Spontaneous Regression of Pulmonary Lymphomatoid Granulomatosis in a Patient with a Solid Tumor: A Case Report

Lymphomatoid granulomatosis (LG) is a rare B-cell lymphoproliferative disease associated with Epstein-Barr virus (EBV). Characteristic for this disease is angiocentric and angiodestructive lymphoid infiltration with atypical EBV-positive В-cells, among which the reactive T lymphocytes predominate, often necrosis is identified. LG is mainly diagnosed in middle and old age, more often in immunocompromised subjects. Morphological grading depends on the proportion of EBV-positive В lymphocytes with different grades of atypia and coagulative necrosis severity. In most cases, lung tissue lesions are identified, other extranodal areas of involvement include CNS, kidney, liver, and skin. The clinical course of LG varies from indolent to aggressive. With a low-grade disease, spontaneous regression is possible, whereas Grade 3 requires treatment and differential diagnosis with diffuse large B-cell lymphoma. This paper reports a case of a 85-year-old prostate cancer patient with LG Grade 3 and lung tissue involvement. As the patient was free of any clinical manifestations, surveillance approach seemed to be reasonable. A series of control CT scans showed a gradual reduction of tumor mass in the left lung with its complete spontaneous regression in 14 months. This case highlights the potential for a favorable outcome of LG Grade 3 without special therapy. This is particularly relevant for elderly patients with various comorbidities.