health & Social Care Trust, Derry, Northern Ireland
- Clinical Translational Research & Innovation Centre, Altnagelvin Hospital, Western Health & Social Care Trust, Derry, Northern Ireland
| | - Terry E. McManus
- Respiratory Department, South West Acute Hospital, Western Health & Social Care Trust, Enniskillen, Northern Ireland
| | - O. Rhun Evans
- Clinical Oncology Department, Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, Northern Ireland
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Šileikienė V, Gurskytė V, Zeleckienė I, Bernotienė E, Čibiras S. Pulmonary artery coil embolisation prevented tumour progression in a patient with advanced squamous cell lung carcinoma. Ups J Med Sci 2020; 125:257-261. [PMID: 32352322 PMCID: PMC7721007 DOI: 10.1080/03009734.2020.1753863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Squamous cell lung carcinoma (SqCLC) is a type of non-small-cell lung cancer, accounting for 25-30% of all lung cancer cases with a median advanced stage survival of 8-11 months. Here we present a rare case of long-term survival with metastatic SqCLC following coil embolisation of the right pulmonary artery.Case presentation: The 49-year-old patient was diagnosed with stage IV (cT4N3M1) SqCLC in 2007 due to a biopsy-proven central malignant tumour in the right lung and bilateral mediastinal lymphadenopathy. A magnetic resonance imaging scan also revealed a metastatic lesion in the liver. Soon after the diagnosis, the patient experienced pulmonary haemorrhage, which was managed by obturating the intermediate bronchus and performing coil embolisation of the right pulmonary artery. The patient also received chemotherapy in 2007 and 2009 without radiological changes. At three different time points in years 2010-2019, biopsies of the primary tumour were taken. All showed dense connective tissue with no indication of cancer growth. In 2020, a positron emission tomography scan showed no pathological metabolic activity in the lungs and liver. Currently, the patient remains in a stable clinical condition with a good performance status.Conclusion: The long-term clinical benefit indicates a direct effect of coil embolisation on tumour progression. We suggest that coil embolisation of tumour-feeding arteries could be considered as a potential treatment method for patients with SqCLC.
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Affiliation(s)
- Virginija Šileikienė
- Clinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Viktorija Gurskytė
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- CONTACT Viktorija Gurskytė Faculty of Medicine, Vilnius University, M. K. Čiurlionio str. 21/27, LT-03101, Vilnius, Lithuania
| | - Ingrida Zeleckienė
- Centre of Radiology and Nuclear Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Elena Bernotienė
- Clinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Sigitas Čibiras
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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Yoon HY, Park HS, Cho MS, Shim SS, Kim Y, Lee JH. Spontaneous remission of advanced progressive poorly differentiated non-small cell lung cancer: a case report and review of literature. BMC Pulm Med 2019; 19:210. [PMID: 31711463 PMCID: PMC6849189 DOI: 10.1186/s12890-019-0978-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/31/2019] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Hee-Young Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, 25 Magokdong-ro 2-gil Gangseo-gu, Seoul, 07804, Republic of Korea
| | - Heae Surng Park
- Department of Pathology, College of Medicine, Ewha Womans University, 25 Magokdong-ro 2-gil Gangseo-gu, Seoul, 07804, Republic of Korea
| | - Min Sun Cho
- Department of Pathology, College of Medicine, Ewha Womans University, 25 Magokdong-ro 2-gil Gangseo-gu, Seoul, 07804, Republic of Korea
| | - Sung Shin Shim
- Department of Radiology, College of Medicine, Ewha Womans University, 25 Magokdong-ro 2-gil Gangseo-gu, Seoul, 07804, Republic of Korea
| | - Yookyung Kim
- Department of Radiology, College of Medicine, Ewha Womans University, 25 Magokdong-ro 2-gil Gangseo-gu, Seoul, 07804, Republic of Korea
| | - Jin Hwa Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, 25 Magokdong-ro 2-gil Gangseo-gu, Seoul, 07804, Republic of Korea.
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Abscopal effect of high-dose-rate brachytherapy on pelvic bone metastases from renal cell carcinoma: a case report. J Contemp Brachytherapy 2019; 11:458-461. [PMID: 31749855 PMCID: PMC6854863 DOI: 10.5114/jcb.2019.89365] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/08/2019] [Indexed: 12/25/2022] Open
Abstract
Radiation therapy is considered an optimal partner for immunotherapies. Several pre-clinical studies have demonstrated that regression of distant metastases, at remote non-irradiated sites of the body, termed the “abscopal effect”, can be achieved by an appropriate timing and combination of radiation with immunotherapy. However, nearly all pre-clinical and clinical studies evaluating a combination of radiation and immunotherapies have used external beam radiation therapy. We present in this case report, the abscopal effect observed in a 30-year-old Japanese woman with metastatic renal cell carcinoma after the treatment with high-dose-rate interstitial brachytherapy combined with nivolumab. This is the first published report demonstrating an abscopal effect following brachytherapy for human malignancy. Our case indicates that immuno-oncology effects are not limited to external beam irradiation regimens as they can also be attained by brachytherapy.
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Vaidya S, Gothi D, Patro M, Sah RB, Kulshreshtha R. "St. Peregrine tumor" with synchronous primary renal cell carcinoma. Lung India 2019; 36:256-259. [PMID: 31031352 PMCID: PMC6503714 DOI: 10.4103/lungindia.lungindia_413_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Sameer Vaidya
- Department of Pulmonary Medicine, ESI-PGIMSR, Delhi, India
| | - Dipti Gothi
- Department of Pulmonary Medicine, ESI-PGIMSR, Delhi, India
| | | | - Ram Babu Sah
- Department of Pulmonary Medicine, ESI-PGIMSR, Delhi, India
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11
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Yamaguchi G, Uchida O, Ichinose S, Ikeda N. Lobectomy for subsegmental lymph node metastasis of unknown origin. NAGOYA JOURNAL OF MEDICAL SCIENCE 2019; 81:165-169. [PMID: 30962666 PMCID: PMC6433625 DOI: 10.18999/nagjms.81.1.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a very rare case of resected subsegmental lymph node metastasis of unknown origin. Hilar (N1) lymph node metastasis of unknown origin has previously been reported, but intrapulmonary lymph node metastasis has not been reported to date. At this patient's first visit to our hospital, an abnormal nodule was found on the upper lung lobe on a chest radiograph. After 4 years' follow-up, the nodule vanished, but a tiny nodule had emerged. 2-Fluoro-2-deoxy-D-glucose positron-emission tomography (FDG-PET) computed tomography was performed, and abnormal accumulation was observed only in the newly emerged intrapulmonary nodule. Right upper lobectomy was performed and a metastatic subsegmental lymph node, but no primary lesion, was found. Our observations suggest that evanescence of a suspicious primary lesion indicates the possibility of metastasis. FDG-PET was useful in this case for detecting lymph node metastases and demonstrating that the primary and further metastatic lesions were absent.
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Affiliation(s)
- Gaku Yamaguchi
- Department of Respiratory Surgery, Funabashi Municipal Medical Center, Chiba, Japan.,Department of Respiratory Surgery International University of Health and Welfare, Ichikawa Hospital, Chiba, Japan
| | - Osamu Uchida
- Department of Respiratory Surgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Shuji Ichinose
- Department of Respiratory Surgery, Funabashi Municipal Medical Center, Chiba, Japan
| | - Norihiko Ikeda
- Department of Respiratory and Thyroid Surgery, Tokyo Medical University Hospital, Tokyo, Japan
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12
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Jeong JH, Choi PJ, Yi JH, Jeong SS, Lee KN. Lymph Node Metastasis after Spontaneous Regression of Non-Small Cell Lung Cancer. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 52:119-123. [PMID: 31089452 PMCID: PMC6493262 DOI: 10.5090/kjtcs.2019.52.2.119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/19/2018] [Accepted: 11/01/2018] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Jae Hwa Jeong
- Department of Thoracic and Cardiovascular Surgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Pil Jo Choi
- Department of Thoracic and Cardiovascular Surgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Jung Hoon Yi
- Department of Thoracic and Cardiovascular Surgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Sang Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Ki Nam Lee
- Department of Radiology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
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13
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Tsunezuka H, Miyata N, Furuya T, Konishi E, Inoue M. Spontaneous Regression of Primary Pulmonary Synovial Sarcoma. Ann Thorac Surg 2019; 105:e129-e131. [PMID: 29455826 DOI: 10.1016/j.athoracsur.2017.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/30/2017] [Accepted: 09/03/2017] [Indexed: 10/18/2022]
Abstract
We report a rare case of primary pulmonary synovial sarcoma that underwent spontaneous regression after a transbronchial biopsy. A 38-year-old woman with a well-demarcated solitary mass shadow on chest roentgenogram was referred to us. A transbronchial biopsy was performed, and immunohistochemical results as well as detection of SYT-SSX1 (SYnovial sarcoma Translocation-Synovial Sarcoma X chromosome breakpoint) transcripts resulted in a diagnosis of synovial sarcoma. A right lower lobectomy was performed during video-assisted thoracoscopic surgery. Pathologic examination revealed widespread coagulative necrosis with feeding arterioles occluded by organized thrombi. To our knowledge, this is the first report of a case of spontaneous regression of primary pulmonary synovial sarcoma.
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Affiliation(s)
- Hiroaki Tsunezuka
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Naoko Miyata
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tatsuo Furuya
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eiichi Konishi
- Division of Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masayoshi Inoue
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Kuwal A, Chauhan N, Dutt N, Elhence P, Advani M, Kumar S. Spontaneous Partial Regression of a Carcinoid Tumor: Radiology May Not Capture the Real Picture. Turk Thorac J 2019; 20:153-156. [PMID: 30958990 PMCID: PMC6453627 DOI: 10.5152/turkthoracj.2018.18059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 08/08/2018] [Indexed: 11/22/2022]
Abstract
A partial or complete resolution of the neoplastic lesion, either spontaneously or in the presence of therapy that is considered inadequate to exert significant influence on the growth of the neoplastic lesion, is considered a spontaneous regression. This phenomenon is extremely rare in lung neoplasms. A close follow up with imaging along with bronchoscopy and a biopsy of the lesion is essential, as they may have potential for distant spread even during radiological regression. Here, we report a case of a partial resolution of a bronchial carcinoid tumor that had a high mitotic activity and was resected.
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Affiliation(s)
- Ashok Kuwal
- Department of Pulmonary Medicine, Pacific Institute of Medical Sciences, Udaipur, Rajasthan, India
| | - Nishant Chauhan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Naveen Dutt
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Poonam Elhence
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Manish Advani
- Department of Pulmonary Medicine, Pacific Institute of Medical Sciences, Udaipur, Rajasthan, India
| | - Sunil Kumar
- Department of Pulmonary Medicine, Pacific Medical College and Hospital, Udaipur, Rajasthan, India
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15
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Matsui T, Mizuno T, Kuroda H, Sakakura N, Arimura T, Yatabe Y, Sakao Y. Spontaneous regression of lung squamous cell carcinoma with synchronous mediastinal progression: A case report. Thorac Cancer 2018; 9:1778-1781. [PMID: 30311443 PMCID: PMC6275820 DOI: 10.1111/1759-7714.12892] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 09/16/2018] [Accepted: 09/16/2018] [Indexed: 02/06/2023] Open
Abstract
Spontaneous regression (SR) of cancer implies the partial or complete disappearance of malignant disease without or with adequate medical treatment. Typically, SR of cancer is a sporadic event, especially in non‐small cell lung cancer (NSCLC). Although the underlying mechanism of SR remains unknown, stimulation of an immunological response has been proposed. Herein, we report the case of a 56‐year‐old woman exhibiting SR of NSCLC with a mediastinal disease. Despite regression of the primary site after a lung biopsy, simultaneous progression of mediastinal lymph node metastasis occurred. Specimens obtained by surgical resection pathologically confirmed both primary and metastatic sites. Reportedly, primary and metastatic tumors shrink synchronously in SR of metastatic NSCLCs. Thus, the fact that the SR of NSCLC can present inconsistent development in primary and metastatic sites should be considered, and direct intervention is recommended if physicians diagnose this phenomenon.
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Affiliation(s)
- Takuya Matsui
- Division of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Tetsuya Mizuno
- Division of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroaki Kuroda
- Division of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Noriaki Sakakura
- Division of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takaaki Arimura
- Division of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yasushi Yatabe
- Division of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yukinori Sakao
- Division of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
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16
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Spontaneous Regression of Metastatic Papillary Thyroid Cancer in a Lymph Node. Case Rep Endocrinol 2018; 2018:5873897. [PMID: 29755799 PMCID: PMC5884408 DOI: 10.1155/2018/5873897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 02/18/2018] [Indexed: 11/30/2022] Open
Abstract
Spontaneous regression of cancer is defined as disappearance of cancer in the absence of specific therapy. In thyroid cancer patients with biochemically incomplete response to initial treatments, spontaneous decline in thyroglobulin levels without any cancer treatment is a well-known phenomenon; however, spontaneous regression of persistent or recurrent structural disease has not been reported. We here present a case of papillary thyroid cancer in a 58-year-old female who underwent total thyroidectomy and two radioiodine ablations. She had persistently elevated thyroglobulin levels. Six years after her initial treatments, she had biopsy-proven cervical lymph node metastasis. The patient opted not to undergo any further treatment. Over the course of the next 10 years, without any additional treatment, the lymph node disappeared and her thyroglobulin levels decreased to almost undetectable ranges, implying near-complete regression. Our case illustrates that metastatic papillary thyroid cancer in lymph nodes can regress spontaneously.
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17
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Esplin N, Fergiani K, Legare TB, Stelzer JW, Bhatti H, Ali SK. Spontaneous regression of a primary squamous cell lung cancer following biopsy: a case report. J Med Case Rep 2018. [PMID: 29526162 PMCID: PMC5846257 DOI: 10.1186/s13256-018-1589-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Spontaneous regression has been defined as occurring when the malignant tumor mass partially or completely disappears without any treatment or as a result of a therapy considered inadequate to influence systemic neoplastic disease. Recently, studies have implicated immunological responses as likely being involved. We report a case of a patient with squamous cell carcinoma of the lung who experienced spontaneous regression following biopsy without other intervention. Case presentation A 57-year-old white man was referred to our pulmonary clinic after an incidental finding of a nodule in the lower lobe of his left lung. Thoracic computed tomography revealed a 2.0 × 1.4 × 1.5 cm spiculated nodule in the superior segment of the left lower lobe. Workup identified the mass as a squamous cell carcinoma that was clinically staged as T1M0N0. The patient deferred treatment of this lesion. He undertook no significant lifestyle or medical changes. Three months later, computed tomography revealed that, compared with the initial study, the solitary mass had decreased in size to 1.6 × 0.9 × 0.9 cm. Follow-up computed tomography 1 year after the original workup demonstrated that the nodule had stabilized to its smaller size. Conclusions Studies have shown that immunological response can be initiated by trauma to an area. Because the tumor regression became evident in our patient only after the tissue biopsy, his immune response to the surgical procedure seems to be a plausible contributor to the spontaneous regression. Further understanding of spontaneous regression can potentially impact the identification of neoplastic drug targets or even the course of a patient’s treatment plan and goals.
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Affiliation(s)
- Nathan Esplin
- University of Central Florida College of Medicine, 6850 Lake Nona Boulevard, Orlando, FL, 32827, USA.
| | - Khadija Fergiani
- University of Central Florida College of Medicine, 6850 Lake Nona Boulevard, Orlando, FL, 32827, USA
| | - Timothy B Legare
- University of Central Florida College of Medicine, 6850 Lake Nona Boulevard, Orlando, FL, 32827, USA
| | - John W Stelzer
- University of Central Florida College of Medicine, 6850 Lake Nona Boulevard, Orlando, FL, 32827, USA
| | - Hammad Bhatti
- Department of Internal Medicine, Orlando VA Medical Center, 13800 Veterans Way, Orlando, FL, 32827, USA
| | - Sayed K Ali
- Department of Internal Medicine, Orlando VA Medical Center, 13800 Veterans Way, Orlando, FL, 32827, USA
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18
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Hori S, Tachihara M, Tamura D, Kobayashi K, Nakata K, Kamiryo H, Sakai Y, Itoh T, Hirose T, Nishimura Y. Spontaneous Regression of Epithelioid Angiosarcoma in a Young Woman. Intern Med 2017; 56:3333-3339. [PMID: 29021485 PMCID: PMC5790723 DOI: 10.2169/internalmedicine.6754-15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
A 20-year-old Japanese woman with a history of pulmonary atresia was referred to our hospital after the detection of an abnormal mass in the right lung and mediastinal lymphadenopathy. A cytological specimen obtained by transbronchial brushing indicated that the pathological diagnosis was non-small cell lung cancer. During the follow-up period, the tumor spontaneously regressed. At four months after the diagnosis, she experienced sudden bleeding from the small intestine. The histological characteristics of the small intestine tumor were compatible with the cytological characteristics of the lung tumor. Detailed immunohistochemical analyses led to a final diagnosis of epithelial angiosarcoma of the small intestine, which might have formed metastatic lesions in the lung.
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Affiliation(s)
- Suya Hori
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Motoko Tachihara
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Daisuke Tamura
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Kazuyuki Kobayashi
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Kyosuke Nakata
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Hiroshi Kamiryo
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Yasuhiro Sakai
- Department of Diagnostic Pathology, Kobe University Hospital, Japan
| | - Tomoo Itoh
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Japan
| | - Takanori Hirose
- Department of Diagnostic Pathology, Hyogo Cancer Center, Japan
| | - Yoshihiro Nishimura
- Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
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19
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Marques C, Queiroga H, Marques M, Moura C. Spontaneous regression of a pulmonary adenocarcinoma after core needle biopsy. AUTOPSY AND CASE REPORTS 2017; 7:20-25. [PMID: 29043206 PMCID: PMC5634430 DOI: 10.4322/acr.2017.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 08/07/2017] [Indexed: 12/31/2022] Open
Abstract
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 histologically confirmed. Due to the patient’s comorbidities and his poor pulmonary function, stereotactic radiotherapy was scheduled. However, by the time the treatment was due to start, the tumor was no longer detectable.
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Affiliation(s)
- Cristiana Marques
- University of Porto, Centro Hospitalar São João, Department of Oncology. Porto, Portugal
| | - Henrique Queiroga
- University of Porto, Centro Hospitalar São João, Department of Pneumology. Porto, Portugal
| | - Margarida Marques
- University of Porto, Centro Hospitalar São João, Department of Radiotherapy. Porto, Portugal
| | - Conceição Moura
- University of Porto, Centro Hospitalar São João, Department of Anatomic Pathology. Porto, Portugal
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