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Tlaiss Y, Farhat H, Hasan F, Yazbek R, Shakaroun N, Bitar N. Complex Presentation of Multicentric Castleman Disease with Coexisting HIV, HHV-8, and Other Opportunistic Infections. Case Rep Hematol 2024; 2024:8817064. [PMID: 39104429 PMCID: PMC11300082 DOI: 10.1155/2024/8817064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 06/28/2024] [Accepted: 07/18/2024] [Indexed: 08/07/2024] Open
Abstract
Castleman disease (CD) is a rare lymphoproliferative disorder characterized by benign lymph node enlargement. We present the case of a 43-year-old male with a complex medical history, including Crohn's disease treated with Adalimumab and later complicated with tuberculosis (TB) infection. Subsequently, in May 2021, he was diagnosed with human immunodeficiency virus (HIV) and started on antiretroviral therapy (efavirez, emricitabine, and tenofovir). Despite stropping adalimumab, anti-Tb, and antiviral therapy, he experienced persistent fever, neurological symptoms, and lymphadenopathy. Toxoplasmosis, Cytomegalovirus (CMV), and Human Herpesvirus-8 (HHV-8) were diagnosed and then treated. Furthermore, the patient displayed intermittent febrile episodes, pancytopenia, altered coagulation parameters, hypoalbuminemia, edema, and generalized abdominal pain, as well as radiological evidence of hepatosplenomegaly and pulmonary infiltrates. Left axillary lymph node biopsy (ALNB) was done and confirmed multicentric castleman disease (MCD). Moreover, the bone marrow aspirate showed plasmocytes. His treatment included chemotherapy with doxorubicin and rituximab while continuing his anti-Tb and antiretroviral therapy. This complex case highlights the diagnostic challenges of managing CD in the presence of multiple coexisting conditions, emphasizing the need for comprehensive evaluation in complex clinical presentations.
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2
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Chablou M, Elberhoumi A, Haddadi A, Idrissi A, Kafih M. Mesenteric Mixed Type of Castleman Disease: A Report of a Rare Case. Cureus 2024; 16:e61735. [PMID: 38975409 PMCID: PMC11226203 DOI: 10.7759/cureus.61735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 07/09/2024] Open
Abstract
Castleman disease is a rare type of lymph node hyperplasia primarily affecting the mediastinum, with mesenteric localization being extremely uncommon. It is classified into solitary and multicentric forms. In this case report, we present the case of a 46-year-old female patient in whom an incidental mesenteric mass was discovered during the workup for a ventral hernia. The mass was completely excised, and the histopathological examination confirmed the diagnosis of mixed-type Castleman disease. Surgery is the treatment of choice for localized forms of this condition, and histological examination is crucial in confirming the diagnosis.
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Affiliation(s)
- Mohamed Chablou
- General Surgery, Provincial Hospital Center, Fquih Ben Salah, MAR
| | - Assia Elberhoumi
- Radiology, Private Hospital Oliviers-Yasmine, Fquih Ben Salah, MAR
| | - Abdellah Haddadi
- General Surgery, Private Hospital Oliviers-Yasmine, Fquih Ben Salah, MAR
| | - Anass Idrissi
- Visceral Surgery, Faculty of Medicine, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Mohamed Kafih
- General Surgery, Private Hospital Oliviers-Yasmine, Fquih Ben Salah, MAR
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3
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Al Derbas RF, Al Nafisi SA, Al Khiary AT, Al Ghamdi FS, Al Oatibi FZ. Stroma-Rich Hyaline Vascular Type of Castleman Disease: A Case Report and Literature Review. Cureus 2024; 16:e60435. [PMID: 38756713 PMCID: PMC11098057 DOI: 10.7759/cureus.60435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 05/18/2024] Open
Abstract
Castleman disease (CD) is a rare lymphoproliferative disorder characterized by abnormal lymph node enlargement. We present the first documented case of a stroma-rich variant of hyaline vascular Castleman disease in Saudi Arabia. A 24-year-old Saudi female known to have acetylcholine receptor antibody-positive myasthenia gravis (MG) presented with shortness of breath, oral thrush, and an acute myasthenia gravis exacerbation, necessitating intensive care unit (ICU) admission. During her hospitalization, she was found to have a large pelvic mass. The mass was surgically excised. The diagnosis of stroma-rich hyaline vascular Castleman disease was rendered after histopathological examination. The patient's symptoms improved after the surgery. This case underscores the importance of considering Castleman disease in complex clinical presentations, especially in the context of autoimmune and paraneoplastic diseases. Recognition and timely intervention are crucial for patient management. Additionally, the report adds to the global literature on Castleman disease, emphasizing the need for further research into its clinical manifestations and associations.
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Affiliation(s)
| | - Sarah A Al Nafisi
- Pathology and Laboratory Medicine, Security Forces Hospital, Riyadh, SAU
| | - Ahmad T Al Khiary
- Pathology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
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4
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Sheth RK, Kumar P, Vishnurag A, Choudhary D, Pushparaj J. A Googly in the Neck-Castleman Disease. Indian J Otolaryngol Head Neck Surg 2024; 76:1275-1278. [PMID: 38440555 PMCID: PMC10908754 DOI: 10.1007/s12070-023-04266-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/05/2023] [Indexed: 03/06/2024] Open
Abstract
Lymphoproliferative disorders comprise of a group of heterogenous diseases characterised by uncontrolled production of lymphocytes.Castleman disease (CD) is one such disease and comprises of a group of rare disorders that involve enlarged lymph nodes and a broad range of inflammatory symptoms and laboratory abnormalities [1]. We came across young girl who presented to us in the out patient department with this disease After ruling out other pathologies and confirming the diagnosis by doing a tissue biopsy the girl was treated surgically and is disease free till date.
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Affiliation(s)
- Ritu K Sheth
- Department of ENT, Seth V.C Gandhi & M. A. Vora Municipal General Hospital, Mumbai, India
| | - Purnima Kumar
- Department of ENT, Seth V.C Gandhi & M. A. Vora Municipal General Hospital, Mumbai, India
| | - Athira Vishnurag
- Department of ENT, Seth V.C Gandhi & M. A. Vora Municipal General Hospital, Mumbai, India
| | - Deepika Choudhary
- Department of ENT, Seth V.C Gandhi & M. A. Vora Municipal General Hospital, Mumbai, India
| | - Jansimary Pushparaj
- Department of ENT, Seth V.C Gandhi & M. A. Vora Municipal General Hospital, Mumbai, India
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5
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Intagliata E, Vecchio R, Vizzini C, Villari L, Cacciola RR, Cacciola E, Vecchio V. Retroperitoneal paraduodenal unicentric Castleman disease: case report and review of the literature. J Surg Case Rep 2024; 2024:rjae073. [PMID: 38370604 PMCID: PMC10873855 DOI: 10.1093/jscr/rjae073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/25/2024] [Indexed: 02/20/2024] Open
Abstract
Castleman disease is a rare and benign disorder, characterized by enlarged lymph nodes and angiofollicular lymphoid hyperplasia. We report a case of a 57-year-old male, who was admitted to our surgical department because of a retroperitoneal nodular mass measuring about 4 cm in maximum diameter, incidentally discovered on a radiologic exam performed for the onset of vague abdominal pain with posterior irradiation. The patient was subdue to laparoscopic removal of the mass and no intra- and post-operative complications were recorded. Histologic diagnosis of hyaline-vascular variant of the Castleman disease was confirmed. Only two cases have been found in the literature reporting the paraduodenal unicentric Castleman disease localization like our case. Although rare, the Castleman disease must be considered in the differential diagnosis among all the lymph nodes diseases, for avoiding improper therapies.
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Affiliation(s)
- Eva Intagliata
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Policlinico “G. Rodolico—San Marco”, Via S. Sofia 78, 95123 Catania, Italy
| | - Rosario Vecchio
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Policlinico “G. Rodolico—San Marco”, Via S. Sofia 78, 95123 Catania, Italy
| | - Clarissa Vizzini
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Policlinico “G. Rodolico—San Marco”, Via S. Sofia 78, 95123 Catania, Italy
| | - Loredana Villari
- Pathological Anatomy Unit, University of Catania, Italy Policlinico “G. Rodolico—San Marco”, Via S. Sofia 78, 95123 Catania, Italy
| | - Rossella Rosaria Cacciola
- Department of Biomedical Science, Hematologic Unit, University of Catania, Policlinico “G. Rodolico—San Marco”, Via S. Sofia 78, 95123 Catania, Italy
| | - Emma Cacciola
- Department of Medical Sciences, Surgical Sciences and Advanced Technologies, Hemostasis Unit, University of Catania, Italy, Policlinico “G. Rodolico—San Marco”, Via S. Sofia 78, 95123 Catania, Italy
| | - Veronica Vecchio
- Department of Biomedical Science, Hematologic Unit, University of Catania, Policlinico “G. Rodolico—San Marco”, Via S. Sofia 78, 95123 Catania, Italy
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6
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Rodriguez C, Rivera Rubi L, Menjivar O, Suazo J. The Role of Radiation Therapy in Unicentric Castleman Disease: A Case Report. Cureus 2023; 15:e49687. [PMID: 38161935 PMCID: PMC10757047 DOI: 10.7759/cureus.49687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Castleman disease (CD) is a rare lymphoproliferative disorder characterized by localized (unicentric) or systemic (multicentric) lymphadenopathy. This study presents a unique case of a 29-year-old female with a rare pelvic presentation of unicentric Castleman disease, specifically the hyaline vascular variant. Despite surgical resection, an unresectable residual lesion prompted adjuvant radiotherapy and subsequent chemotherapy. The literature highlights surgical resection as the primary treatment for localized Castleman disease; however, radiotherapy and combined chemotherapy regimens like cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) have shown promise in unresectable cases, emphasizing a multidisciplinary approach. This case underscores the importance of tailoring treatment strategies for uncommon Castleman disease presentations.
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Affiliation(s)
| | | | - Oscar Menjivar
- Oncology, Yucatan's Higher Speciality Hospital, Merida, MEX
| | - Juan Suazo
- Oncology, Leeds Teaching Hospitals, Leeds, GBR
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Gupta A, Anand A, Hussain SH, Shah R, Ranjan R, Subedi V, Baral A, Mishra A, Pradhan A, Dulal S. Transformation of HHV-8-negative idiopathic multicentric Castleman disease into diffuse large B-cell lymphoma: A case report from Nepal. Clin Case Rep 2023; 11:e7903. [PMID: 37705586 PMCID: PMC10495613 DOI: 10.1002/ccr3.7903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/06/2023] [Accepted: 08/29/2023] [Indexed: 09/15/2023] Open
Abstract
Key Clinical Message Idiopathic Castleman disease transforming into Diffuse Large B-cell Lymphoma has an aggressive course and can lead to mortality. Hence, early diagnosis and intervention are required. Abstract Idiopathic Castleman disease transforming into non-Hodgkin lymphoma has an aggressive course, poor prognosis, and high mortality rate. Hence, early diagnosis and intervention are necessary. In a developing country like Nepal, where infectious diseases, particularly TB, are high, concomitant infection worsens the disease course. It also poses a diagnostic challenge as the clinical presentation may be similar.
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Affiliation(s)
| | - Ayush Anand
- BP Koirala Institute of Health SciencesDharanNepal
| | | | - Raju Shah
- BP Koirala Institute of Health SciencesDharanNepal
| | - Rajesh Ranjan
- Department of Internal MedicineBP Koirala Institute of Health SciencesDharanNepal
| | - Viplaw Subedi
- Department of Internal MedicineBP Koirala Institute of Health SciencesDharanNepal
| | - Aastha Baral
- Department of Internal MedicineBP Koirala Institute of Health SciencesDharanNepal
| | - Akshat Mishra
- Department of Internal MedicineBP Koirala Institute of Health SciencesDharanNepal
| | - Anju Pradhan
- Department of PathologyBP Koirala Institute of Health SciencesDharanNepal
| | - Soniya Dulal
- Department of Internal MedicineBP Koirala Institute of Health SciencesDharanNepal
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8
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Aldosari S, Altalhi B, Albisher N, Mohammed S, Alhazmi A, Alsobhi S. Castleman disease: a case report of an unusual adrenal incidentaloma and literature review. J Surg Case Rep 2023; 2023:rjad248. [PMID: 37220596 PMCID: PMC10200125 DOI: 10.1093/jscr/rjad248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/10/2023] [Indexed: 05/25/2023] Open
Abstract
Adrenal incidentaloma (AI) is an incidental detection of an adrenal mass on an image not performed for a suspected adrenal problem. AI has become a commonly encountered lesion that requires further investigations for evidence of hormonal hypersecretion or malignancy potential. According to guidelines, surgical intervention is the standard of care for unilateral AI. We report on a case of a 64-year-old female who presented with a nonfunctional adrenal mass associated with compressive symptoms, which was revealed to be a mixed hyaline vascular and plasma cell variant Castleman disease (CD) after surgical resection. Although hyaline vascular variant and plasma cell variant of CD has been identified in adrenal glands, this is the first report of a mixed hyaline vascular and plasma cell variant in an adrenal mass.
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Affiliation(s)
- Sarah Aldosari
- Correspondence address. Department of Surgery, King Faisal Specialist Hospital & Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia. Tel: 966503565794; E-mail:
| | - Bassam Altalhi
- Department of Surgery, Almoosa Specialist Hospital, Alahsa, Saudi Arabia
| | - Nesreen Albisher
- Department of Surgery, Almoosa Specialist Hospital, Alahsa, Saudi Arabia
| | - Shamayel Mohammed
- Pathology & Laboratory Medicine Department, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Alaa Alhazmi
- Department of Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Saif Alsobhi
- Department of Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
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9
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Clinical and histopathology characteristics of Castleman disease: a multicenter study of 51 Brazilian patients. Ann Hematol 2023; 102:1121-1129. [PMID: 36763110 DOI: 10.1007/s00277-023-05116-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 01/26/2023] [Indexed: 02/11/2023]
Abstract
Castleman's disease (CD) is a rare and heterogeneous lymphoproliferative disorder, with limited available clinical information in Brazil. A retrospective study was carried out through information contained in the medical records of 51 patients, between July 1999 and June 2020. Seven patients were excluded, and 44 were analyzed in total. The average age of unicentric CD (UCD) patients was 35 years old and of multicentric CD (MCD) patients was 49 years old (p = 0.013). Regarding gender, there was a predominance of females among patients with UCD (68.4%) and males in patients with MCD (57.9%) (p = 0.103). The most common site of involvement in UCD was the cervical region (36.8%). A total of 73.7% of patients with UCD and 68.4% of patients with MCD presented the histological form hialyne-vascular (HV) (p = 0.499). Most patients with laboratory abnormalities had MCD. A total of 78% of the patients were asymptomatic, with the majority of symptomatic patients with MCD (p = 0.042). Only two of the 27 patients evaluated for the presence of human immunodeficiency virus (HIV) had positive serology. HHV-8 was evaluated in 14 cases, being positive in two. Of the patients with UCD, 94.7% underwent excisional biopsy, against only 41.2% of patients with MCD (p = 0.01). The mean follow-up was 61 months. We observed similarities in the clinical profile between patients in our study and patients described in the literature, such as gender, mean age, B symptoms, visceromegaly, fluid accumulation, and treatment. Unlike the literature, the cervical region was the most affected site, besides the greater association of the HV histological subtype among patients with MCD.
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10
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Jbali S, Zarraa S, Hadhri A, Noubbigh GEF, Yahyaoui S, Nasr C. Castleman disease of the parapharyngeal space: Diagnosis and management. Int J Surg Case Rep 2022; 99:107599. [PMID: 36113371 PMCID: PMC9568718 DOI: 10.1016/j.ijscr.2022.107599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Castleman's disease (CD) is a rare and benign disease often identified in the mediastinum with few cases in the head and neck area. Parapharyngeal Castleman's disease was rarely reported in the literature. The aim of our work was to discuss the management of this particular location of CD. It was about a case report that has been reported in line with the SCARE 2020 criteria (Agha et al., 2020 [1]). Case presentation We report the case of a 53-year-old female patient who presented a left parotid tumefaction. Radiological investigations showed a parapharyngeal mass that was surgically removed. Definitive pathologic report concluded to Castleman's disease. She presented, one year later, a retropharyngeal recurrence, which was treated by radiotherapy with good response. Clinical discussion and conclusion Castleman's disease located in parapharyngeal spaces is an entity that was rarely reported in the literature. Surgical excision is the golden standard treatment. Radiotherapy is also an effective treatment that can be offered for unresectable cases or recurrences of Castleman's disease. Castleman’s disease (CD) located in parapharyngeal spaces was rarely reported in the literature. Its clinical and radiological presentation are common to all parapharyngeal space tumors. Its confirmation is based on histology proof and an assessment is necessary in search of other localizations of this disease. Surgery is the first line treatment. Radiotherapy is an effective treatment for unresectable cases or recurrences of unicentric CD.
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Affiliation(s)
- S Jbali
- Head and Neck Department, Salah Azaiez Institute of Cancer, Tunis University of Medicine, University Tunis El Manar, Tunis, Tunisia.
| | - S Zarraa
- Radiotherapy Department, Salah Azaiez Institute of Cancer, Tunis University of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - A Hadhri
- Radiotherapy Department, Salah Azaiez Institute of Cancer, Tunis University of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - G E F Noubbigh
- Radiotherapy Department, Principal Military Training Hospital, Tunis University of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - S Yahyaoui
- Radiotherapy Department, Salah Azaiez Institute of Cancer, Tunis University of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - C Nasr
- Radiotherapy Department, Salah Azaiez Institute of Cancer, Tunis University of Medicine, University Tunis El Manar, Tunis, Tunisia
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11
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Krokenberger M, Schwamborn K, Strassen U. Prevalence of
Castleman's
disease in patients suffering from cervical lymphadenopathy. Laryngoscope Investig Otolaryngol 2022; 7:1430-1435. [PMID: 36258858 PMCID: PMC9575065 DOI: 10.1002/lio2.891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/29/2022] [Accepted: 07/30/2022] [Indexed: 11/07/2022] Open
Abstract
Objectives Study design Material and methods Results Conclusion Level of Evidence
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Affiliation(s)
- Michael Krokenberger
- Department of Otolaryngology–Head & Neck Surgery Klinikum rechts der Isar, Technical University of Munich (TUM) Munich Germany
| | - Kristina Schwamborn
- Institute of Pathology, Klinikum rechts der Isar, Technical University of Munich (TUM) Munich Germany
| | - Ulrich Strassen
- Department of Otolaryngology–Head & Neck Surgery Klinikum rechts der Isar, Technical University of Munich (TUM) Munich Germany
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12
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Min GJ, Jeon YW, Kim TY, Kwag DH, Lee JH, Lee JY, Park SS, Park S, Yoon JH, Lee SE, Cho BS, Eom KS, Kim YJ, Lee S, Kim HJ, Min CK, Lee JW, Cho SG. Long-term treatment outcome of Castleman’s disease: A real-world experience. Front Oncol 2022; 12:974770. [PMID: 35992883 PMCID: PMC9389339 DOI: 10.3389/fonc.2022.974770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background Castleman disease (CD), classified as unicentric CD (UCD) or multicentric CD (MCD), is a rare non-neoplastic lymphoproliferative disorder of unknown origin. Owing to its rarity, the clinical characteristics, therapeutic modalities, treatment outcomes, and prognostic factors related to UCD or MCD are not well defined. Method We retrospectively analyzed 88 patients with CD, including those with hyaline-vascular, plasma-cell, mixed type, hypervascular, and plasmablastic subtypes, for presenting symptoms, physical, laboratory, and radiologic findings, and treatment response in the Korean population. Results The median patient age was 44 years (range: 18–84 years) with slight predominance of women (53.4%). UCD and MCD accounted for 38.6% (n=34) and 61.4% (n=54) of cases, respectively. Histopathologically, UCD patients were classified as 88.2% (n=30) hyaline-vascular and 11.8% (n=4) plasma cell types, whereas MCD patients were classified as 27.8% (n=15) hypervascular, 61.1% (n=33) plasma cell, 7.4% (n=4) mixed, and 3.7% (n=2) plasmablastic types. Twelve (13.6%) patients exhibited a poor performance status with an Eastern Cooperative Oncology Group score of 2. The most common presenting symptom was sustained fever, followed by fatigue, anorexia, peripheral edema, and weight loss. Furthermore, splenomegaly, pleural effusion, and ascites were observed to be associated with CD. Surgical resection and siltuximab were the preferred treatment modalities for UCD and MCD, respectively, with favorable symptomatic, laboratory, and radiologic outcomes and safety profiles. The overall survival was 90.2%, with no significant difference between the UCD and MCD groups (p=0.073), but progression-free survival was significantly poorer in the MCD group (p=0.001). Age ≥60 years and splenomegaly significantly affected the overall and progression-free survival rates. Conclusion Patients with UCD had favorable outcomes with surgical resection of a solitary mass, whereas in patients with MCD, old age and splenomegaly were identified as independent prognostic factors. Further well-designed prospective studies under advancing knowledge of the pathophysiology of MCD are warranted to establish suitable guidelines for the discontinuation or prolonging infusion intervals of siltuximab and treatment modalities for HHV-8 positive MCD patients or patients with siltuximab failure.
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Affiliation(s)
- Gi-June Min
- Department of Hematology, Seoul St. Mary’s Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young-Woo Jeon
- Department of Hematology, Yeouido St. Mary’s Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Tong Yoon Kim
- Department of Hematology, Seoul St. Mary’s Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Dae Hun Kwag
- Department of Hematology, Seoul St. Mary’s Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jong Hyuk Lee
- Department of Hematology, Seoul St. Mary’s Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Joon Yeop Lee
- Department of Hematology, Seoul St. Mary’s Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung-Soo Park
- Department of Hematology, Seoul St. Mary’s Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Silvia Park
- Department of Hematology, Seoul St. Mary’s Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jae-Ho Yoon
- Department of Hematology, Seoul St. Mary’s Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung-Eun Lee
- Department of Hematology, Seoul St. Mary’s Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Byung-Sik Cho
- Department of Hematology, Seoul St. Mary’s Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ki-Seong Eom
- Department of Hematology, Seoul St. Mary’s Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yoo-Jin Kim
- Department of Hematology, Seoul St. Mary’s Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Seok Lee
- Department of Hematology, Seoul St. Mary’s Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hee-Je Kim
- Department of Hematology, Seoul St. Mary’s Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Chang-Ki Min
- Department of Hematology, Seoul St. Mary’s Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jong Wook Lee
- Department of Hematology, Seoul St. Mary’s Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Seok-Goo Cho
- Department of Hematology, Seoul St. Mary’s Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- *Correspondence: Seok-Goo Cho,
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13
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Rehman MEU, Chattaraj A, Neupane K, Rafae A, Saeed S, Basit J, Ibrahim A, Khouri J, Mukherjee S, Anwer F. Efficacy and Safety of Regimens Used for the Treatment of Multicentric Castleman Disease: A Systematic Review. Eur J Haematol Suppl 2022; 109:309-320. [PMID: 35770616 DOI: 10.1111/ejh.13823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Treatment options for multicentric Castleman disease (MCD) remain limited. The only FDA-approved drug is siltuximab for idiopathic MCD (iMCD), but the response rate with siltuximab is less than 50%. We performed a systematic review to examine the efficacy and safety of various regimens used for the treatment of MCD. METHODS A database search on PubMed, Embase, Cochrane, Web of Science, and Clinicaltrials.gov using the terms "Castleman disease," "treatment outcome" and "patient safety" was done. RESULTS AND CONCLUSIONS Results from a randomized controlled trial (RCT) and an extension study highlighted the efficacy and long-term safety of siltuximab for iMCD; other trials showed tocilizumab to be a suitable alternative. A recent trial reported high response rates with thalidomide in iMCD patients. Promising results were reported for bortezomib in relapsed/ refractory MCD. For human herpesvirus 8 (HHV-8) associated MCD, rituximab along with doxorubicin therapy followed by maintenance with zidovudine and valganciclovir is the most effective therapy. A single-arm trial has highlighted the potential role of tocilizumab in HHV-8 MCD. Data for these regimens are limited and mostly comprise non-randomized trials. Further research on emerging agents could have a major impact on the treatment of this rare disease.
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Affiliation(s)
| | - Asmi Chattaraj
- Department of Internal Medicine, University Pittsburgh Medical Center, Mckeesport, PA, USA
| | - Karun Neupane
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Abdul Rafae
- Department of Internal Medicine, McLaren Flint-Michigan State University, Flint, MI, USA
| | - Sajeel Saeed
- Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Jawad Basit
- Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Atif Ibrahim
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jack Khouri
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sudipto Mukherjee
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Faiz Anwer
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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14
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Saadallah MAH. Castleman's disease: A rare case report and review of literature. Int J Surg Case Rep 2022. [PMCID: PMC9193861 DOI: 10.1016/j.ijscr.2022.107282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Castleman's disease – also known as giant lymph node hyperplasia – is a rare pathology, poorly understood. Described for the first time in 1954, it is considered a lymphoproliferative disorder that manifests without any other obvious symptoms and may be confused with other causes of lymph nodal enlargement. We are reporting in this paper the case of a 30-year-old Maldivian female who presented to our surgical OPD with a right cervical large solitary soft tissue lesion. All the investigations were negative except for a large highly vascularized unicentric soft tissue mass measuring around 4 cm in the anterior triangle of the neck seen by the ultrasound separable from all other surroundings. An excisional biopsy & complete resection was done under general anesthesia in the operation theater of a Maldivian Regional hospital. Unicentric Castleman's disease as a diagnosis was confirmed based on the final histopathological study of the specimen, and the absence of other cervical and extra-cervical lymphadenopathy. The patient doesn't have recurrence or newly developed lymph nodes at the time of reporting this article. Neck lymph nodes are involved by CD and may be confused with other common causes of neck lymphadenopathy. The definitive diagnosis of CD is based on histopathological assessment and multiple treatment modalities have been tried. There are three types of CD: hyaline-vascular type (most common), plasma cell type and mixed variant type. The localized form of the disease is mostly asymptomatic with a single site lymph node enlargement. Surgical resection is considered the cornerstone of radical treatment for unicentric CD.
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15
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Fajgenbaum DC, Goiffon RJ, Soumerai JD, Harris CK. Case 16-2022: A 55-Year-Old Man with Fevers, Night Sweats, and a Mediastinal Mass. N Engl J Med 2022; 386:2036-2048. [PMID: 35613025 DOI: 10.1056/nejmcpc2115849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- David C Fajgenbaum
- From the Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.C.F.); and the Departments of Radiology (R.J.G.), Medicine (J.D.S.), and Pathology (C.K.H.), Massachusetts General Hospital, and the Departments of Radiology (R.J.G.), Medicine (J.D.S.), and Pathology (C.K.H.), Harvard Medical School - both in Boston
| | - Reece J Goiffon
- From the Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.C.F.); and the Departments of Radiology (R.J.G.), Medicine (J.D.S.), and Pathology (C.K.H.), Massachusetts General Hospital, and the Departments of Radiology (R.J.G.), Medicine (J.D.S.), and Pathology (C.K.H.), Harvard Medical School - both in Boston
| | - Jacob D Soumerai
- From the Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.C.F.); and the Departments of Radiology (R.J.G.), Medicine (J.D.S.), and Pathology (C.K.H.), Massachusetts General Hospital, and the Departments of Radiology (R.J.G.), Medicine (J.D.S.), and Pathology (C.K.H.), Harvard Medical School - both in Boston
| | - Cynthia K Harris
- From the Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (D.C.F.); and the Departments of Radiology (R.J.G.), Medicine (J.D.S.), and Pathology (C.K.H.), Massachusetts General Hospital, and the Departments of Radiology (R.J.G.), Medicine (J.D.S.), and Pathology (C.K.H.), Harvard Medical School - both in Boston
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16
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Zhao D, Ozdemirli M, Nayar V. Intracranial Castleman disease: Illustrative case and literature review. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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17
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Gündüz E, Kırkızlar HO, Ümit EG, Karaman Gülsaran S, Özkocaman V, Özkalemkaş F, Candar Ö, Elverdi T, Küçükyurt S, Paydaş S, Ceneli Ö, Karakuş S, Maral S, Ekinci Ö, İpek Y, Kis C, Güven ZT, Akdeniz A, Celkan T, Eroğlu Küçükdiler AH, Akgün Çağlıyan G, Özçelik Şengöz C, Karataş A, Bulduk T, Özcan A, Belen Apak FB, Canbolat A, Kartal İ, Ören H, Töret E, Özdemir GN, Bakanay Öztürk ŞM. Castleman Disease: A Multicenter Case Series from Turkey. Turk J Haematol 2022; 39:130-135. [PMID: 35176839 PMCID: PMC9160699 DOI: 10.4274/tjh.galenos.2022.2021.0670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: Castleman disease (CD) is a rare disease also known as angiofollicular lymph node hyperplasia. The two main histological subtypes are the hyaline vascular and plasma cell variants. It is further classified as unicentric CD (UCD) or multicentric CD (MCD) according to the anatomical distribution of the disease and the number of lymph nodes involved. The aim of this multicenter study was to evaluate all cases of CD identified to date in Turkey to set up a national registry to improve the early recognition, treatment, and follow-up of CD. Materials and Methods: Both adult (n=130) and pediatric (n=10) patients with lymph node or involved field biopsy results reported as CD were included in the study. Patients’ demographic information, clinical and laboratory characteristics, imaging study results, treatment strategies, and clinical outcomes were evaluated retrospectively. Results: A total of 140 patients (69 male and 71 female) with a diagnosis of UCD (n=73) or MCD (n=67) were included. The mean age was 39 years in the UCD group and 47 years in the MCD group. Female patients were more common in the UCD group. The most common histological subtype was hyaline vascular for both UCD and MCD patients. Asymptomatic patients were more common in the UCD group. Anemia, elevations of acute phase reactants, and hypoalbuminemia were more common in the MCD group. The most commonly used treatment strategies for UCD were surgical excision, rituximab, and radiotherapy, respectively. All UCD patients were alive at a median of 19.5 months of follow-up. The most commonly used treatment strategies for MCD were methyl prednisolone, R-CHOP, R-CVP, and rituximab. Thirteen MCD patients had died at a median of 34 months of follow-up. Conclusion: This study is important in presenting the patient characteristics and treatment strategies for CD from Turkey, with the potential of increasing awareness about CD. Treatment data may help in making decisions, particularly in countries that do not have access to siltuximab. However, larger prospective studies are needed to make definitive conclusions.
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Affiliation(s)
- Eren Gündüz
- Eskişehir Osmangazi University Faculty of Medicine Department of Hematology, Eskişehir, Turkey
| | | | - Elif Gülsüm Ümit
- Trakya University Faculty of Medicine Department of Hematology, Edirne, Turkey
| | | | - Vildan Özkocaman
- Uludag University Faculty of Medicine Department of Hematology, Bursa, Turkey
| | - Fahir Özkalemkaş
- Uludag University Faculty of Medicine Department of Hematology, Bursa, Turkey
| | - Ömer Candar
- Uludag University Faculty of Medicine Department of Hematology, Bursa, Turkey
| | - Tuğrul Elverdi
- İstanbul University Cerrahpaşa Faculty of Medicine Department of Hematology, İstanbul, Turkey
| | - Selin Küçükyurt
- İstanbul University Cerrahpaşa Faculty of Medicine Department of Hematology, İstanbul, Turkey
| | - Semra Paydaş
- Çukurova University Faculty of Medicine Department of Hematology, Adana, Turkey
| | - Özcan Ceneli
- Necmettin Erbakan University Meram Faculty of Medicine Department of Hematology, Konya, Turkey
| | - Sema Karakuş
- Ankara Başkent University Faculty of Medicine Department of Hematology, Ankara, Turkey
| | - Senem Maral
- Health Sciences University Dışkapı Yıldırım Beyazıt Training and Research Hospital, Department of Hematology, Ankara, Turkey
| | - Ömer Ekinci
- Fırat University Faculty of Medicine Department of Hematology, Elazığ, Turkey
| | - Yıldız İpek
- Kartal Dr Lutfi Kirdar City Hospital Department of Hematology, İstanbul, Turkey
| | - Cem Kis
- Adana Baskent University Faculty of Medicine Department of Hematology, Adana, Turkey
| | - Zeynep Tuğba Güven
- Erciyes University Faculty of Medicine Department of Hematology, Kayseri, Turkey
| | - Aydan Akdeniz
- Mersin University Faculty of Medicine Department of Hematology, Mersin, Turkey
| | - Tiraje Celkan
- İstinye University Faculty of Medicine Department of Pediatric Hematology, İstanbul, Turkey
| | | | | | - Ceyda Özçelik Şengöz
- Karadeniz Technical University Faculty of Medicine Department of Hematology, Trabzon, Turkey
| | - Ayse Karataş
- Hacettepe University Faculty of Medicine Department of Hematology, Ankara, Turkey
| | - Tuba Bulduk
- Health Sciences University Gulhane Training and Research Hospital, Department of Hematology, Ankara, Turkey
| | - Alper Özcan
- Erciyes University Faculty of Medicine Department of Pediatric Hematology, Kayseri, Turkey
| | - Fatma Burcu Belen Apak
- Ankara Başkent University Faculty of Medicine Department of Pediatric Hematology, Ankara, Turkey
| | - Aylin Canbolat
- İstanbul Medeniyet University Faculty of Medicine Department of Pediatric Hematology, İstanbul, Turkey
| | - İbrahim Kartal
- Ondokuz Mayıs University Faculty of Medicine Department of Pediatric Hematology, Samsun, Turkey
| | - Hale Ören
- Dokuz Eylül University Faculty of Medicine Department of Pediatric Hematology, İzmir, Turkey
| | - Ersin Töret
- Eskişehir Osmangazi University Faculty of Medicine Department of Pediatric Hematology, Eskişehir, Turkey
| | - Gül Nihal Özdemir
- İstinye University Faculty of Medicine Department of Pediatric Hematology, İstanbul, Turkey
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18
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Chinthareddy RR, Muthirevula A, Srikrishna SV, Lingaraju VC. Mediastinal Castleman disease with supraclavicular extension-a diagnostic dilemma and surgical challenge. Indian J Thorac Cardiovasc Surg 2021; 37:691-693. [PMID: 34776668 DOI: 10.1007/s12055-021-01179-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 11/25/2022] Open
Abstract
Castleman's disease, also known as angiofollicular lymph node hyperplasia, is a rare lymphoproliferative disorder, with unicentric or multicentric variety. Herein, we present an unusual case of unicentric Castleman disease in a 19-year-old boy presenting as a left posterior mediastinal mass with supraclavicular extension, a rare form of presentation, with very few cases reported in the past. It can be misdiagnosed as other malignant pathology and mismanaged as in our case; hence, a high index of suspicion is necessary.
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Affiliation(s)
- Rohan Reddy Chinthareddy
- Department of Thoracic Surgery, Mazumdar Shaw Medical Centre, Narayana Health City, 258/A, Hosur Road, Bommasandra Industrial Area, Bengaluru, Karnataka 560099 India
| | - Arvind Muthirevula
- Department of Thoracic Surgery, Mazumdar Shaw Medical Centre, Narayana Health City, 258/A, Hosur Road, Bommasandra Industrial Area, Bengaluru, Karnataka 560099 India
| | - Srirangapatna Varadaraj Srikrishna
- Department of Thoracic Surgery, Mazumdar Shaw Medical Centre, Narayana Health City, 258/A, Hosur Road, Bommasandra Industrial Area, Bengaluru, Karnataka 560099 India
| | - Vijay Cholenahalli Lingaraju
- Department of Thoracic Surgery, Mazumdar Shaw Medical Centre, Narayana Health City, 258/A, Hosur Road, Bommasandra Industrial Area, Bengaluru, Karnataka 560099 India
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19
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Kadoura L, Hamza A, Jobran AWM, Habes YMN, Agha S, Alyousfi R, Ayoub K. Unicentric Castleman disease in the mesentery with ambiguous symptoms: a rare case report. J Surg Case Rep 2021; 2021:rjab367. [PMID: 34457238 PMCID: PMC8390332 DOI: 10.1093/jscr/rjab367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/04/2021] [Indexed: 11/14/2022] Open
Abstract
Castleman disease (CD) is a rare clinical entity characterized by enlarged lymph nodes. It may affect a single lymph node (unicentric) or multiple lymph nodes in the body (multicentric). However, it is exceptionally uncommon for unicentric Castleman disease (UCD) to present in the mesentery. Herein, we report a case of 38-year-old female complaining of polymenorrhea and abdominal discomfort for 4 months. Her past medical history was unremarkable; however, she has started smoking recently. The physical examination and radiography indicated a large, well-defined mass in the right hypochondrium. Eventually, the patient underwent laparotomy and the mass was excised totally. The Pathologic study confirmed the diagnosis as mesenteric CD, hyaline-vascular type. After 5 months of follow-up, the patient showed no evidence of recurrence. In conclusion, this case underscores the importance of taking mesenteric CD into consideration in each patient who presents with solid abdominal mass or ambiguous abdominal discomfort.
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Affiliation(s)
- Lama Kadoura
- Department of Surgery, Aleppo University Hospital, Aleppo, Syria
| | - Amr Hamza
- Correspondence address. Tel: 00963 962 084 481; E-mail:
| | | | | | - Sarab Agha
- Department of Pathology, Aleppo University Hospital, Aleppo, Syria
| | - Rama Alyousfi
- Department of Pathology, Aleppo University Hospital, Aleppo, Syria
| | - Kusay Ayoub
- Department of Surgery, Aleppo University Hospital, Aleppo, Syria
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20
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Retroperitoneal unicentric Castleman's disease-A case report and review of literature. Int J Surg Case Rep 2021; 86:106325. [PMID: 34425426 PMCID: PMC8387779 DOI: 10.1016/j.ijscr.2021.106325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/01/2021] [Accepted: 08/15/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Castleman's disease is not so commonly diagnosed worldwide due to non-specific symptoms Clinical findings are variable. No definite blood investigation or any biomarkers are established to diagnose this disease. Radiological investigations do not play much role in diagnosing. It can be unicentric or multicentric. Etiological factors are not well understood except predilection of this disease towards immune-compromised persons. Surgery is considered as a prime modality to treat, if resectable. CASE PRESENTATION Patient had recurrent abdominal pain in left lumbar region which was intermittent for last 6 months, dull aching with no aggravating and relieving factors. There was no history of abnormal bowel habits, urinary complaints, fever, night sweats, weight loss, rashes in body, joint pains and loss of appetite. On examination, there was a single, firm, non-tender, intra-abdominal, retroperitoneal mass of approximately size 10 ∗ 7 cm in left lumbar region encroaching inferiorly towards left inguinal region. Digital rectal examination (DRE) and external genitalia were normal. CLINICAL DISCUSSION All routine blood investigations along with relevant tumour markers were normal. Magnetic Resonance Imaging (MRI) abdomen showed a well-defined mass suggestive of stromal tumour or retroperitoneal sarcoma. Patient underwent surgery in which complete excision of the mass was done. Postoperative event was uneventful and currently doing well. CONCLUSION Take away lesson in this case report is that we should not presume all retroperitoneal mass as cancer or sarcoma, we have to think about other rare causes like Castleman's disease, if clinical picture, blood and radiological investigation are discordant.
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Unicentric Castleman's disease of hepatic hilum and retroperitoneum: a case report for endoscopic ultrasonography differential diagnosis and a literature review. Clin J Gastroenterol 2021; 14:1250-1254. [PMID: 34109527 DOI: 10.1007/s12328-021-01418-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
Castleman's disease (CD) is a highly heterogeneous clinico-pathological entity belonging to the lymphoproliferative disorders. CD can occur in any part of the human body where lymph nodes are present. In addition, very few cases have been reported in hepatic hilum. Here, we present a case of a middle-aged female patient who was presented with abdominal pain and diagnosed as localized Castleman's disease of hepatic hilar and retroperitoneal origin. Diagnosing CD is complex due to its resemblance to many other diseases. EUS and FNA may play a more important role in differential diagnosis of CD and other disease in digestive system.
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22
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International evidence-based consensus diagnostic and treatment guidelines for unicentric Castleman disease. Blood Adv 2021; 4:6039-6050. [PMID: 33284946 DOI: 10.1182/bloodadvances.2020003334] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/09/2020] [Indexed: 02/06/2023] Open
Abstract
Castleman disease (CD) includes a group of rare and heterogeneous disorders with characteristic lymph node histopathological abnormalities. CD can occur in a single lymph node station, which is referred to as unicentric CD (UCD). CD can also involve multicentric lymphadenopathy and inflammatory symptoms (multicentric CD [MCD]). MCD includes human herpesvirus-8 (HHV-8)-associated MCD, POEMS-associated MCD, and HHV-8-/idiopathic MCD (iMCD). The first-ever diagnostic and treatment guidelines were recently developed for iMCD by an international expert consortium convened by the Castleman Disease Collaborative Network (CDCN). The focus of this report is to establish similar guidelines for the management of UCD. To this purpose, an international working group of 42 experts from 10 countries was convened to establish consensus recommendations based on review of treatment in published cases of UCD, the CDCN ACCELERATE registry, and expert opinion. Complete surgical resection is often curative and is therefore the preferred first-line therapy, if possible. The management of unresectable UCD is more challenging. Existing evidence supports that asymptomatic unresectable UCD may be observed. The anti-interleukin-6 monoclonal antibody siltuximab should be considered for unresectable UCD patients with an inflammatory syndrome. Unresectable UCD that is symptomatic as a result of compression of vital neighboring structures may be rendered amenable to resection by medical therapy (eg, rituximab, steroids), radiotherapy, or embolization. Further research is needed in UCD patients with persisting constitutional symptoms despite complete excision and normal laboratory markers. We hope that these guidelines will improve outcomes in UCD and help treating physicians decide the best therapeutic approach for their patients.
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Chen H, Ba W, Chen H, Yang H. Cutaneous involvement as initial presentation of multicentric plasmacytic Castleman disease. J Cutan Pathol 2021; 48:701-705. [PMID: 33469928 DOI: 10.1111/cup.13964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 01/09/2023]
Abstract
Castleman disease (CD) is an unusual lymphoproliferative disorder characterized by multiple lymphadenopathy accompanied by marked systemic inflammatory symptoms. CD can be unicentric (UCD) or multicentric (MCD), and it can be classified into three types based on histopathology: hyaline vascular type, plasma cell type, and mixed hyaline vascular and plasma cell type. CD involving skin is an unusual clinical manifestation. Abnormalities including rash, hyperpigmentation, cherry hemangiomatosis, paraneoplastic pemphigus, and Kaposi sarcoma have been reported to occur in MCD. Here, we reported an unusual case of MCD which presented initially with disseminated dark brown papules, patches, and plaques, and pathologically demonstrated plasma cell type CD, a finding which is rarely reported. The peculiar clinicopathological features will be discussed.
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Affiliation(s)
- Hongxiao Chen
- Department of Dermatology, Linyi People's Hospital, Shandong, China
| | - Wei Ba
- Department of Dermatology, Chinese PLA General Hospital and Medical School, Beijing, China
| | - Hao Chen
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Hongyu Yang
- Department of Pathology, St. Vincent Evansville Medical Center, Evansville, Indiana, USA
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Castleman disease: A single-center case series. Int J Surg Case Rep 2021; 80:105650. [PMID: 33631648 PMCID: PMC7907481 DOI: 10.1016/j.ijscr.2021.105650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 01/11/2023] Open
Abstract
Castleman disease is an overgrowth of lymphatic cells, usually in the chest or abdomen. Multicentric Castleman disease affects lymphatic cells throughout the body. HHV-8 and HIV have been associated with multicentric Castleman disease. Unicentric Castleman disease affects a single group of lymph nodes. Centricity is considered the most important indicator of patient outcomes.
Background Castleman disease (CD) is a rare lymphocytic disorder. Unicentric CD (UCD) has an excellent long-term prognosis after surgical excision; however, multicentric CD (MCD) has a severe clinical course with poor outcomes. Study design We analyzed the clinical presentation of 28 patients treated at a single institution from 1995 to 2017. Demographics, clinical variables, anatomical site, centricity, histopathology, immunochemistry, and surgical approach were reviewed. We evaluated the 5-year recurrence and survival for patients with UCD and MCD. Results Of the 28 patients, 57 % (n = 16) were female, with a mean age of 41.6 ± 15.6 years. CD was asymptomatic in 57 % (n = 16) of patients, 21 % (n = 6) presented with local symptoms such as pain, and 21 % (n = 6) of patients also had systemic symptoms, including weight loss and fever. CD was unicentric in 64 % (n = 18) and multicentric in 36 % (n = 10). The hyaline vascular variant was noted in 57 % (n = 16) of the tumors, plasmacytoid variant in 36 % (n = 10), and mixed variants in 7% (n = 2) of tumors. Anatomical distributions included: head and neck (20 %), thorax and axilla (24 %), retroperitoneal (13 %), abdominopelvic (30 %) regions, and other (13 %). Complete surgical resection was performed in 95 % of patients with UCD. Surgical biopsy and medical therapy were provided to all patients with MCD. The recurrence rate for UCD and MCD was 6 % (n = 1) and 14 % (n = 1), respectively. The five-year disease-free survival rate for UCD was 95 % (n = 19) and MCD was 33 % (n = 2). We found 100 % survival in patients with UCD and histology demonstrating the HV variant. Conclusion CD is rare and often misdiagnosed due to the absence of specific clinical symptoms. Surgeons should include CD in their differential diagnoses when evaluating patients with lymph node hyperplasia. Surgery can be curative in nearly all patients with UCD. Patients with MCD require a combination of surgical therapy, chemotherapy, and immunotherapy; however, cytoreductive surgery benefits for patients with MCD have not been established.
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25
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Korbi AE, Jellali S, Jguiri M, Bellalah A, Ferjaoui M, Bouatay R, Kolsi N, Harrathi K, Koubaa J. Castelman's disease of the neck: a case report and literature review. Pan Afr Med J 2020; 37:369. [PMID: 33796182 PMCID: PMC7992414 DOI: 10.11604/pamj.2020.37.369.26909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/14/2020] [Indexed: 11/26/2022] Open
Abstract
Castleman’s disease is a rare pathology, poorly understood. It is considered as a lymphoproliferative disorder, described for the first time in 1954, which may be confused with other causes of lymphadenopathy. We report in this paper the case of a young women presenting with left latero-cervical lymphadenopathy. All the investigations were negative except a large high-vascularized level II cervical lymphadenopathy. We performed a cervicotomy. The extemporaneous histological exam was non-contributive. We decided to perform a complete level II and III left cervical lymphadenectomy. The diagnosis of unicentric Castleman's disease was confirmed based on the final histological study of the specimen, and the absence of other cervical and extra-cervical lymphadenopathy. The patient is free of recurrence at the time of reporting this article.
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Affiliation(s)
- Amel El Korbi
- ENT Department of Fattouma Bourguiba, University Hospital of Monastir, Monastir, Tunisia.,Research Unit "Quality and Security of care" (UR12SP41), University of Monastir, Monastir, Tunisia
| | - Sondes Jellali
- ENT Department of Fattouma Bourguiba, University Hospital of Monastir, Monastir, Tunisia
| | - Mahbouba Jguiri
- Department of Rheumatology, Fattouma Bourguiba University Hospital of Monastir, Monastir, Tunisia
| | - Ahlem Bellalah
- Anatomical and Cytological Pathology Department, Fattouma Bourguiba University Hospital of Monastir, Monastir, Tunisia
| | - Mehdi Ferjaoui
- ENT Department of Fattouma Bourguiba, University Hospital of Monastir, Monastir, Tunisia
| | - Rachida Bouatay
- ENT Department of Fattouma Bourguiba, University Hospital of Monastir, Monastir, Tunisia
| | - Naourez Kolsi
- ENT Department of Fattouma Bourguiba, University Hospital of Monastir, Monastir, Tunisia.,Research Unit "Quality and Security of care" (UR12SP41), University of Monastir, Monastir, Tunisia
| | - Khaled Harrathi
- ENT Department of Fattouma Bourguiba, University Hospital of Monastir, Monastir, Tunisia
| | - Jamel Koubaa
- ENT Department of Fattouma Bourguiba, University Hospital of Monastir, Monastir, Tunisia
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26
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Han EJ, O JH, Jung SE, Park G, Choi BO, Jeon YW, Min GJ, Cho SG. FDG PET/CT Findings of Castleman Disease Assessed by Histologic Subtypes and Compared with Laboratory Findings. Diagnostics (Basel) 2020; 10:diagnostics10120998. [PMID: 33255420 PMCID: PMC7761046 DOI: 10.3390/diagnostics10120998] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 01/09/2023] Open
Abstract
Castleman disease (CD) is a relatively rare lymphoproliferative disorder and the pathophysiology of the subtypes are incompletely understood. Fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) demonstrates the metabolic activity of inflammatory and tumorous conditions. The FDG uptake intensity and sites of involved lesions on FDG PET/CT were assessed by histologic subtypes, and compared to the patient's hemoglobin, platelet, albumin, and high-sensitivity C-reactive protein (hs-CRP) levels. In total, 60 PET/CT images of 44 consecutive CD patients were included: 4 (9%) unicentric and 40 (91%) multicentric; 21 (48%) hyaline vascular subtype, 16 (36%) plasma cell, and 7 (16%) mixed or unclassified. The maximum standardized uptake value (SUVmax) and tumor-to-liver (T/L) ratio of involved lymph nodes (LNs) were 5.3 ± 2.4 (range, 1.6-11.5) and 2.8 ± 1.6 (range, 1.1-9.6), respectively, with no significant difference between the histologic subtypes. Higher number of involved LN stations and presence of extra-nodal involvement on FDG PET/CT were associated with thrombocytopenia, hypoalbuminemia, and elevated hs-CRP levels (p values < 0.05). FDG-avidity was not different by histologic subtypes and did not correlate with laboratory findings. However, the extent of nodal and extra-nodal involvement as noted on FDG PET/CT was significantly associated with abnormal laboratory findings in patients with CD.
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Affiliation(s)
- Eun Ji Han
- Division of Nuclear Medicine, Department of Radiology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Joo Hyun O
- Division of Nuclear Medicine, Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
- Correspondence:
| | - Seung-Eun Jung
- Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Gyeongsin Park
- Department of Hospital Pathology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Byung-Ock Choi
- Department of Radiation Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Young-Woo Jeon
- Department of Hematology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Gi-June Min
- Department of Hematology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (G.-J.M.); (S.-G.C.)
| | - Seok-Goo Cho
- Department of Hematology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea; (G.-J.M.); (S.-G.C.)
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Lin J, Yu S, Wang R, Chen J. Multicentric Castleman's disease in a renal allograft recipient: a case report and literature review. J Int Med Res 2020; 48:300060519897481. [PMID: 32046545 PMCID: PMC7111022 DOI: 10.1177/0300060519897481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Giant lymph node hyperplasia is the main symptom of Castleman’s disease (CD), which is a rare and easily overlooked lymphoproliferative disease that mimics both benign and malignant lesions. Several cases of CD after renal transplantation have been reported in the literature. A 43-year-old man was admitted to our medical center with high serum globulin levels after receiving a living donor kidney transplant. A lymph node biopsy raised suspicion for multicentric CD. Because of the poor therapeutic effect of reduction of immunosuppression, the patient was treated with CHOP chemotherapy comprising four cycles of monthly cyclophosphamide (750 g/m2, day 1), vincristine (1.4 g/m2, day 1), doxorubicin (50 g/m2, day 1), and prednisone (60 mg/m2, daily). Following the treatment, his serum globulin levels decreased to the normal range. At the 2-year follow-up examination, the abdominal, axillary, and inguinal lymph nodes had significantly decreased in size. Without a pathological diagnosis, multicentric CD after renal transplantation can be easily ignored and misdiagnosed. If the clinical signs cannot be relieved by minimizing the dose of common immunosuppressants, the CHOP regimen may be a better option. Biological agents may be added in patients with positive immunohistochemistry staining and good economic conditions.
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Affiliation(s)
- Jinwen Lin
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou China
| | - Shiping Yu
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou China
| | - Rending Wang
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou China
| | - Jianghua Chen
- Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou China
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Overview of Castleman disease. Blood 2020; 135:1353-1364. [PMID: 32106302 DOI: 10.1182/blood.2019000931] [Citation(s) in RCA: 214] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/03/2020] [Indexed: 01/02/2023] Open
Abstract
Castleman disease (CD) describes a group of at least 4 disorders that share a spectrum of characteristic histopathological features but have a wide range of etiologies, presentations, treatments, and outcomes. CD includes unicentric CD (UCD) and multicentric CD (MCD), the latter of which is divided into idiopathic MCD (iMCD), human herpes virus-8 (HHV8)-associated MCD (HHV8-MCD), and polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, skin changes (POEMS)-associated MCD (POEMS-MCD). iMCD can be further subclassified into iMCD-thrombocytopenia, ascites, reticulin fibrosis, renal dysfunction, organomegaly (iMCD-TAFRO) or iMCD-not otherwise specified (iMCD-NOS). Advances in diagnosis, classification, pathogenesis, and therapy are substantial since the original description of UCD by Benjamin Castleman in 1954. The advent of effective retroviral therapy and use of rituximab in HHV8-MCD have improved outcomes in HHV8-MCD. Anti-interleukin-6-directed therapies are highly effective in many iMCD patients, but additional therapies are required for refractory cases. Much of the recent progress has been coordinated by the Castleman Disease Collaborative Network (CDCN), and further progress will be made by continued engagement of physicians, scientists, and patients. Progress can also be facilitated by encouraging patients to self-enroll in the CDCN's ACCELERATE natural history registry (#NCT02817997; www.CDCN.org/ACCELERATE).
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Wang J, Liang LJ, Wang YM, Mei ZY, Liu YZ, Liu LN, Fang BJ, Song YP. [Analysis of the clinicopathologic features as well as diagnosis and treatment of 59 patients with Castleman disease]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 41:666-670. [PMID: 32942821 PMCID: PMC7525172 DOI: 10.3760/cma.j.issn.0253-2727.2020.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Indexed: 12/12/2022]
Abstract
Objective: To investigate the clinicopathologic features, treatment, and prognosis in patients with Castleman disease (CD) . Methods: We retrospectively analyzed the clinicopathologic data of 59 patients for whom a diagnosis of Castleman disease was confirmed using pathological examination from October 2011 to October 2019 at the Henan Cancer Hospital. The patients were divided into the following two groups as per the following clinical classifications: unicentric CD (UCD, n=47) and multicentric CD (MCD, n=12) . Data on clinical manifestations, laboratory findings, treatment, and prognosis were analyzed. Results: There was no significant difference in the median age and the ratio of male to female between the UCD and MCD. UCD was characterized by asymptomatic enlargement of the single lymph node. The main pathological type was hyaline vascular histopathology (83.0%) . Of these, 44 patients chose surgical resection, and their prognosis was good. Treatment. MCD was characterized by multiple enlarged superficial and/or deep lymph nodes with B symptoms, weakness, and hepatosplenomegaly. Anemia, hypoproteinemia, and globulin level were increased on laboratory examinations. Plasmacyte histopathology was the main pathological type and was present in about 50.0% of the subjects. Only chemotherapy was performed for these MCD patients, followed by chemotherapy or chemotherapy followed by radiotherapy, and the efficient was 58.3% (7/12) . Conclusions: UCD, characterized by asymptomatic enlargement of the single lymph node, shows good postoperative prognosis. MCD has relatively complex clinical manifestations and poor prognosis, and optimal treatment is yet to be established.
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Affiliation(s)
- J Wang
- Department of Hematology, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China
| | - L J Liang
- Department of Hematology, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China
| | - Y M Wang
- Department of Hematology, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China
| | - Z Y Mei
- Department of Hematology, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China
| | - Y Z Liu
- Department of Hematology, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China
| | - L N Liu
- Department of Hematology, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China
| | - B J Fang
- Department of Hematology, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China
| | - Y P Song
- Department of Hematology, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China
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Nguyen H, Song JY. Mimickers of pulmonary lymphoma. Semin Diagn Pathol 2020; 37:283-295. [PMID: 32586652 DOI: 10.1053/j.semdp.2020.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 12/16/2022]
Abstract
There are multiple entities that involve the lung that have radiographic, clinical, and morphologic overlaps with pulmonary lymphoma. In this review, we will discuss these entities in detail and provide relevant updates.
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Affiliation(s)
- Ha Nguyen
- Department of Pathology, City of Hope, Duarte, CA, USA
| | - Joo Y Song
- Department of Pathology, City of Hope, Duarte, CA, USA.
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Excellent Outcomes with Surgery or Radiotherapy in the Management of Castleman Disease Including a Case of Oligocentric Disease. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:685-689. [PMID: 32522439 DOI: 10.1016/j.clml.2020.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Castleman disease (CD) is a rare polyclonal lymphoproliferative disorder of unclear etiology. Standard therapy for unicentric CD is surgical resection. Radiotherapy can be used; however, its efficacy is poorly characterized. PATIENTS AND METHODS We reviewed patients with histologically confirmed CD undergoing definitive local therapy at our institution between 1990 and 2017. Overall survival was determined from the date of diagnosis. Local progression-free survival and distant failure-free survival were determined from the date of first definitive therapy. The Kaplan-Meier method was used to analyze survival. RESULTS Forty-four patients (29 female and 15 male) were identified with a median age at diagnosis of 40 years (range, 14-70 years). Thirty-five (80%) patients received surgery alone, 3 (7%) had surgery followed by radiotherapy, and 6 (14%) had radiotherapy alone. Thirty-nine (89%) patients had a single area of involvement, and 3 (7%) patients had limited regional involvement. Two (5%) patients had multicentric CD and received consolidative radiotherapy. The 3-year overall, local progression-free, and distant failure-free survival were 92%, 100%, and 100%, respectively. No distant failures were observed. The median radiation dose was 3960 cGy (range, 3600-5940 cGy) in 22 fractions (range, 18-33 fractions). CONCLUSIONS Unicentric CD is readily amenable to cure with local therapy. Surgical excision is preferred, but radiation appears to be an effective alternative for patients when surgery is high risk or not feasible. Patients with oligo- or multi-centric CD may experience prolonged disease-free survival with consolidative radiotherapy after partial response to systemic therapy.
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Arenas DJ, Floess K, Kobrin D, Pai RAL, Srkalovic MB, Tamakloe MA, Rasheed R, Ziglar J, Khor J, Parente SAT, Pierson SK, Martinez D, Wertheim GB, Kambayashi T, Baur J, Teachey DT, Fajgenbaum DC. Increased mTOR activation in idiopathic multicentric Castleman disease. Blood 2020; 135:1673-1684. [PMID: 32206779 PMCID: PMC7205815 DOI: 10.1182/blood.2019002792] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 02/03/2020] [Indexed: 12/13/2022] Open
Abstract
Idiopathic multicentric Castleman disease (iMCD) is a rare and poorly understood hematologic disorder characterized by lymphadenopathy, systemic inflammation, cytopenias, and life-threatening multiorgan dysfunction. Interleukin-6 (IL-6) inhibition effectively treats approximately one-third of patients. Limited options exist for nonresponders, because the etiology, dysregulated cell types, and signaling pathways are unknown. We previously reported 3 anti-IL-6 nonresponders with increased mTOR activation who responded to mTOR inhibition with sirolimus. We investigated mTOR signaling in tissue and serum proteomes from iMCD patients and controls. mTOR activation was increased in the interfollicular space of iMCD lymph nodes (N = 26) compared with control lymph nodes by immunohistochemistry (IHC) for pS6, p4EBP1, and p70S6K, known effectors and readouts of mTORC1 activation. IHC for pS6 also revealed increased mTOR activation in iMCD compared with Hodgkin lymphoma, systemic lupus erythematosus, and reactive lymph nodes, suggesting that the mTOR activation in iMCD is not just a product of lymphoproliferation/inflammatory lymphadenopathy. Further, the degree of mTOR activation in iMCD was comparable to autoimmune lymphoproliferative syndrome, a disease driven by mTOR hyperactivation that responds to sirolimus treatment. Gene set enrichment analysis of serum proteomic data from iMCD patients (n = 88) and controls (n = 42) showed significantly enriched mTORC1 signaling. Finally, functional studies revealed increased baseline mTOR pathway activation in peripheral monocytes and T cells from iMCD remission samples compared with healthy controls. IL-6 stimulation augmented mTOR activation in iMCD patients, which was abrogated with JAK1/2 inhibition. These findings support mTOR activation as a novel therapeutic target for iMCD, which is being investigated through a trial of sirolimus (NCT03933904).
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Affiliation(s)
- Daniel J Arenas
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Katherine Floess
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Dale Kobrin
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ruth-Anne Langan Pai
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Maya B Srkalovic
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mark-Avery Tamakloe
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rozena Rasheed
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jasira Ziglar
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Johnson Khor
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sophia A T Parente
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sheila K Pierson
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Gerald B Wertheim
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; and
| | - Taku Kambayashi
- Department of Pathology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joseph Baur
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - David T Teachey
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; and
| | - David C Fajgenbaum
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Imen BI, Zenaidi H, Abdelwahed Y, Sabeur R, Ayoub Z. Management of isolated retroperitoneal Castelman's disease: A case report. Int J Surg Case Rep 2020; 70:24-27. [PMID: 32361607 PMCID: PMC7200444 DOI: 10.1016/j.ijscr.2020.03.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/14/2020] [Accepted: 03/27/2020] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Castleman's disease (CD) is a rare disorder characterized by benign angio follicular lymphoid hyperplasia, with gentle behavior. Its etiology and prevalence are unclear. It is usually found in the mediastinal area and it is rare to see this tumor in the retroperitoneum. PRESENTATION OF CASE A 53 year old male with a retroperitoneal hypervascular calcified mass densely adherent to the psoas muscle that was accidentally encountered on a CT scan. Provisional diagnosis of retroperitoneal liposarcoma was made and the patient underwent an exploratory laparotomy. The histologic examination of the surgically resected specimen disclosed « a hyaline type of Castleman's disease ». DISCUSSION Castleman's disease, is a rare heterogenous group of lymphoproliferative disorders that arises mostly in the mediastinum. The retroperitoneal localization is very rare. Clinically, CD can be subdivided into a localized form (unicentric disease) and a generalized form (multicentric disease) according to the number of lymph nodes involved. A careful histological and immunohistochemical examination of the tumor tissue after surgery is the only way for tumor diagnosis. CONCLUSION Castelman's disease is a rare entity that has often benign and non invasive behavior, but remains a diagnostic challenge. There is no reliable diagnostic method and its definitive diagnosis is based on histopathology report. For treating the unicentric variant, radical surgical resection is considered to be the gold standard.
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Affiliation(s)
- Ben Ismail Imen
- Department of General Surgery, Trauma and Burns Center, Ben Arous, Tunisia.
| | - Hakim Zenaidi
- Department of General Surgery, Trauma and Burns Center, Ben Arous, Tunisia.
| | - Yahmadi Abdelwahed
- Department of General Surgery, Trauma and Burns Center, Ben Arous, Tunisia.
| | - Rebii Sabeur
- Department of General Surgery, Trauma and Burns Center, Ben Arous, Tunisia.
| | - Zoghlami Ayoub
- Department of General Surgery, Trauma and Burns Center, Ben Arous, Tunisia.
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Xiao-dong L, Qiu-xu W, Wei-xian L. Castleman Disease of the Parotid Gland: A Case Report. J Oral Maxillofac Surg 2020; 78:400.e1-400.e6. [DOI: 10.1016/j.joms.2019.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/05/2019] [Accepted: 11/12/2019] [Indexed: 12/23/2022]
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35
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Singh U, Nayak M, Singh S, Shenoy KR. Castleman's disease in an adolescent. APOLLO MEDICINE 2020. [DOI: 10.4103/am.am_47_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Raboso E, Barberá R, Guimaraens L, Solorzano JL, Delgado-Vargas B. Castleman's disease as an unusual cause for dysphagia and dyspnea in a pediatric patient. Int J Pediatr Otorhinolaryngol 2019; 125:164-167. [PMID: 31326733 DOI: 10.1016/j.ijporl.2019.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/14/2019] [Accepted: 07/14/2019] [Indexed: 10/26/2022]
Abstract
Castleman's disease is a very rare entity in pediatric population and its presentation in the neck is scarcely described in the literature. We present the case of a 10-year-old-girl with an expanding neck mass over several months causing dysphagia and dyspnea. Surgical excision of the mass was performed and the analysis revealed unicentric Castleman's Disease. This is the second largest reported case of neck pediatric CD in the literature, and it presented with a symptomatology that differs from the other cases described. This fact highlights the need to include CD in the differential diagnosis of pediatric neck masses.
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Affiliation(s)
- Eduardo Raboso
- Otolaryngology Department, MD Anderson Cancer Center Madrid, Spain
| | - Rafael Barberá
- Otolaryngology Department, MD Anderson Cancer Center Madrid, Spain
| | - Leopoldo Guimaraens
- Endovascular and Percutaneous Therapeutic Department, Hospital Nuestra Señora del Rosario, Madrid, Spain
| | | | - Beatriz Delgado-Vargas
- Otolaryngology Department, MD Anderson Cancer Center Madrid, Spain; Otolaryngology Department, Hospital Universitario de Torrejón, Torrejón de Ardoz, Spain.
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Bhogal RH, Wotherspoon A, Khan AK. Mesenteric Castleman's disease mimicking neuroendocrine tumour. Int J Surg Case Rep 2019; 63:56-58. [PMID: 31563665 PMCID: PMC6796708 DOI: 10.1016/j.ijscr.2019.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 08/02/2019] [Accepted: 09/04/2019] [Indexed: 11/20/2022] Open
Abstract
Mesenteric Castleman’s disease is a rare pathology. It should be included in the differential for abdominal lymphadenopathy. Patients have an excellent prognosis after resection.
Introduction Castleman’s disease is a rare entity and is a benign hyperplastic enlargement of lymph nodes. It can occur anywhere within the body but only approximately 50 cases of mesenteric Castleman’s disease have been reported within the literature. Case presentation We report a female patient who was thought to have developed a neuroendocrine tumour within the small bowel and a large nodal mass within the mesentery based on nuclear scintigraphy imaging. Following surgical resection the nodal mass found confirmed to be Castleman’s disease. Discussion Although rare complete resection of mesenteric Castleman’s disease offer excellent long term outcome although the diagnosis may only be made after surgery. Conclusion The diagnosis of mesenteric Castleman’s disease is often made post-operatively but complete surgical resection offers excellent long-term survival.
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Affiliation(s)
- Ricky H Bhogal
- Department of Academic Surgery, The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, United Kingdom.
| | - Andrew Wotherspoon
- Department of Histopathology, The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, United Kingdom
| | - Aamir K Khan
- Department of Academic Surgery, The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, United Kingdom
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Abstract
The thymus is a dynamic organ that undergoes changes throughout life and can demonstrate a myriad of pathologic alterations. A number of benign entities of the thymus prove to be diagnostic dilemmas owing to their resemblance and association with true thymic tumors. These are usually discovered incidentally on routine imaging and most patients are either asymptomatic or present with signs and symptoms of compression of adjacent organs. The radiologic appearance of these lesions varies from simple cysts to complex masses that are suspicious for malignancy. The diagnosis is usually made purely on morphologic grounds, however, immunohistochemical stains can help rule out possible differential diagnoses. Surgical removal is usually curative in these lesions and recurrences are rare. The prognosis is excellent, however, some of these lesions may be associated with myasthenia gravis and/or thymomas. In this review, we describe non-neoplastic lesions and benign tumoral lesions of the thymus, with emphasis on the clinical, radiologic, and pathologic features. The differential diagnosis of each entity is also discussed.
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Choi DL, Brannock K, Tang AL. Castleman Disease Presenting as a Parapharyngeal Mass: A Case Report and Review of the Literature. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2019; 12:1179547619853799. [PMID: 31258339 PMCID: PMC6591652 DOI: 10.1177/1179547619853799] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 05/08/2019] [Indexed: 11/23/2022]
Abstract
Objectives: Masses in the parapharyngeal space often pose a diagnostic and therapeutic
challenge due to an inaccessible location for biopsy and proximity to
critical neurovascular structures of the neck. The aims of this study are to
describe a rare case of Castleman disease (CD) presenting in the
parapharyngeal space. Methods: Case report of a 38-year-old male presenting to a tertiary care center and
literature review. Results & conclusions: The parapharyngeal space is an unusual location for CD. Surgeons,
radiologists, and pathologists must be aware of this disease entity within
the differential diagnosis to provide appropriate perioperative counseling
for patients.
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Affiliation(s)
- David Leo Choi
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kristina Brannock
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Alice L Tang
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Abstract
Castleman disease (CD) is divided clinically into unicentric or multicentric type. Pathologically, CD is divided into hyaline-vascular and plasma cell variants. Unicentric CD is most common, about 75% of these cases are hyaline-vascular variant, and surgical excision is often curative. In contrast, there are a number of types of multicentric CD including HHV8-associated, idiopathic, and a subset of cases that arise in association with POEMS syndrome. Therapy is required for most patients with multicentric CD, but there is no consensus approach currently. As is evidence, the designation Castleman disease encompasses a heterogeneous group of diseases of varied pathogenesis and which require different therapies.
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Affiliation(s)
- Wei Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Boutboul D, Fadlallah J, Chawki S, Fieschi C, Malphettes M, Dossier A, Gérard L, Mordant P, Meignin V, Oksenhendler E, Galicier L. Treatment and outcome of Unicentric Castleman Disease: a retrospective analysis of 71 cases. Br J Haematol 2019; 186:269-273. [DOI: 10.1111/bjh.15921] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/26/2019] [Indexed: 01/10/2023]
Affiliation(s)
- David Boutboul
- Department of Clinical Immunology Hôpital Saint‐Louis Assistance Publique Hôpitaux de Paris (APHP) Paris France
- National Reference Centre for Castleman Disease (CRMdC) Paris France
- UMR1149 CRI INSERM‐Université Paris Diderot Paris France
- Université Paris Diderot, Paris 7 Paris France
| | - Jehane Fadlallah
- Department of Clinical Immunology Hôpital Saint‐Louis Assistance Publique Hôpitaux de Paris (APHP) Paris France
- Université Paris Diderot, Paris 7 Paris France
| | - Sylvain Chawki
- Department of Clinical Immunology Hôpital Saint‐Louis Assistance Publique Hôpitaux de Paris (APHP) Paris France
| | - Claire Fieschi
- Department of Clinical Immunology Hôpital Saint‐Louis Assistance Publique Hôpitaux de Paris (APHP) Paris France
- Université Paris Diderot, Paris 7 Paris France
- Inserm U1126 Centre Hayem Hôpital Saint‐Louis Paris France
| | - Marion Malphettes
- Department of Clinical Immunology Hôpital Saint‐Louis Assistance Publique Hôpitaux de Paris (APHP) Paris France
- EA3518 Université Paris Diderot, Paris 7 Paris France
| | - Antoine Dossier
- Department of Internal Medicine Hôpital Bichat Assistance Publique Hôpitaux de Paris (APHP) Paris France
| | - Laurence Gérard
- Department of Clinical Immunology Hôpital Saint‐Louis Assistance Publique Hôpitaux de Paris (APHP) Paris France
- National Reference Centre for Castleman Disease (CRMdC) Paris France
- EA3518 Université Paris Diderot, Paris 7 Paris France
| | - Pierre Mordant
- Université Paris Diderot, Paris 7 Paris France
- INSERM UMR‐S1152 Hôpital BichatUniversité Paris Diderot, Paris 7 Paris France
- Division of Thoracic and vascular surgery Hôpital Bichat Paris France
| | - Véronique Meignin
- National Reference Centre for Castleman Disease (CRMdC) Paris France
- Department of Pathology Hôpital Saint‐Louis Assistance Publique Hôpitaux de Paris (APHP) Paris France
| | - Eric Oksenhendler
- Department of Clinical Immunology Hôpital Saint‐Louis Assistance Publique Hôpitaux de Paris (APHP) Paris France
- National Reference Centre for Castleman Disease (CRMdC) Paris France
- Université Paris Diderot, Paris 7 Paris France
- EA3518 Université Paris Diderot, Paris 7 Paris France
| | - Lionel Galicier
- Department of Clinical Immunology Hôpital Saint‐Louis Assistance Publique Hôpitaux de Paris (APHP) Paris France
- National Reference Centre for Castleman Disease (CRMdC) Paris France
- EA3518 Université Paris Diderot, Paris 7 Paris France
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Carolus A, Schroers R, Tischoff I, Schmieder K, Brenke C. Rare finding in peripheral nerve surgery: an unicentric Castleman disease presenting as median nerve tumour. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2018; 5:68-71. [PMID: 30397634 PMCID: PMC6211252 DOI: 10.1080/23320885.2018.1525301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 09/14/2018] [Indexed: 11/30/2022]
Abstract
A 51 year old man presented with progressive swelling in the upper arm. MRI revealed a solitary mass extending from the median nerve. Intraoperative finding was a tumour extending within the nerve in its proximal fibres. The histological result showed a Castleman disease.
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Affiliation(s)
- Anne Carolus
- Department of Neurosurgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Roland Schroers
- Department of Hematology and Oncology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Iris Tischoff
- Department of Pathology, University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Kirsten Schmieder
- Department of Neurosurgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Christopher Brenke
- Department of Neurosurgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany
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C G RR, B S. Castleman disease: Case series of two surgical patients from different ends of the disease spectrum with literature review. Int J Surg Case Rep 2018; 53:163-167. [PMID: 30399511 PMCID: PMC6216084 DOI: 10.1016/j.ijscr.2018.10.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/14/2018] [Indexed: 12/12/2022] Open
Abstract
Castleman disease: heterogeneous group of hyperimmune lymphoproliferative disorders. Unicentric type: localized disease; surgery is primary treatment; good prognosis. Multicentric type: Serious systemic disease; 70% linked to HHV8; antiviral therapy. Idiopathic Multicentric type: diagnosis by exclusion; Interleukin-6 blockade useful.
Castleman Disease (CD) is a rare, heterogeneous group of hyperimmune lymphoproliferative disorders, not very familiar to surgeons. Unicentric Castleman Disease (UCCD) at one end of the spectrum is a localized disease, with little or no systemic symptoms. It may be an incidental radiological finding or detected while investigating for a symptomatic lymph node mass. Surgery is the primary treatment and has good long term prognosis. Multicentric Castleman Disease (MCCD) is a more serious systemic condition, often associated with constitutional symptoms. Exaggerated systemic inflammatory response secondary to “Cytokine storm” involving Interleukin-6 (IL-6) may cause multi-organ dysfunction. In addition, immunosuppression or malignant transformation can prove lethal. Human Herpes Simplex Virus 8 (HHV8) associated MCCD is a major subgroup occurring in immunocompromised individuals due to the viral trigger. Antiviral therapy is important in its treatment. Idiopathic MCCD (IMCCD) has no known biomarker and is diagnosed after excluding infective, autoimmune and malignant conditions of lymphoid tissue. IMCCD requires systemic therapy. We report a patient of UCCD who presented as a retroperitoneal mass in right iliac fossa causing pressure on femoral nerve. Following successful surgical excision she had good recovery. We report another patient who had large inguinal lymph node mass with constitutional symptoms. IMCCD was diagnosed after excision biopsy and comprehensive work up. Patient was started on corticosteroids followed by CD-20 targeted therapy. These two cases showcase the two ends of the clinical spectrum of CD requiring different management protocols. Awareness among surgeons and diligent work-up is imperative for early diagnosis and best outcome.
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Affiliation(s)
| | - Suresh B
- Goa Medical College, Bambolim, Goa, 403202, India.
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Kapriniotis K, Lampridis S, Mitsos S, Patrini D, Lawrence DR, Panagiotopoulos N. Biologic Agents in the Treatment of Multicentric Castleman Disease. Turk Thorac J 2018; 19:220-225. [PMID: 30455994 DOI: 10.5152/turkthoracj.2018.18066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 08/07/2018] [Indexed: 01/09/2023]
Abstract
Multicentric Castleman disease (MCD) causes an extensive range of systematic symptoms and can be life-threatening if not treated promptly and appropriately. The pathophysiology of the disease remains unclear; however, interleukin 6 (IL-6) pathway and human herpesvirus 8 infection appear to play an important role. As a result, the treatment of MCD remains complex and often insufficient, although a plethora of therapeutic approaches have been used. Between these, biological agents in the form of monoclonal antibodies against specific pathogenic processes of the disease have improved survival rates significantly. In the present study, we review the clinical results of rituximab, which targets B lymphocytes, siltuximab and tocilizumab, which target the IL-6 pathway, bortezomib, which is a selective proteasome inhibitor, and anakinra, which is an interleukin 1 receptor antagonist. The introduction of these biological agents in the treatment of MCD appears to be promising in the first studies performed. However, more clinical trials are required to assess the efficacy and safety of each agent and to form therapeutic strategies that will be widely accepted.
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Affiliation(s)
- Konstantinos Kapriniotis
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Savvas Lampridis
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sofoklis Mitsos
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Davide Patrini
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - David R Lawrence
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Nikolaos Panagiotopoulos
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Nordin AB, Nordin AD, Ranalli MA, Kenney BD. Castleman's disease requiring repeat surgical excision. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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International, evidence-based consensus treatment guidelines for idiopathic multicentric Castleman disease. Blood 2018; 132:2115-2124. [PMID: 30181172 DOI: 10.1182/blood-2018-07-862334] [Citation(s) in RCA: 231] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 08/22/2018] [Indexed: 02/08/2023] Open
Abstract
Castleman disease (CD) describes a group of heterogeneous hematologic disorders with characteristic histopathological features. CD can present with unicentric or multicentric (MCD) regions of lymph node enlargement. Some cases of MCD are caused by human herpesvirus-8 (HHV-8), whereas others are HHV-8-negative/idiopathic (iMCD). Treatment of iMCD is challenging, and outcomes can be poor because no uniform treatment guidelines exist, few systematic studies have been conducted, and no agreed upon response criteria have been described. The purpose of this paper is to establish consensus, evidence-based treatment guidelines based on the severity of iMCD to improve outcomes. An international Working Group of 42 experts from 10 countries was convened by the Castleman Disease Collaborative Network to establish consensus guidelines for the management of iMCD based on published literature, review of treatment effectiveness for 344 cases, and expert opinion. The anti-interleukin-6 monoclonal antibody siltuximab (or tocilizumab, if siltuximab is not available) with or without corticosteroids is the preferred first-line therapy for iMCD. In the most severe cases, adjuvant combination chemotherapy is recommended. Additional agents are recommended, tailored by disease severity, as second- and third-line therapies for treatment failures. Response criteria were formulated to facilitate the evaluation of treatment failure or success. These guidelines should help treating physicians to stratify patients based on disease severity in order to select the best available therapeutic option. An international registry for patients with CD (ACCELERATE, #NCT02817997) was established in October 2016 to collect patient outcomes to increase the evidence base for selection of therapies in the future.
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Jhan J, Li C, Wu W, Lee H. Isolated retroperitoneal Castleman's disease: A case report and literature review. Clin Case Rep 2018; 6:1543-1548. [PMID: 30147901 PMCID: PMC6099000 DOI: 10.1002/ccr3.1654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/01/2018] [Accepted: 06/02/2018] [Indexed: 12/15/2022] Open
Abstract
Unicentric Castleman's disease (CD) may rarely present as an isolated retroperitoneal tumor. Even experienced surgeons may misdiagnose CD because of its rarity. Surgeons should consider this disease when faced with an isolated retroperitoneal tumor. Unicentric CD is usually cured with surgical resection. In contrast, multicentric CD need numerous systemic therapies.
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Affiliation(s)
- Jhen‐Hao Jhan
- Department of UrologySchool of MedicineCollege of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
- Department of UrologyKaohsiung Medical University HospitalKaohsiungTaiwan
| | - Ching‐Chia Li
- Department of UrologySchool of MedicineCollege of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
- Department of UrologyKaohsiung Medical University HospitalKaohsiungTaiwan
- Department of UrologyKaohsiung Municipal Ta‐Tung HospitalKaohsiungTaiwan
- Graduate Institute of MedicineCollege of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
| | - Wen‐Jeng Wu
- Department of UrologySchool of MedicineCollege of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
- Department of UrologyKaohsiung Medical University HospitalKaohsiungTaiwan
- Department of UrologyKaohsiung Municipal Ta‐Tung HospitalKaohsiungTaiwan
- Graduate Institute of MedicineCollege of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
| | - Hsiang‐Ying Lee
- Department of UrologySchool of MedicineCollege of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
- Department of UrologyKaohsiung Medical University HospitalKaohsiungTaiwan
- Department of UrologyKaohsiung Municipal Ta‐Tung HospitalKaohsiungTaiwan
- Graduate Institute of MedicineCollege of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
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Wala SJ, Fallon EM, Forlenza CJ, Shukla N, LaQuaglia MP. Unicentric Castleman disease in the mediastinum. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Lan X, Li Z, Zhang M. Analysis of clinical characteristics and prognosis factors of 71 cases with HIV-negative Castleman's disease: hypoproteinemia is an unfavorable prognostic factor which should be treated appropriately. J Cancer Res Clin Oncol 2018; 144:1265-1277. [PMID: 29736622 DOI: 10.1007/s00432-018-2647-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/19/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE HIV negative Castleman's disease has been reported as a group of poorly understood lymphoproliferative disorder, and we want to explore the clinical feature and prognosis factors of CD. METHODS We retrospectively collected the clinical information of 71 CD patients without HIV infection diagnosed in the first affiliated hospital of Zhengzhou university. RESULTS Different clinical classifications, including 35 patients (49.30%) with unicentric Castleman disease and 36 (50.7%) with multicentric Castleman disease, has their specific features compared with each other and unfavorable risk factors calculated by the univariate analysis. As for all of CD patients without HIV infection, there were 7 significant risk factors identified by the results of log-rank test, including clinical complaint, edema (hydrothorax, ascites, pelvic effusion), fatigue, anemia, hypoproteinemia and elevated serum β2-MG. Then, we created a Cox regression model of these clinical and statistic significant factors which indicated hypoproteinemia was an independent poor prognosis factors of CD in both univariate and multivariate analysis. CONCLUSIONS Our study emphasized the distinction of clinical characteristics between UCD and MCD and the importance of different poor risk factors of different clinical classifications which may directed more precise and appropriate treatment strategy.
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Affiliation(s)
- Xuan Lan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, No 1 Jianshe St., Erqi District, Zhengzhou, 450052, China
| | - Zhaoming Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, No 1 Jianshe St., Erqi District, Zhengzhou, 450052, China
| | - Mingzhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, No 1 Jianshe St., Erqi District, Zhengzhou, 450052, China.
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Multicentric Castleman's disease in human immunodeficiency virus infection: two case reports. J Med Case Rep 2018; 12:117. [PMID: 29728131 PMCID: PMC5935983 DOI: 10.1186/s13256-018-1656-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 03/18/2018] [Indexed: 11/22/2022] Open
Abstract
Background Castleman’s Disease is a rare B-cell lymphoproliferative disease. It is mostly benign and is characterized by non-neoplastic lymph node hypertrophy, associated with infection by human herpesvirus-8 in people with the human immunodeficiency virus/acquired immunodeficiency syndrome. Although the unicentric or localized form presents as benign, the multifocal form can manifest severe systemic symptoms. We report two unusual cases of men presenting cervical enlarged lymph nodes that were believed to be infectious. Case presentation The first case is a 41-year-old feoderm man who presented to the Department of Infectious Diseases of the Hospital das Clínicas in May 2015, with irregular fever history (38–39 °C), dyspnea, weight loss (8 kg/1 year), and asthenia with increased cervical lymph nodes of 1-year duration. His immunohistochemical diagnosis presented Castleman’s disease in plasmacytic/diffuse form. In the second case, a 35-year-old feoderm man presented at the same hospital with multiple cervical enlarged lymph nodes and histopathological evidence of Castleman’s disease associated with human herpesvirus-8. Conclusion Considering the importance of differential diagnosis of lymphoid disorders, Castleman’s disease is a challenging diagnosis in people living with human immunodeficiency virus/acquired immunodeficiency syndrome and can be easily misdiagnosed when lymphoid disorders are present in the human immunodeficiency virus/acquired immunodeficiency syndrome population due to nonspecific symptoms and signs.
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