Lung Cancer |

Vanishing Cancer: A Case of Spontaneous Resolution of Non-small Cell Lung Cancer in a Patient With Acquired Immunodeficiency Syndrome FREE TO VIEW

Catherine Chen, MD; Joshua Sill, MD
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Eastern Virginia Medical School, Norfolk, VA

Chest. 2015;148(4_MeetingAbstracts):578A. doi:10.1378/chest.2261050
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SESSION TITLE: Lung Cancer Student/Resident Case Report Posters

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Spontaneous regression of malignancy is rare, occurring in 1 in 60,000 to 100,000 people with cancer. It has been described in most types of malignancies from humoral to solid tumors, and in singular as well as metastaic lesions. However, lung cancer regressions are rare accounting for less than 4% of documented cases.

CASE PRESENTATION: A 63 year old African American female smoker with a history of hepatitis C infection and acquired immunodeficiency syndrome (AIDS) was diagnosed with non-small cell lung cancer (NSCLC) in 2007 after CT guided biopsy of a spiculated 1.2 cm right lung nodule. A positron emission tomography (PET) scan suggested possible metastasis to mediastinal lymph nodes. She was lost to follow up until 2010 when repeat PET scan showed resolution of the mediastinal lymphadenopathy near-complete resolution of the right upper lobe mass. The only residual abnormality was a small scar where her cancer had been. She was again lost to follow up until 2014, when repeat imaging revealed a contralateral, 2 cm lung mass and pleural carcinomatosis. The right upper lobe scar remained unchanged, with no evidence of recurrence of her original tumor. CT guided biopsy of the new, contralateral mass confirmed the presence of adenocarcinoma. Review of the 2007 biopsy revealed non-invasive broncheoalveolar carcinoma, of a different tumor type and morphology than her new cancer. She was subsequently started on chemotherapy. Our patient’s adherence to antiviral therapy was inconsistent. In 2007, her CD4 count was 118/cmm. With therapy, it climbed to 288/cmm by the end of the year, but she was again lost to follow-up. At the time of the second biopsy in 2014, it had dropped to 16/cmm.

DISCUSSION: This is the second published case of spontaneous regression of NSCLC in an AIDS patient. Her background immunodeficiency lends credence to the proposed immunologic and cytokine mechanisms of regression. She did not receive optimal medical therapy for AIDS especially in more recent years. Clearly spontaneous regression does not protect against development of new malignancies. The relationship between anti-retroviral therapy and immune reconstitution in malignancy regression merits further examination.

CONCLUSIONS: While many theories exist about the reason for spontaneous regression of cancer, the exact mechanism remains unclear. And though rare, this phenomenon should be better documented and studied.

Reference #1: Challis, G. B., and H. J. Stam. "The spontaneous regression of cancer: a review of cases from 1900 to 1987." Acta Oncologica 29.5 (1990): 545-550.

Reference #2: Menon, Manoj P., and Keith D. Eaton. "Spontaneous Regression of Non-Small-Cell Lung Cancer in AIDS After Immune Reconstitution." Journal of Thoracic Oncology 10.1 (2015): e1-e2.

Reference #3: Kappauf, H., et al. "Complete spontaneous remission in a patient with metastatic non-small-cell lung cancer Case report, review of literature, and discussion of possible biological pathways involved." Annals of oncology 8.10 (1997): 1031-1039.

DISCLOSURE: The following authors have nothing to disclose: Catherine Chen, Joshua Sill

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