[Spontaneous neoplasm regression].
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Evidence is discussed from three animal systems (Shope papillomas in rabbits, Moloney sarcomas in mice, Schmidt-Ruppin-Rous sarcomas in Japanese quail) that immune reactions can be important in spontaneous tumor regression. In vitro studies performed in these systems indicate that blocking serum factors can thwart cell-mediated immune responses and that "unblocking" antibodies are often found in animals whose tumors have regressed. To what extent spontaneous regressions of human neoplasms are due to immunologic mechanisms is unknown; in 2 patients who had undergone spontaneous tumor regression, tumor cell cytotoxic lymphocytes and unblocking serum factors were detected. Better animal models and better knowledge about the mechanisms of tumor immune reactions are needed before tumor regression can be more successfully induced by immunologic manipulation (to what extent that will even be feasible in man is unknown).
Occurrence of benign tumors in large pediatric population have never been studied. Basing on the data on the pediatric population of Khabarovsk, the authors developed a method of improved analysis of benign tumor morbidity. The method suggests the use of case histories as well as medical check-up data. Mathematical modelling was employed to compare primary incidence and occurrence indexes. The improved mean incidence of benign tumors in children for 1985-1989 was 66.8 cases and improved occurrence--174.2 per 10,000 children. The values are by the order of magnitude higher than those reported by hospitals.
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Gestational trophoblastic neoplasia represents a biologic spectrum of tumors progressing from the hydatid mole, to invasive mole, and to choriocarcinoma. This progression is reflected in increasing degrees of aneuploidy in the respective lesions. Just as there is a natural tendency for the rejection of the trophoblast of a normal pregnancy culminating either in parturition or in spontaneous abortion, rejection of tumors of trophoblast occurs at any point in the progression of the disease spectrum. The unusual effectiveness of chemotherapy in trophoblastic disease may be related to this natural tendency to rejection. This tendency, in turn, is thought to derive from the genetic disparity between the maternal host and the tumor tissue of fetal origin, since the fetus possesses both maternal and fetal antigens.
Multiple pulmonary nodular densities simulating metastastic cancer were discovered in a routine chest roentgenogram of a 30-year-old pregnant woman. Lung biopsy revealed nodules composed of smooth muscle and collagenous tissue containing entrapped glandular elements. The lesions were initially interpreted as multiple pulmonary fibroleiomyomatous hamartomas (MPFLH). During pregnancy and the post-partum period, the pulmonary nodules regressed spontaneously. Critical analysis of the published cases as well as our own case indicates that multiple pulmonary fibroleiomyomatous hamartomas (MPFLH) cannot be distinguished from benign metastasizing leiomyoma (BML) by either clinical, roentgenographic, or pathologic criteria and that all represent pulmonary metastases from a primary uterine neoplasm. The spontaneous regression of the pulmonary nodules in the present case as well as the increased risk for development of progressive pulmonary insufficiency in the pre-menopausal patients indicates an apparent hormonal dependence. Total abdominal hysterectomy and bilateral salpingo-oophorectomy appears to be the treatment of choice.
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A case of Multiple Trichoepithelioma with extensive skin involvement without familial history is reported. Some of the lesions showed spontaneous remission over the years, and in two, the microscopcal examination, demonstrated malignant changes (Basal cell Epithelioma).
Melanomas may first present as nodal metastasis. Most of these cases have a discernible primary source. A proportion of these, however, have no apparent primary. A very few patients in this latter group actually have an identifiable primary source that regressed and disappeared. There is a set of stringent clinical and histologic criteria that must be met before a melanoma can be classified as complete spontaneous regression, and only 24 cases in the literature meet all these criteria. This report reviews those cases and presents the first report to provide sequential photographic documentation of a complete spontaneous regression of a cutaneous malignant melanoma. It also gives a 10-year follow-up, the longest in the literature.
The mechanisms responsible for spontaneous regression of cancer may be nonimmunologic. Among other possible models, it is suggested that the necrotizing properties of endotoxin offer an open approach to the problem.
Where immunologic intergrity wanes, clinicians observe a greatly increased incidence of neoplasia. Factors in this phenomenon are reviewed. With complete and detailed recorded data on patients who have exhibited spontaneous regression of cancer, a systematic data-reduction approach becomes a practical reality, without the inherent handicaps of missing details in patient histories or anecdotal and often conjectural observations. Presented here is the plea for detailed recording of complete histories of all carcinoma patients who exhibit the phenomenon of spontaneous regression. Physicans of several decades ago generally considered as unrelated much data deemed important to us today.
A case is presented of a 44-year-old Caucasian man who was operated on in October of 1988 for a cutaneous melanoma in his trunk and who in the space of 1 year manifested a single subcutaneous nodule compatible with a metastasis of melanoma by fine-needle aspiration biopsy. No other abnormal findings were revealed by physical and instrumental examinations. During the subsequent hospitalization, we witnessed (in conjunction with the occurrence of painful symptoms in the hands of an inflammatory nature) the total, progressive, spontaneous regression of the metastasis, which was confirmed by the clinic and the tests. After 15 months of follow-up, the patient has not shown any further signs of illness.
There is indisputable scientific evidence of a spontaneous regression of cancer in several cases. The implication is that possibly there are other than the suspected aetiological factors involved in the problem of the origin, and even more important, in the cure of cancer.