The outcome of watchful waiting in patients with previously treated follicular lymphoma.

Watchful waiting (WW) is one of the standard approaches for newly diagnosed follicular lymphoma (FL) patients with low-tumor burden. However, the impact of WW in FL patients at the first progression, remains unclear. We reviewed 206 FL patients who experienced the first progression after responding to the initial treatment at our institution between 1998 and 2017. Patients were classified into either the WW cohort (132 patients) or the immediate treatment cohort (74 patients). Overall, the median follow-up from the first progression was 79.8 months (range, 2.1-227.0 months). In the WW cohort, the estimated median time to next treatment (TNT) was 19.7 months (95% confidence interval [CI], 13.4-30.2), and 76.5% (95% CI, 68.0-84.1) of the patients subsequently underwent the second-line treatment at 5 years. There was a significant difference in the median time to treatment failure in the WW cohort (72.8 months; 95% CI, 64.6-94.0) compared to the immediate treatment cohort (23.3 months; 95% CI, 13.4-38.8) (HR, 2.13; 95% CI, 1.48-3.06), whereas overall survival and the cumulative incidence of histological transformation were not significantly different between two cohorts. In a multivariate analysis, rituximab refractory status, progression of disease within 24 months from the induction of first-line therapy, and a high Follicular Lymphoma International Prognostic Index score at diagnosis were significantly associated with shorter TNT. Interestingly, 15 patients (11%) of the WW cohort experienced spontaneous tumor regression during WW, and their TNT (median, 82.1 months, 95% CI, 11.7-NA) was longer than that of the remaining patients in the WW cohort (median, 16.5 months, 95% CI, 13.0-25.4), with a significant difference (p = 0.01). The results of the present study suggested that WW could be a safe and reasonable option even at the first progression for the selected FL patients, without a negative impact on clinical outcomes.

SPONTANEOUS RESOLUTION OF A NONFUNCTIONING PITUITARY ADENOMA OVER ONE-MONTH PERIOD: A CASE REPORT.

Spontaneous resolution of nonfunctioning pituitary adenoma after hemorrhagic apoplexy is a rare clinical entity of unknown etiology and is defined as disappearance of a tumor without any specific treatment. Here we present a 54-year-old male patient who presented with acute onset of severe headache, vomiting, photophobia, and sonophobia. He was referred to brain computed tomography, which showed a 16x12x16 mm tumor mass located in the sellar region with signs of hemorrhage. Endocrinologic evaluation was consistent with under-function of pituitary gonadotropic cells. Magnetic resonance imaging (MRI) performed ten days later was consistent with hemorrhagic apoplexy of the pituitary adenoma. The patient's symptoms resolved after conservative treatment with dexamethasone, but he was scheduled for elective pituitary surgery. Preoperative MRI was performed one month after the first one and disclosed normal pituitary gland without any signs of adenoma. Our case is remarkable due to the fact that spontaneous remission of pituitary adenoma occurred within the first month, which is the shortest interval reported to date. Our case highlights the importance of conservative therapy as the first-line treatment for pituitary apoplexy in the absence of neurological impairment, since spontaneous remission may occur in a short time interval.

Spontaneously Regressed Rathke's Cleft Cyst.

We report two rare cases of spontaneously regressed Rathke's cleft cyst (RCC). A 52-year-old woman presented with headache. A pituitary hormone study was normal. Brain magnetic resonance imaging (MRI) showed a 0.45-cm3 cystic sellar lesion. The cyst was hyperintense on T1-weighed imaging and hypointense on T2-weighted imaging without rim enhancement, comparable to a RCC. Six months later, brain MRI showed no change in the cyst size. Without any medical treatments, brain MRI 1 year later revealed a spontaneous decrease in cyst volume to 0.05 cm3. A 34-year-old woman presented with headache and galactorrhea lasting 1 week. At the time of the visit, the patient's headache had disappeared. Her initial serum prolactin level was 81.1 ng/mL, and after 1 week without the cold medicine, the serum prolactin level normalized to 11.28 ng/mL. Brain MRI showed a RCC measuring 0.71 cm3. Without further treatments, brain computed tomography 6 months later showed a spontaneous decrease in cyst volume to 0.07 cm3. Another 6 months later, brain MRI revealed that the cyst had remained the same size. Neither patient experienced neurological symptoms, such as headache or visual disturbance, during the period of cyst reduction. The RCCs in both patients underwent spontaneous regression without any medical treatment during a period of 6 months to 1 year. Although spontaneous regression of a RCC is rare, it is still possible and a sufficient follow-up period should be considered.

Spontaneously Regressed Rathke's Cleft Cyst

We report two rare cases of spontaneously regressed Rathke's cleft cyst (RCC). A 52-year-old woman presented with headache. A pituitary hormone study was normal. Brain magnetic resonance imaging (MRI) showed a 0.45-cm³ cystic sellar lesion. The cyst was hyperintense on T1-weighed imaging and hypointense on T2-weighted imaging without rim enhancement, comparable to a RCC. Six months later, brain MRI showed no change in the cyst size. Without any medical treatments, brain MRI 1 year later revealed a spontaneous decrease in cyst volume to 0.05 cm³. A 34-year-old woman presented with headache and galactorrhea lasting 1 week. At the time of the visit, the patient's headache had disappeared. Her initial serum prolactin level was 81.1 ng/mL, and after 1 week without the cold medicine, the serum prolactin level normalized to 11.28 ng/mL. Brain MRI showed a RCC measuring 0.71 cm³. Without further treatments, brain computed tomography 6 months later showed a spontaneous decrease in cyst volume to 0.07 cm³. Another 6 months later, brain MRI revealed that the cyst had remained the same size. Neither patient experienced neurological symptoms, such as headache or visual disturbance, during the period of cyst reduction. The RCCs in both patients underwent spontaneous regression without any medical treatment during a period of 6 months to 1 year. Although spontaneous regression of a RCC is rare, it is still possible and a sufficient follow-up period should be considered.

Spontaneously Regressed Rathke's Cleft Cyst

We report two rare cases of spontaneously regressed Rathke's cleft cyst (RCC). A 52-year-old woman presented with headache. A pituitary hormone study was normal. Brain magnetic resonance imaging (MRI) showed a 0.45-cm³ cystic sellar lesion. The cyst was hyperintense on T1-weighed imaging and hypointense on T2-weighted imaging without rim enhancement, comparable to a RCC. Six months later, brain MRI showed no change in the cyst size. Without any medical treatments, brain MRI 1 year later revealed a spontaneous decrease in cyst volume to 0.05 cm³. A 34-year-old woman presented with headache and galactorrhea lasting 1 week. At the time of the visit, the patient's headache had disappeared. Her initial serum prolactin level was 81.1 ng/mL, and after 1 week without the cold medicine, the serum prolactin level normalized to 11.28 ng/mL. Brain MRI showed a RCC measuring 0.71 cm³. Without further treatments, brain computed tomography 6 months later showed a spontaneous decrease in cyst volume to 0.07 cm³. Another 6 months later, brain MRI revealed that the cyst had remained the same size. Neither patient experienced neurological symptoms, such as headache or visual disturbance, during the period of cyst reduction. The RCCs in both patients underwent spontaneous regression without any medical treatment during a period of 6 months to 1 year. Although spontaneous regression of a RCC is rare, it is still possible and a sufficient follow-up period should be considered.

Spontaneous Regression of Massive Infiltrative Hepatocellular Carcinoma with Change in Hepatic Contour: A Case Report with Literature Review

Spontaneous regression of hepatocellular carcinoma (HCC) is associated with alcohol abstinence, herbal medication, radiation, ischemia and immune reaction against systemic or local infections. Herein, we report a case of 67-year-old man with spontaneous disappearance of HCC after local infection as a rare cause. The patient had no clinical symptoms except for markedly increased tumor marker of HCC (protein induced by vitamin K absence or antagonist-II: 731 mAU/mL). On computed tomography (CT) and magnetic resonance imaging, massive infiltrating HCC with portal vein invasion was confirmed. During conservative treatment, he was admitted due to suppurative diabetic foot. After medical treatment, HCC disappeared on follow-up CT scans, along with change in hepatic contour. The disappearance of HCC might be a result of immune response by treatment of the diabetic foot and that of ischemia by portal vein tumor thrombosis secondarily. We summarized case reports regarding spontaneous regression of HCC by infection and ischemia.

Spontaneous regression of a pulmonary adenocarcinoma after core needle biopsy.

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.

Spontaneous regression of a pulmonary adenocarcinoma after core needle biopsy

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.

Spontaneous Regression of Hyperplastic Gastric Polyps

Although gastric hyperplastic polyps are recognized as benign lesions, there is concern regarding carcinomatous changes in the polyps, depending on their size. If the polyp size is larger than 1.0~2.0 cm, endoscopic resection is usually recommended. Gastric hyperplastic polyps easily undergo changes in their shape and size over time. However, spontaneous regression of hyperplastic polyps is very rare. We present a recent case wherein gastric hyperplastic polyps disappeared spontaneously. We present the case along with a literature review.

A Case of Gastric Langerhans Cell Histiocytosis with Spontaneous Regression

A 44-year-old male was followed-up with esophagogastroduodenoscopy due to an esophageal submucosal tumor. On the lesser curvature of the gastric low body, a 0.5 cm sized round elevated lesion with hyperemia was noticed. Two pieces of biopsy were taken from this lesion for histopathologic examination. Histology showed Langerhans cell infiltration. Immunohistochemical staining was positive for CD1a antigen, which confirmed the diagnosis of Langerhans cell histiocytosis. There was no evidence of other organ involvement. The lesions spontaneously disappeared 4 months later without any treatment. We report a very rare case of gastric Langerhans cell histiocytosis.

Spontaneous Regression of a Large Hepatocellular Carcinoma with Multiple Lung Metastases

A 75-year-old Japanese man with chronic hepatitis C was found to have a large liver tumor and multiple nodules in the bilateral lungs. We diagnosed the tumor as hepatocellular carcinoma (HCC) with multiple lung metastases based on imaging studies and high titers of HCC tumor markers. Remarkably, without any anticancer treatment or medication, including herbal preparations, the liver tumor decreased in size, and the tumor makers diminished. Moreover, after 1 year, the multiple nodules in the bilateral lungs had disappeared. Fifteen months after the first medical examination, transcatheter arterial chemoembolization (TACE) was performed for the residual HCC. Because local relapse was observed on follow-up computed tomography, a second TACE was performed 13 months after the first one. At 4 years after the second TACE (7 years after the initial medical examination), there was no recurrence of primary or metastatic lesions. Spontaneous regression of HCC is very rare, and its mechanism remains unclear. Understanding the underlying mechanism of this rare phenomenon may offer some hope of finding new therapies, even in advanced metastatic cases.

Pathologically Confirmed Spontaneous Partial Regression of Hepatocellular Carcinoma / 대한내과학회지

Spontaneous regression of hepatocellular carcinoma (HCC) is extremely rare, and dozens of cases have been reported in the literature. In this report, we present a case of pathologically confirmed HCC that partially regressed without medical intervention. A 54-year-old Korean male with chronic hepatitis B had a hepatic mass detected by abdominal ultrasonography during a routine visit. A clinical diagnosis of HCC was made after measuring serum alpha-fetoprotein levels followed by dynamic computed tomography and magnetic resonance imaging. The patient delayed surgical resection; however, after 5 months, the size of the HCC decreased from 3.2 to 1.0 cm in diameter without any treatment. At that time the mass was surgically resected. Histopathology confirmed that the hepatic mass was consistent with partially regressed HCC and showed more intra- and peri-tumoral lymphocytes consisting of greater CD4+ T cell infiltration than what is normally seen in resected HCC.

Pathologically Confirmed Spontaneous Partial Regression of Hepatocellular Carcinoma / 대한내과학회지

Spontaneous regression of hepatocellular carcinoma (HCC) is extremely rare, and dozens of cases have been reported in the literature. In this report, we present a case of pathologically confirmed HCC that partially regressed without medical intervention. A 54-year-old Korean male with chronic hepatitis B had a hepatic mass detected by abdominal ultrasonography during a routine visit. A clinical diagnosis of HCC was made after measuring serum alpha-fetoprotein levels followed by dynamic computed tomography and magnetic resonance imaging. The patient delayed surgical resection; however, after 5 months, the size of the HCC decreased from 3.2 to 1.0 cm in diameter without any treatment. At that time the mass was surgically resected. Histopathology confirmed that the hepatic mass was consistent with partially regressed HCC and showed more intra- and peri-tumoral lymphocytes consisting of greater CD4+ T cell infiltration than what is normally seen in resected HCC.

Spontaneous regression of non-small cell lung cancer in a patient with idiopathic pulmonary fibrosis: a case report.

Treatment of lung cancer in patients with idiopathic pulmonary fibrosis (IPF) is difficult because the mortality rate after surgery or chemotherapy is high for these patients. Spontaneous regression of cancer is rare, especially in lung cancer. A 62-year-old man, previously diagnosed with IPF, presented with stage IIIC (T2N3M0) non-small cell lung cancer. About 4 months later, spontaneous regression of the primary tumor was observed without treatment. To the best of our knowledge, this is the first report of spontaneous regression of lung cancer in a patient with IPF.

Spontaneous Regression of Non-Small Cell Lung Cancer in a Patient with Idiopathic Pulmonary Fibrosis: A Case Report / 결핵및호흡기질환

Treatment of lung cancer in patients with idiopathic pulmonary fibrosis (IPF) is difficult because the mortality rate after surgery or chemotherapy is high for these patients. Spontaneous regression of cancer is rare, especially in lung cancer. A 62-year-old man, previously diagnosed with IPF, presented with stage IIIC (T2N3M0) non-small cell lung cancer. About 4 months later, spontaneous regression of the primary tumor was observed without treatment. To the best of our knowledge, this is the first report of spontaneous regression of lung cancer in a patient with IPF.

Preditores moleculares de evolução da mola hidatiforme no tecido trofoblástico / Molecular prognostic predictors in trophoblastic tissue of hydatidiform mole

A mola hidatiforme (MH) é a forma mais comum de doença trofoblástica gestacional e representa uma condição benigna que em alguns casos pode sofrer malignização. Todas as pacientes diagnosticadas com doenças molares são acompanhadas por pelo menos seis meses para detecção precoce da neoplasia trofoblástica gestacional. No momento, existem poucas ferramentas para avaliação prognóstica da mola hidatiforme. Foi descrita a expressão diferencial de diversos fatores em tecido molar em comparação ao trofoblasto não neoplásico. Essas moléculas podem estar relacionadas com o comportamento agressivo da MH e consequentemente poderiam servir para melhor entendimento do processo de malignização e como preditoras da evolução da doença trofoblástica gestacional.

The hydatidiform mole (HM) is the most common form of gestational trophoblastic disease and a benign condition that in some cases may undergo malignant transformation. All patients diagnosed with molar diseases are monitored for at least six months for early detection of gestational trophoblastic neoplasia. Currently, there are few prognostic tools for the prediction of hydatidiform mole evolution. Differential expression on molar tissue of different molecular factors have been described when compared to non-neoplastic trophoblast. These markers may be associated with aggressive behavior of HM and therefore could serve as predictors of the development of gestational trophoblastic disease and to better understand molar malignant transformation. This review article will summarize and evaluate prognostic molecular markers of HM.

Spontaneous Regression of Sclerosing Mesenteritis Presenting as a Huge Mass / 대한소화기학회지

Sclerosing mesenteritis is a rare benign disease originated from the mesenteries. It can be related to autoimmune disease, vasculitis, ischemia, infection, trauma and operation, but most of cases are idiopathic. The overall prognosis of sclerosing mesenteritis is usually good with benign, course. However, no consensus of treatment has yet been established. We report a case of spontaneous partial regression of sclerosing mesenteritis presented as a huge mass and diagnosed by finding of contrast enhanced abdominal computed tomography and percutaneous ultrasonography guided needle biopsy.

A case of spontaneous regression of advanced gastric cancer.

An 84 yr-old male with a history of nausea and vomiting for 3 weeks was admitted to our hospital. Esopahgogastroduodenoscopy showed the diffuse infiltrative type of gastric cancer encircling from the cardia to the lower body. On abdominal computerized tomography, the gastric wall was diffusely thickened with overlying mucosal enhancement without lymph node involvement. Histologic examination revealed poorly differentiated adenocarcinoma. So surgical resection was planned. However, patient refused all medical care, and then he was discharged. He lived without any medical support and then he revisited our hospital and showed relieved symptoms on the follow-up exam. On esophagogastroduodenoscopy, the gastric mucosa of the body looked normal without any dysplastic change. Abdominal CT revealed a decreased thickening of the gastric wall of the body. The histology from the endoscopic forceps biopsy showed no evidence of malignancy. The patient is alive without any sign of tumor recurrence after 14 months.

Dificuldade diagnóstica e mau prognóstico associados à regressão de melanoma cutâneo primário / Difficulty in the diagnosis and bad prognosis associated with the regression of primary cutaneous melanoma

O melanoma cutâneo primário em regressão (melanoma em regressão) espontânea parcial é frequente, porém a regressão completa é rara. O diagnóstico é difícil, principalmente na regressão completa. Relatam-se três casos de melanoma em regressão nos quais a biópsia inicial não revelou melanoma, e o diagnóstico foi obtido pelas metástases. Não há consenso sobre o significado prognóstico da regressão. Nos casos descritos, o melanoma em regressão associou-se a pior prognóstico, pela própria característica do tumor ou dificuldade no diagnóstico precoce e estadiamento. Conclui-se que a regressão no melanoma primário pode conferir maior dificuldade ao diagnóstico e estadiamento, com consequente pior prognóstico. Deve-se indicar biópsia excisional de lesão suspeita sempre que possível.

The partial regression of cutaneous melanoma is a frequent event. Nevertheless, complete regression is a rare and difficult to diagnose condition.We report three cases of regressed cutaneous melanoma (RCM) whose initial biopsies did not reveal melanoma and in which the diagnosis was based on the presence of metastasis. There is no consensus about the prognosis of RCMs. Some authors relate a higher prevalence of metastasis, coinciding with our cases' outcomes, where the RCM had the worst prognosis due to the tumors' aggressiveness or to the difficulty in establishing an early diagnosis and staging. We have concluded that the regression of melanoma complicates the diagnosis, staging and formulation of a worst-case scenario prognosis. Excisional biopsy should always be the first choice.

A Case of Spontaneous Regression of Advanced Gastric Cancer

An 84 yr-old male with a history of nausea and vomiting for 3 weeks was admitted to our hospital. Esopahgogastroduodenoscopy showed the diffuse infiltrative type of gastric cancer encircling from the cardia to the lower body. On abdominal computerized tomography, the gastric wall was diffusely thickened with overlying mucosal enhancement without lymph node involvement. Histologic examination revealed poorly differentiated adenocarcinoma. So surgical resection was planned. However, patient refused all medical care, and then he was discharged. He lived without any medical support and then he revisited our hospital and showed relieved symptoms on the follow-up exam. On esophagogastroduodenoscopy, the gastric mucosa of the body looked normal without any dysplastic change. Abdominal CT revealed a decreased thickening of the gastric wall of the body. The histology from the endoscopic forceps biopsy showed no evidence of malignancy. The patient is alive without any sign of tumor recurrence after 14 months.