Sustained Regression of Parotid Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma After Nutritional and Nutraceutical Intervention Without Chemoimmunotherapy: A Case Report.

Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) in the setting of Sjögren's syndrome (SS) is a well-recognized complication of chronic autoimmune salivary gland inflammation. Standard management options include radiotherapy, immunotherapy, and combination chemoimmunotherapy, with active surveillance reserved for stable, low-burden disease. The potential role of structured nutritional and nutraceutical intervention in this setting has not been previously described. We report the case of a woman who presented at age 52 with SS-associated bilateral parotid MALT lymphoma that progressed substantially over 28 months of active observation, with palpable bilateral parotid enlargement reaching 10 x 5 cm on the left and 6 x 6 cm on the right. Proposed chemoimmunotherapy was deferred by the patient, and she independently initiated a structured multicomponent protocol comprising a strict vegan diet restricted in methionine and cysteine, urinary alkalization, and orally administered nutraceuticals including therapeutic-dose slow-releasing sodium selenite (32 mg/day), B6 pyridoxal-5'-phosphate (P5P), iron, zinc, copper, and manganese, with adjunctive rectal ozone therapy started at approximately Month 3. Serial clinical examinations and ultrasonography documented progressive bilateral parotid regression from approximately Month 7. At Month 20, repeat ultrasonography confirmed substantial radiographic reduction: the right parotid lesion decreased to 1.5 × 0.8 cm and the left to 2.7 × 0.8 cm, with both parotid glands returning to normal overall size with residual hypoechoic lesions and no cervical lymphadenopathy. At approximately Month 19, the hematologist documented no significant lymphadenopathy or splenomegaly on serial physical examination. Prednisone dosing, prescribed for concurrent autoimmune hemolytic anemia (AIHA), fluctuated independently of parotid gland changes throughout, making a corticosteroid-mediated response unlikely. This case documents a rapid and durable regression of progressive bilateral parotid MALT lymphoma after a dietary and nutraceutical protocol targeting tumor redox biology, without chemoimmunotherapy. Although spontaneous regression cannot be excluded, the response timing and proposed mechanism of glutathione and thioredoxin antioxidant pathway disruption merit further clinical study.