title: Regression of gastric large B-Cell lymphoma accompanied by a florid lymphoma-like T-cell reaction: immunomodulatory effect of Ganoderma lucidum (Lingzhi)?
abstract: Complete regression of high-grade lymphoma is extremely rare. We report 1 such case that might have been conceivably mediated by Ganoderma lucidum (Lingzhi), an immunomodulatory herbal medicine. A 47-year-old man presented with epigastric pain. Endoscopy revealed a large gastric ulcer, which on biopsy was diagnostic of large B-cell lymphoma. At gastrectomy 11 days later, no evidence was found of large B-cell lymphoma despite thorough sampling. Instead, there was a dense and permeative infiltrate of CD3(+) CD8(+) cytotoxic small T lymphocytes spanning the whole thickness of the gastric wall. In situ reverse transcription polymerase chain reaction for T-cell receptor beta-chain family did not detect a monoclonal T-cell population. We postulate that the cytotoxic T cells may represent an active host-immune response against the large B-cell lymphoma that resulted in a complete regression. On questioning, the patient had taken megadoses of Ganoderma lucidum, which might have triggered the successful immune reaction.
authors.affiliation: Department of Pathology, Queen Elizabeth Hospital, Wylie Road, Kowloon, Hong Kong.
authors.forename: Wah
authors.initials: W
authors.lastname: Cheuk
authors.forename: John K C
authors.initials: JK
authors.lastname: Chan
authors.forename: Gerard
authors.initials: G
authors.lastname: Nuovo
authors.forename: May K M
authors.initials: MK
authors.lastname: Chan
authors.forename: Manson
authors.initials: M
authors.lastname: Fok
mesh_terms: D015703:Antigens, CD / Q000378:metabolism; D014408:Biomarkers, Tumor / Q000378:metabolism; D004365:Drugs, Chinese Herbal; D016099:Endoscopy, Gastrointestinal; D005743:Gastrectomy; D006801:Humans; D007155:Immunologic Factors; D016393:Lymphoma, B-Cell / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D020940:Reishi; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D013276:Stomach Ulcer / Q000209:etiology / Q000473:pathology; D013602:T-Lymphocytes, Cytotoxic / Q000276:immunology*
chemical_list: D015703:Antigens, CD; D014408:Biomarkers, Tumor; D004365:Drugs, Chinese Herbal; D007155:Immunologic Factors