Apoptosis of T cells in multicentric Castleman's disease

Optic neuropathy associated with Castleman disease

A 44-year-old woman with Castleman disease presented with acute visual loss in the left eye. A full ophthalmologic examination and imaging were performed. Visual acuity was 20/20 in the right eye and 20/100 in the left eye. Total dyschromatopsia, a relative afferent pupillary defect, and a cecocentral scotoma were observed in the left eye. Mild disc edema, without leaking during fluorescein angiography, was also observed. Magnetic resonance imaging revealed a small cystic epidermoid-like lesion in the right prepontine and suprasellar cistern. Her visual acuity did not improve and deteriorated to 20/200 in the left eye at 22 months after the initial visual loss. Optic neuropathy may rarely be associated with Castleman disease and suggests a poor prognosis.

Hyaline-vascular type Castleman's disease involving both orbits

PURPOSE

To describe a patient with hyaline-vascular type Castleman's disease (CD) whose initial examination revealed only upper eyelid mass. Further, to review all aspects of CD.

METHODS

Case report. An 18-year-old woman initially presented with swelling of both upper eyelids. She underwent an anterior orbitotomy with surgical excision followed by close observation.

RESULTS

Histopathological examination of the upper eyelid mass confirmed the presence of hyaline-vascular type CD. One year after surgical treatment, the patient is still asymptomatic, with no pathologic clinical or laboratory findings.

CONCLUSIONS

Castleman's disease is a rare but valid clinical entity. It should be considered in the differential diagnosis of asymptomatic orbital mass. Our understanding of CD has advanced recently. The treatment modalities for CD (e.g. surgical excision, radiation therapy and combination chemotherapy) are usually curative and optimizing. Castleman's disease involving the orbital area is now attracting ophthalmological interest.

The heterogeneity of Castleman disease: report of five cases and review of the literature

Castleman disease (CD; angiofollicular lymphoid hyperplasia) is a heterogeneous group of lymphoproliferative disorders of uncertain cause. Three histologic variants (hyaline vascular, plasma cell, and mixed) and two clinical types (localized and multicentric) of CD have been described. We report 5 cases of CD treated in our institute and review the literature about the management of this relatively rare disorder. Localized and multicentric CD may be different clinical disorders with overlapping histologic features. Localized disease generally presented with a single enlarged lymph node or widening of the mediastinum, whereas multicentric disease is a systemic lymphoproliferative disorder characterized by lymphadenopathy, hepatosplenomegaly, constitutional symptoms, anemia, hypoalbuminemia, and hypergammaglobulinemia. Unlike the localized type, for which surgical excision is curative regardless of the histologic type, multicentric disease often necessitates aggressive systemic therapy and portends a poorer outcome.