Complete remission of splenic marginal zone lymphoma after an acute flare-up of hepatitis B in a hepatitis B virus carrier.
A 44-year-old female presented with asymptomatic leukocytosis and moderate splenomegaly. The diagnosis of splenic marginal zone lymphoma (SMZL) was made by a splenectomy. A virological examination revealed the patient to be a hepatitis B virus (HBV) carrier. The lymphocyte count in her peripheral blood decreased after splenectomy, but remained high for 2 years and bone marrow infiltration was obvious. Two years after the splenectomy, she was admitted for an acute flare-up of hepatitis B. The liver dysfunction improved without any medication and thereafter returned to the normal range within a few weeks. At the same time, the lymphocyte count in her peripheral blood rapidly decreased to normal levels. Atypical lymphocytes disappeared from the peripheral blood and bone marrow aspirates and biopsy specimen revealed complete remission of SMZL, including the disappearance of the clonal rearrangement of IgH-JH. There has been no recurrence of acute hepatitis and she has been in complete remission for SMZL for more than 6 years. The clinical course of this patient suggests that an immune response against HBV also affects the clearance of lymphoma cells. This is the first report that a complete remission was achieved in a patient with SMZL after a hepatitis B flare-up.
Fujimoto
Katsuya
K
Department of Internal Medicine II, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
Endo
Tomoyuki
T
Department of Internal Medicine II, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan. t-endo@fd5.so-net.ne.jp.
Nishio
Mitsufumi
M
Department of Internal Medicine II, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
Obara
Masato
M
Department of Internal Medicine II, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
Yamaguchi
Keisuke
K
Department of Internal Medicine II, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
Takeda
Yukari
Y
Department of Internal Medicine II, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
Goto
Hideki
H
Department of Internal Medicine II, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
Kasahara
Ikumi
I
Department of Internal Medicine II, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
Sato
Norihiro
N
Translational Research and Clinical Trial Center, Hokkaido University Hospital, Sapporo, Japan.
Koike
Takao
T
Department of Internal Medicine II, Hokkaido University Graduate School of Medicine, N-15, W-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
D000328:Adult; D005260:Female; D006509:Hepatitis B / Q000276:immunology*; D006515:Hepatitis B virus; D006801:Humans; D018442:Lymphoma, B-Cell, Marginal Zone / Q000276:immunology / Q000601:surgery / Q000821:virology*; D012075:Remission, Spontaneous; D013156:Splenectomy; D013160:Splenic Neoplasms / Q000601:surgery*