Spontaneous Remission of Epstein-Barr Virus-Positive Diffuse Large B-Cell Lymphoma of the Elderly
A 94-year-old female patient presented with anorexia and left axillar lymphadenopathy on admission. Her past history was angina pectoris at 83 years of age and total gastrectomy due to gastric cancer at 87 years. The family history revealed that her son had had a malignant lymphoma, the histopathological diagnosis of which was DLBCL. A physical examination showed both cervical, axillar, and inguinal lymphadenopathy without tenderness. She refused chemotherapy as her son had died from hematemesis during chemotherapy. No palpable lymph nodes were identified by physical examination or computed tomography 3 months after admission, and regression of soluble interleukin-2 receptors (sIL-2R) was observed. She died from pneumonia 10 months later after initial symptoms of anorexia.\nThe patient had elevated ferritin, sIL-2R, and lactate dehydrogenase (LDH). These titers decreased gradually over the 10 months after admission (fig. ). Whole-body computed tomography showed cervical, axillar, and inguinal lymphadenopathy (fig. ), and Gallium-68 imaging revealed positive accumulation in both cervical and axillar lymph nodes (fig. ).\nTwo right inguinal lymph node specimens measuring 20 × 11 × 8 mm and 10 × 7 × 5 mm were removed. After fixation in 10% buffered formalin for 24 h, these excision biopsies were embedded in paraffin, sectioned at 4 μm, and stained with hematoxylin-eosin. Atypical large lymphoid cells were found with chromatin-rich nuclei and small-sized cells (fig. ). Immunohistological studies on this lymph node biopsy showed CD20-positive large cells, CD3-positive small cells, and CD30-partly-positive large cells (fig. ). In situ hybridization showed EBV-positive (fig. ), LMP-partly-positive, and EBNA2-negative cells.