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Case Reports in Hematology
Volume 2017, Article ID 2676254, 6 pages
https://doi.org/10.1155/2017/2676254
Case Report

Spontaneous Remission of an Untreated, MYC and BCL2 Coexpressing, High-Grade B-Cell Lymphoma: A Case Report and Literature Review

1University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA
2Department of Laboratory Medicine, University of Washington School of Medicine, P.O. Box 357110, 1959 NE Pacific Street, Seattle, WA 98195, USA
3Department of Medicine, University of Washington School of Medicine, P.O. Box 356420, 1959 NE Pacific Street, Seattle, WA 98195, USA
4Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA 98109, USA

Correspondence should be addressed to Ryan D. Cassaday; ude.wu@yadassac

Received 8 November 2016; Revised 9 January 2017; Accepted 31 January 2017; Published 21 February 2017

Academic Editor: Tatsuharu Ohno

Copyright © 2017 D. Alan Potts et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Non-Hodgkin lymphomas (NHL) are a heterogeneous group of hematologic malignancies typically treated with multiagent chemotherapy. Rarely, spontaneous remissions can be observed, particularly in more indolent subtypes. The prognosis of aggressive NHL can be predicted using clinical and histopathologic factors. In aggressive B-cell NHL, the importance of MYC and BCL2 proto-oncogene coexpression (as assessed by immunohistochemistry) and high-grade histologic features are particularly noteworthy. We report a unique case of spontaneous remission in a patient with an aggressive B-cell NHL which harbored high-risk histopathologic features, including MYC protein expression at 70–80%, BCL2 protein expression, and morphologic features suggestive of high-grade B-cell lymphoma, NOS (formerly B-cell lymphoma unclassifiable with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma [BCLU]). After undergoing a biopsy to confirm this diagnosis, he opted to forego curative-intent chemotherapy. The single, yet relatively large area of involvement noted on 18F-fluorodeoxyglucose positron emission tomography-computed tomography steadily resolved on subsequent follow-up studies. He remained without evidence of recurrence one year later, having never received treatment. This case emphasizes the potential for spontaneous remission in NHL and demonstrates that this phenomenon can be observed despite contemporary high-risk histopathologic features.