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Franquet T, Franks TJ, Lee KS, Marchiori E, Mazzini S, Giménez A, Johkoh T, Cho J, Galvin JR. Human Oncoviruses and Thoracic Tumors: Understanding the Imaging Findings. Radiographics 2022; 42:644-660. [PMID: 35363552 DOI: 10.1148/rg.210157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Approximately 1.4 million virus-induced cancers occur annually, representing roughly 10% of the cancer burden worldwide. Seven oncogenic DNA and RNA viruses (ie, oncoviruses) are implicated in approximately 12%-25% of all human cancers owing to a variety of mechanisms as uncommon consequences of the normal viral life cycle. These seven well-recognized human oncoviruses are Epstein-Barr virus (EBV), human T-lymphotropic virus 1, hepatitis B virus, hepatitis C virus, HIV, human papilloma virus (HPV), and human herpesvirus 8 (HHV-8). Several viruses-namely, EBV, HPV, and Kaposi sarcoma herpesvirus or HHV-8-are increasingly being recognized as being related to HIV and/or AIDS, the growing number of transplant cases, and the use of immunosuppressive therapies. Infectious and inflammatory processes, and the accompanying lymphadenopathy, are great mimickers of human oncovirus-related tumors. Although it is often difficult to differentiate these entities, the associated clinical setting and radiologic findings may provide clues for an accurate diagnosis and appropriate management. Malignant lymphoid lesions are best evaluated with multidetector chest CT. The radiologic findings of these lesions are often nonspecific and are best interpreted in correlation with clinical data and histopathologic findings. ©RSNA, 2022.
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Affiliation(s)
- Tomás Franquet
- From the Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, C/ Sant Quintí 89, 08041, Barcelona, Spain (T.F., S.M., A.G.); Department of Pulmonary and Mediastinal Pathology, Department of Defense, the Joint Pathology Center, Silver Spring, Md, and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (T.J.F.); Department of Radiology, Samsung ChangWon Hospital, Sungkyunkwan University School of Medicine (SKKU-SOM), ChangWon, Gyeongsangnam-Do, Korea (K.S.L.); Department of Radiology, Hospital Universitário Clementino Fraga Filho-Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil (E.M.); Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (J.C.); and Departments of Diagnostic Radiology and Internal Medicine, University of Maryland School of Medicine, Baltimore, Md (J.R.G.)
| | - Teri J Franks
- From the Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, C/ Sant Quintí 89, 08041, Barcelona, Spain (T.F., S.M., A.G.); Department of Pulmonary and Mediastinal Pathology, Department of Defense, the Joint Pathology Center, Silver Spring, Md, and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (T.J.F.); Department of Radiology, Samsung ChangWon Hospital, Sungkyunkwan University School of Medicine (SKKU-SOM), ChangWon, Gyeongsangnam-Do, Korea (K.S.L.); Department of Radiology, Hospital Universitário Clementino Fraga Filho-Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil (E.M.); Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (J.C.); and Departments of Diagnostic Radiology and Internal Medicine, University of Maryland School of Medicine, Baltimore, Md (J.R.G.)
| | - Kyung Soo Lee
- From the Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, C/ Sant Quintí 89, 08041, Barcelona, Spain (T.F., S.M., A.G.); Department of Pulmonary and Mediastinal Pathology, Department of Defense, the Joint Pathology Center, Silver Spring, Md, and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (T.J.F.); Department of Radiology, Samsung ChangWon Hospital, Sungkyunkwan University School of Medicine (SKKU-SOM), ChangWon, Gyeongsangnam-Do, Korea (K.S.L.); Department of Radiology, Hospital Universitário Clementino Fraga Filho-Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil (E.M.); Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (J.C.); and Departments of Diagnostic Radiology and Internal Medicine, University of Maryland School of Medicine, Baltimore, Md (J.R.G.)
| | - Edson Marchiori
- From the Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, C/ Sant Quintí 89, 08041, Barcelona, Spain (T.F., S.M., A.G.); Department of Pulmonary and Mediastinal Pathology, Department of Defense, the Joint Pathology Center, Silver Spring, Md, and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (T.J.F.); Department of Radiology, Samsung ChangWon Hospital, Sungkyunkwan University School of Medicine (SKKU-SOM), ChangWon, Gyeongsangnam-Do, Korea (K.S.L.); Department of Radiology, Hospital Universitário Clementino Fraga Filho-Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil (E.M.); Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (J.C.); and Departments of Diagnostic Radiology and Internal Medicine, University of Maryland School of Medicine, Baltimore, Md (J.R.G.)
| | - Sandra Mazzini
- From the Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, C/ Sant Quintí 89, 08041, Barcelona, Spain (T.F., S.M., A.G.); Department of Pulmonary and Mediastinal Pathology, Department of Defense, the Joint Pathology Center, Silver Spring, Md, and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (T.J.F.); Department of Radiology, Samsung ChangWon Hospital, Sungkyunkwan University School of Medicine (SKKU-SOM), ChangWon, Gyeongsangnam-Do, Korea (K.S.L.); Department of Radiology, Hospital Universitário Clementino Fraga Filho-Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil (E.M.); Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (J.C.); and Departments of Diagnostic Radiology and Internal Medicine, University of Maryland School of Medicine, Baltimore, Md (J.R.G.)
| | - Ana Giménez
- From the Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, C/ Sant Quintí 89, 08041, Barcelona, Spain (T.F., S.M., A.G.); Department of Pulmonary and Mediastinal Pathology, Department of Defense, the Joint Pathology Center, Silver Spring, Md, and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (T.J.F.); Department of Radiology, Samsung ChangWon Hospital, Sungkyunkwan University School of Medicine (SKKU-SOM), ChangWon, Gyeongsangnam-Do, Korea (K.S.L.); Department of Radiology, Hospital Universitário Clementino Fraga Filho-Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil (E.M.); Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (J.C.); and Departments of Diagnostic Radiology and Internal Medicine, University of Maryland School of Medicine, Baltimore, Md (J.R.G.)
| | - Takeshi Johkoh
- From the Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, C/ Sant Quintí 89, 08041, Barcelona, Spain (T.F., S.M., A.G.); Department of Pulmonary and Mediastinal Pathology, Department of Defense, the Joint Pathology Center, Silver Spring, Md, and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (T.J.F.); Department of Radiology, Samsung ChangWon Hospital, Sungkyunkwan University School of Medicine (SKKU-SOM), ChangWon, Gyeongsangnam-Do, Korea (K.S.L.); Department of Radiology, Hospital Universitário Clementino Fraga Filho-Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil (E.M.); Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (J.C.); and Departments of Diagnostic Radiology and Internal Medicine, University of Maryland School of Medicine, Baltimore, Md (J.R.G.)
| | - Junhun Cho
- From the Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, C/ Sant Quintí 89, 08041, Barcelona, Spain (T.F., S.M., A.G.); Department of Pulmonary and Mediastinal Pathology, Department of Defense, the Joint Pathology Center, Silver Spring, Md, and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (T.J.F.); Department of Radiology, Samsung ChangWon Hospital, Sungkyunkwan University School of Medicine (SKKU-SOM), ChangWon, Gyeongsangnam-Do, Korea (K.S.L.); Department of Radiology, Hospital Universitário Clementino Fraga Filho-Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil (E.M.); Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (J.C.); and Departments of Diagnostic Radiology and Internal Medicine, University of Maryland School of Medicine, Baltimore, Md (J.R.G.)
| | - Jeffrey R Galvin
- From the Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, C/ Sant Quintí 89, 08041, Barcelona, Spain (T.F., S.M., A.G.); Department of Pulmonary and Mediastinal Pathology, Department of Defense, the Joint Pathology Center, Silver Spring, Md, and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (T.J.F.); Department of Radiology, Samsung ChangWon Hospital, Sungkyunkwan University School of Medicine (SKKU-SOM), ChangWon, Gyeongsangnam-Do, Korea (K.S.L.); Department of Radiology, Hospital Universitário Clementino Fraga Filho-Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil (E.M.); Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (J.C.); and Departments of Diagnostic Radiology and Internal Medicine, University of Maryland School of Medicine, Baltimore, Md (J.R.G.)
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Wang T, Chen X, Chen W, Shi L, Liu J. A retrospective study of 44 patients with head and neck Castleman's disease. Eur Arch Otorhinolaryngol 2021; 279:2625-2630. [PMID: 34480599 DOI: 10.1007/s00405-021-07065-0] [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: 08/03/2021] [Accepted: 08/28/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To explore the clinical and pathological features, therapy and prognosis of Castleman's disease (CD) in the head and neck. METHODS We retrospectively analyzed the clinical and pathological data of 44 patients with head and neck CD who were diagnosed in the Fujian Medical University Union hospital (Fujian, China) between May 2008 and June 2021. According to the clinical classification, they were divided into two groups, the unicentric CD (UCD, n = 20) and the multicentric CD (MCD, n = 24). Their clinical features, imaging findings, laboratory examination, and treatment results were, respectively, analyzed. RESULTS The age of UCD patients was younger than that of MCD patients. Most of the UCD patients (80%) were female, with asymptomatic single lymphadenectasis, and the prognosis was favorable; while 70.8% of the MCD patients were male, with multiple lymph nodes throughout the body, and more prone to hepatosplenomegaly, pneumonia, serous effusion, anemia, hypoalbuminemia, elevated globulin, coagulation disorders, etc., the prognosis was bleak. Two cases of MCD patients were with systemic lupus erythematosus (SLE). CONCLUSIONS UCD usually manifests as asymptomatic single lymph node enlargement, complete surgical resection was the mainstay of treatment modality. MCD has relatively complicated clinical symptoms and poor prognosis, and anti-IL-6 therapy may be effective.
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Affiliation(s)
- Taiqin Wang
- Department of Otolaryngology, Fujian Medical University Union Hospital, 29# Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Xiaoqiang Chen
- Department of Otolaryngology, Fujian Medical University Union Hospital, 29# Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Wei Chen
- Department of Otolaryngology, Fujian Medical University Union Hospital, 29# Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Liangwen Shi
- Department of Otolaryngology, Fujian Medical University Union Hospital, 29# Xinquan Road, Fuzhou, 350001, Fujian, China
| | - Jianzhi Liu
- Department of Otolaryngology, Fujian Medical University Union Hospital, 29# Xinquan Road, Fuzhou, 350001, Fujian, China.
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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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Haap M, Wiefels J, Horger M, Hoyer A, Müssig K. Clinical, laboratory and imaging findings in Castleman's disease - The subtype decides. Blood Rev 2018; 32:225-234. [PMID: 29223447 DOI: 10.1016/j.blre.2017.11.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 11/21/2017] [Accepted: 11/28/2017] [Indexed: 01/09/2023]
Abstract
Castleman's disease (CD) is a rare lymphoproliferative disorder with its distinct unicentric (uCD) and multicentric (mCD) entities. The present work aimed at characterizing CD in more detail. From the 775 articles found by a PubMed search, 1133 cases were extracted. Two own cases were included. UCD was identified in 719 (42% males) and mCD in 416 (63% males) cases. Age in uCD was 34±17 and in mCD 48±18years. The hyaline-vascular type predominated in uCD and the plasma cell type in mCD. Clinical symptoms were more common in mCD. The head and neck region was most frequently affected in uCD and the axillary region in mCD. Prevalence of human immunodeficiency virus (HIV) and human herpesvirus-8 (HHV-8) positivity was higher in mCD. In CT scans, high contrast enhancement and calcifications were more frequent in uCD (all p<0.0001). The two forms of CD not only differ markedly in their clinical, laboratory and imaging findings, but also in treatment response and prognosis.
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Affiliation(s)
- Michael Haap
- Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Tübingen, Germany; Department of Internal Medicine, Endocrinology und Diabetology, Angiology, Nephrology and Clinical Chemistry, University of Tübingen, Tübingen, Germany
| | - Julia Wiefels
- Department of Internal Medicine, Endocrinology und Diabetology, Angiology, Nephrology and Clinical Chemistry, University of Tübingen, Tübingen, Germany
| | - Marius Horger
- Department of Radiology, University of Tübingen, Tübingen, Germany
| | - Annika Hoyer
- Institute for Biometry and Epidemiology, German Diabetes Center, Leibniz Center of Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), München, Neuherberg, Germany
| | - Karsten Müssig
- German Center for Diabetes Research (DZD), München, Neuherberg, Germany; Divison of Endocrinology und Diabetology, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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Oksenhendler E, Boutboul D, Fajgenbaum D, Mirouse A, Fieschi C, Malphettes M, Vercellino L, Meignin V, Gérard L, Galicier L. The full spectrum of Castleman disease: 273 patients studied over 20 years. Br J Haematol 2018; 180:206-216. [PMID: 29143319 DOI: 10.1111/bjh.15019] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/19/2017] [Indexed: 12/16/2022]
Abstract
The spectrum of Castleman disease (CD) has considerably extended since its first description in 1956. Recently, an international collaborative working group has reached consensus on the diagnostic criteria and classification of CD. We herein report 273 patients with lymph node histopathology consistent with CD and investigate the newly established diagnostic criteria. Twenty of these patients with Castleman-like histopathology were removed from analyses, because they were diagnosed with an exclusionary disorder (18 with haematological malignancy). Among the 253 remaining patients, 57 were considered unicentric CD (UCD), 169 were multicentric CD associated with Human Herpesvirus 8 (HHV-8+MCD), including 140 patients with human immunodeficiency virus (HIV) infection and 29 patients without HIV infection, and 27 were HHV-8 negative/idiopathic multicentric CD (iMCD). 2-(18 F)fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography was useful in 62 patients for staging/classification of the disease and for excluding associated lymphoma. UCD was mainly associated with hyaline-vascular histopathological features, and most patients were asymptomatic. Of the 27 patients that we had originally diagnosed with iMCD, 26 met the newly established diagnostic criteria. Patients with iMCD and HHV-8+ MCD demonstrated similar characteristics, including fever, splenomegaly, cytopenia and inflammatory symptoms. However, the disease was more aggressive in HHV-8+ MCD, particularly in HIV-infected patients.
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Affiliation(s)
- Eric Oksenhendler
- Department of Clinical Immunology, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
- EA3518, Université Paris Diderot Paris 7, Paris, France
- National Reference Centre for Castleman Disease (CRMdC), Paris, France
| | - 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
| | - David Fajgenbaum
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Adrien Mirouse
- 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
- National Reference Centre for Castleman Disease (CRMdC), Paris, France
- Inserm U1126, Centre Hayem, Hôpital Saint-Louis, Paris, France
- Université Paris Diderot Paris 7, Paris, France
| | - Marion Malphettes
- Department of Clinical Immunology, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
- National Reference Centre for Castleman Disease (CRMdC), Paris, France
- Inserm U1126, Centre Hayem, Hôpital Saint-Louis, Paris, France
| | - Laetitia Vercellino
- Department of Nuclear Medicine, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP), 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
| | - Laurence Gérard
- Department of Clinical Immunology, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
- EA3518, Université Paris Diderot Paris 7, Paris, France
- National Reference Centre for Castleman Disease (CRMdC), Paris, France
| | - Lionel Galicier
- Department of Clinical Immunology, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
- EA3518, Université Paris Diderot Paris 7, Paris, France
- National Reference Centre for Castleman Disease (CRMdC), Paris, France
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Kligerman SJ, Auerbach A, Franks TJ, Galvin JR. Castleman Disease of the Thorax: Clinical, Radiologic, and Pathologic Correlation: From the Radiologic Pathology Archives. Radiographics 2017; 36:1309-32. [PMID: 27618318 DOI: 10.1148/rg.2016160076] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Castleman disease is a complex lymphoproliferative disease pathologically divided into two subtypes, the hyaline vascular variant (HVV) and the plasma cell variant (PCV). The HVV is the most common, is thought to represent a benign neoplasm of lymph node stromal cells, and is treated with surgical resection. It is most commonly found in the mediastinum, where it classically appears as a unicentric, avidly enhancing mass at computed tomography (CT) and magnetic resonance imaging. This appearance can mimic other avidly enhancing mediastinal masses, and location, clinical history, laboratory data, and nuclear medicine single photon emission CT (SPECT) and positron emission tomography (PET) studies can help narrow the differential diagnosis. Multicentric Castleman disease (MCD), which in the majority of cases is composed of the PCV, is an aggressive lymphoproliferative disorder associated with human herpesvirus infection, interleukin 6 dysregulation, and other systemic disorders. While it can be difficult to differentiate MCD from lymphoma, the presence of avidly enhancing lymph nodes can suggest the diagnosis. The purpose of this article is to review the clinical, immunologic, and pathologic findings associated with both unicentric Castleman disease and MCD and discuss how the imaging findings correlate with the pathophysiology of the disease.
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Affiliation(s)
- Seth J Kligerman
- From the Department of Diagnostic Radiology and Nuclear Medicine, Division of Chest Imaging (S.J.K., J.R.G.), and Department of Internal Medicine, Division of Pulmonary/Critical Care (J.R.G.), University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; Department of Hematopathology (A.A.) and Department of Pulmonary and Mediastinal Pathology (T.J.F.), the Joint Pathology Center, Department of Defense, Defense Health Agency, Silver Spring, Md; and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
| | - Aaron Auerbach
- From the Department of Diagnostic Radiology and Nuclear Medicine, Division of Chest Imaging (S.J.K., J.R.G.), and Department of Internal Medicine, Division of Pulmonary/Critical Care (J.R.G.), University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; Department of Hematopathology (A.A.) and Department of Pulmonary and Mediastinal Pathology (T.J.F.), the Joint Pathology Center, Department of Defense, Defense Health Agency, Silver Spring, Md; and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
| | - Teri J Franks
- From the Department of Diagnostic Radiology and Nuclear Medicine, Division of Chest Imaging (S.J.K., J.R.G.), and Department of Internal Medicine, Division of Pulmonary/Critical Care (J.R.G.), University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; Department of Hematopathology (A.A.) and Department of Pulmonary and Mediastinal Pathology (T.J.F.), the Joint Pathology Center, Department of Defense, Defense Health Agency, Silver Spring, Md; and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
| | - Jeffrey R Galvin
- From the Department of Diagnostic Radiology and Nuclear Medicine, Division of Chest Imaging (S.J.K., J.R.G.), and Department of Internal Medicine, Division of Pulmonary/Critical Care (J.R.G.), University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; Department of Hematopathology (A.A.) and Department of Pulmonary and Mediastinal Pathology (T.J.F.), the Joint Pathology Center, Department of Defense, Defense Health Agency, Silver Spring, Md; and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
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Ikeura T, Horitani S, Masuda M, Kasai T, Yanagawa M, Miyoshi H, Uchida K, Takaoka M, Miyasaka C, Uemura Y, Okazaki K. IgG4-related Disease Involving Multiple Organs with Elevated Serum Interleukin-6 Levels. Intern Med 2016; 55:2623-8. [PMID: 27629957 DOI: 10.2169/internalmedicine.55.6919] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 63-year-old woman presented to our hospital with elevated levels of serum IgG4, marked wall thickening of the gallbladder, hepatomegaly, and abdominal lymphadenopathy. She experienced a recurrent fever and leg edema. Her laboratory data demonstrated anemia, hypoalbuminemia, and elevated serum levels of interleukin-6 and C-reactive protein. The patient was eventually diagnosed with IgG4-related disease according to the comprehensive diagnostic criteria, although the patient exhibited common clinical manifestations of multicentric Castleman disease such as a fever, anemia, lymphadenopathy, and elevated levels of serum interleukin-6 and C-reactive protein. This case report highlights the difficulties in differentiating between these two diseases.
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Affiliation(s)
- Tsukasa Ikeura
- The Third Department of Internal Medicine, Kansai Medical University, Japan
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Polizzotto MN, Millo C, Uldrick TS, Aleman K, Whatley M, Wyvill KM, O'Mahony D, Marshall V, Whitby D, Maass-Moreno R, Steinberg SM, Little RF, Yarchoan R. 18F-fluorodeoxyglucose Positron Emission Tomography in Kaposi Sarcoma Herpesvirus-Associated Multicentric Castleman Disease: Correlation With Activity, Severity, Inflammatory and Virologic Parameters. J Infect Dis 2015; 212:1250-60. [PMID: 25828248 PMCID: PMC4577043 DOI: 10.1093/infdis/jiv204] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/13/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Kaposi sarcoma herpesvirus (KSHV)-associated multicentric Castleman disease (MCD) is a lymphoproliferative inflammatory disorder commonly associated with human immunodeficiency virus (HIV). Its presentation may be difficult to distinguish from HIV and its complications, including lymphoma. Novel imaging strategies could address these problems. METHODS We prospectively characterized (18)F-fluorodeoxyglucose positron emission tomography (PET) findings in 27 patients with KSHV-MCD. Patients were imaged with disease activity and at remission with scans evaluated blind to clinical status. Symptoms, C-reactive protein level, and HIV and KSHV loads were assessed in relation to imaging findings. RESULTS KSHV-MCD activity was associated with hypermetabolic symmetric lymphadenopathy (median maximal standardized uptake value [SUVmax], 6.0; range, 2.0-8.0) and splenomegaly (3.4; 1.2-11.0), with increased metabolism also noted in the marrow (2.1; range, 1.0-3.5) and salivary glands (3.0; range, 2.0-6.0). The (18)F-fluorodeoxyglucose PET abnormalities improved at remission, with significant SUVmax decreases in the lymph nodes (P = .004), spleen (P = .008), marrow (P = .004), and salivary glands (P = .004). Nodal SUVmax correlated with symptom severity (P = .005), C-reactive protein level (R = 0.62; P = .004), and KSHV load (R = 0.54; P = .02) but not HIV load (P = .52). CONCLUSIONS KSHV-MCD activity is associated with (18)F-FDG PET abnormalities of the lymph nodes, spleen, marrow, and salivary glands. These findings have clinical implications for the diagnosis and monitoring of KSHV-MCD and shed light on its pathobiologic mechanism.
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Affiliation(s)
| | - Corina Millo
- Positron Emission Tomography Department, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda
| | | | | | - Millie Whatley
- Positron Emission Tomography Department, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda
| | | | | | - Vickie Marshall
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Cancer Laboratory for Cancer Research, Maryland
| | - Denise Whitby
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Cancer Laboratory for Cancer Research, Maryland
| | - Roberto Maass-Moreno
- Positron Emission Tomography Department, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda
| | - Seth M. Steinberg
- Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute
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9
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Pfenning AR, Hara E, Whitney O, Rivas MV, Wang R, Roulhac PL, Howard JT, Wirthlin M, Lovell PV, Ganapathy G, Mouncastle J, Moseley MA, Thompson JW, Soderblom EJ, Iriki A, Kato M, Gilbert MTP, Zhang G, Bakken T, Bongaarts A, Bernard A, Lein E, Mello CV, Hartemink AJ, Jarvis ED. Convergent transcriptional specializations in the brains of humans and song-learning birds. Science 2014; 346:1256846. [PMID: 25504733 DOI: 10.1126/science.1256846] [Citation(s) in RCA: 285] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Song-learning birds and humans share independently evolved similarities in brain pathways for vocal learning that are essential for song and speech and are not found in most other species. Comparisons of brain transcriptomes of song-learning birds and humans relative to vocal nonlearners identified convergent gene expression specializations in specific song and speech brain regions of avian vocal learners and humans. The strongest shared profiles relate bird motor and striatal song-learning nuclei, respectively, with human laryngeal motor cortex and parts of the striatum that control speech production and learning. Most of the associated genes function in motor control and brain connectivity. Thus, convergent behavior and neural connectivity for a complex trait are associated with convergent specialized expression of multiple genes.
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Affiliation(s)
- Andreas R Pfenning
- Department of Neurobiology, Howard Hughes Medical Institute, and Duke University Medical Center, Durham, NC 27710, USA.
| | - Erina Hara
- Department of Neurobiology, Howard Hughes Medical Institute, and Duke University Medical Center, Durham, NC 27710, USA
| | - Osceola Whitney
- Department of Neurobiology, Howard Hughes Medical Institute, and Duke University Medical Center, Durham, NC 27710, USA
| | - Miriam V Rivas
- Department of Neurobiology, Howard Hughes Medical Institute, and Duke University Medical Center, Durham, NC 27710, USA
| | - Rui Wang
- Department of Neurobiology, Howard Hughes Medical Institute, and Duke University Medical Center, Durham, NC 27710, USA
| | - Petra L Roulhac
- Department of Neurobiology, Howard Hughes Medical Institute, and Duke University Medical Center, Durham, NC 27710, USA
| | - Jason T Howard
- Department of Neurobiology, Howard Hughes Medical Institute, and Duke University Medical Center, Durham, NC 27710, USA
| | - Morgan Wirthlin
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, USA
| | - Peter V Lovell
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, USA
| | - Ganeshkumar Ganapathy
- Department of Neurobiology, Howard Hughes Medical Institute, and Duke University Medical Center, Durham, NC 27710, USA
| | - Jacquelyn Mouncastle
- Department of Neurobiology, Howard Hughes Medical Institute, and Duke University Medical Center, Durham, NC 27710, USA
| | - M Arthur Moseley
- Duke Proteomics and Metabolomics Core Facility, Center for Genomic and Computational Biology, Duke University Medical Center, Durham, NC 27710, USA
| | - J Will Thompson
- Duke Proteomics and Metabolomics Core Facility, Center for Genomic and Computational Biology, Duke University Medical Center, Durham, NC 27710, USA
| | - Erik J Soderblom
- Duke Proteomics and Metabolomics Core Facility, Center for Genomic and Computational Biology, Duke University Medical Center, Durham, NC 27710, USA
| | - Atsushi Iriki
- Laboratory for Symbolic Cognitive Development, Brain Science Institute, RIKEN, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - Masaki Kato
- Laboratory for Symbolic Cognitive Development, Brain Science Institute, RIKEN, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - M Thomas P Gilbert
- Centre for GeoGenetics, Natural History Museum of Denmark, University of Copenhagen, 1350 Copenhagen, Denmark. Trace and Environmental DNA Laboratory, Department of Environment and Agriculture, Curtin University, Perth, Western Australia 6102, Australia
| | - Guojie Zhang
- China National GeneBank, BGI-Shenzhen, Shenzhen 518083, China. Centre for Social Evolution, Department of Biology, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Trygve Bakken
- Allen Institute for Brain Science, Seattle, WA 98103, USA
| | | | - Amy Bernard
- Allen Institute for Brain Science, Seattle, WA 98103, USA
| | - Ed Lein
- Allen Institute for Brain Science, Seattle, WA 98103, USA
| | - Claudio V Mello
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, USA
| | | | - Erich D Jarvis
- Department of Neurobiology, Howard Hughes Medical Institute, and Duke University Medical Center, Durham, NC 27710, USA.
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10
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What a differential a virus makes: a practical approach to thoracic imaging findings in the context of HIV infection--part 2, extrapulmonary findings, chronic lung disease, and immune reconstitution syndrome. AJR Am J Roentgenol 2012; 198:1305-12. [PMID: 22623542 DOI: 10.2214/ajr.11.8004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The Centers for Disease Control and Prevention reported more than one million people with HIV infection in the United States in 2006, an increase of 11% over 3 years. Worldwide, nearly 34 million people are infected with HIV. Pulmonary disease accounts for 30-40% of acute hospitalizations of HIV-seropositive patients, underscoring the importance of understanding the range of cardiothoracic imaging findings associated with HIV infection. This article will cover extrapulmonary thoracic diseases, chronic lung diseases, and immune reconstitution inflammatory syndrome in HIV-infected patients. Our approach is focused on the radiologist's perspective by recognizing and categorizing key imaging findings to generate a differential diagnosis. The differential diagnosis can be further refined by incorporating clinical data, such as patient demographics, CD4 count, and presenting symptoms. In addition, with prolonged survival of HIV-infected patients in the era of highly active antiretroviral therapy, radiologists can also benefit from awareness of imaging features of a myriad of chronic cardiopulmonary diseases in this patient population. Finally, the change of imaging findings and clinical status in response to treatment provides important diagnostic information, such as in immune reconstitution syndrome. CONCLUSION Developing a practical approach to key cardiothoracic imaging findings in HIV-infected patients will aid the radiologist in generating a clinically relevant differential diagnosis and interpretation, thereby improving patient care.
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11
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Abstract
OBJECTIVES We undertook a systematic review of 404 published cases of Castleman's disease to identify the role of the surgeon beyond assistance in tissue-based diagnosis. BACKGROUND Castleman's disease is a rare primary disease of the lymph node caused by infection with herpesviridae. Little is known about the role of surgery in this condition. DATA SOURCES Medline, Embase, Cochrane Database of Systematic Reviews, ISI Thompson Web of Knowledge, and hand search of articles' bibliography. STUDY SELECTION Of the 1791 citations identified through the initial electronic search and screened for possible inclusion, 488 articles were retained after title and abstract reviews. Of these, 239 were accepted for this review. DATA EXTRACTION A complete dataset containing age, gender, centricity (unicentric vs multicentric), histopathologic type (hyaline vascular [HV] vs plasma cell [PC]), anatomical location of the only focus in unicentric Castleman's disease (UCD) or the dominant focus in multicentric Castleman's disease (MCD), nature of the surgical approach (resective vs diagnostic), and outcome (disease-free survival [DFS] vs death due to disease) was extracted. RESULTS A resective or debulking surgical approach was described in 77.0% of all patients, but was far more common in unicentric (262/278; 94.2%) than multicentric (49/126; 38.9%) disease (χ² 146.8; P < 0.0001). Unicentric disease had a significantly higher overall survival (95.3% vs 61.1%; χ² 55.7; P < 0.0001), 3 year DFS (89.7% vs 55.6%; χ² 27.8; P < 0.0001), and 5 year DFS (81.2% vs 34.4%; χ² 28.6; P < 0.0001) than multicentric disease. Failure to treat unicentric disease by resective surgery resulted in a significant mortality (17.6% vs 3.8% χ²; P < 0.05). In multicentric disease, outcomes are comparable between debulking surgery alone, immunochemotherapy alone, or a combination of both (28.0% vs 28.9% vs 50.0%; P = nonsignificant). CONCLUSIONS Surgery is the gold standard for treatment of unicentric Castelman's disease. The role of debulking surgery in human immunodeficiency virus (-) MCD needs to be evaluated in prospective studies.
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12
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What a Differential a Virus Makes: A Practical Approach to Thoracic Imaging Findings in the Context of HIV Infection??? Part 1, Pulmonary Findings. AJR Am J Roentgenol 2012; 198:1295-304. [DOI: 10.2214/ajr.11.8003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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13
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Abstract
Kaposi's sarcoma (KS), a low-grade malignancy that is associated with human herpesvirus-8 (HHV-8), is a multifocal tumor that most commonly affects mucocutaneous sites. It might also involve lymph nodes and visceral organs, in particular of the respiratory and gastrointestinal tract, but it can affect every organ system. Four forms of the disease have been recognized: the classic, the endemic, the transplant-associated, and the epidemic form. The endemic form, or African KS, currently accounts for 10%-50% of all cancers in adults and up to 25% of cancers in children in certain parts of Africa. The epidemic form or acquired immune deficiency syndrome (AIDS)-associated KS is a frequent neoplasm in bisexual and homosexual men with AIDS in the United States. Even though in North America and Europe the incidence of KS in men with AIDS has decreased significantly after the introduction of highly active antiretroviral therapy (HAART), in some developing countries, the incidence of KS keeps growing. The pathophysiology, clinical manifestations, imaging findings, and more relevant differential diagnoses are reviewed.
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Affiliation(s)
- Carlos S Restrepo
- Department of Radiology, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
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14
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Restrepo CS, Chen MM, Martinez-Jimenez S, Carrillo J, Restrepo C. Chest neoplasms with infectious etiologies. World J Radiol 2011; 3:279-88. [PMID: 22224176 PMCID: PMC3251813 DOI: 10.4329/wjr.v3.i12.279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 09/19/2011] [Accepted: 10/11/2011] [Indexed: 02/06/2023] Open
Abstract
A wide spectrum of thoracic tumors have known or suspected viral etiologies. Oncogenic viruses can be classified by the type of genomic material they contain. Neoplastic conditions found to have viral etiologies include post-transplant lymphoproliferative disease, lymphoid granulomatosis, Kaposi’s sarcoma, Castleman’s disease, recurrent respiratory papillomatosis, lung cancer, malignant mesothelioma, leukemia and lymphomas. Viruses involved in these conditions include Epstein-Barr virus, human herpes virus 8, human papillomavirus, Simian virus 40, human immunodeficiency virus, and Human T-lymphotropic virus. Imaging findings, epidemiology and mechanism of transmission for these diseases are reviewed in detail to gain a more thorough appreciation of disease pathophysiology for the chest radiologist.
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16
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Abstract
HIV-associated plasmablastic multicentric Castleman disease is an increasingly frequent diagnosis. Kaposi sarcoma herpesvirus is found in the monotypic polyclonal plasmablasts that characterize this disease. Unlike Kaposi sarcoma, the incidence does not correlate with CD4 cell count or use of highly active antiretroviral therapy. It is a relapsing and remitting illness, and diagnostic criteria are emerging that define disease activity based on the presence of a fever and raised C-reactive protein coupled with a list of clinical features. Treatment protocols increasingly stratify therapy according to performance status and organ involvement. I advocate rituximab monotherapy for good performance status patients without organ involvement and rituximab with chemotherapy for more aggressive disease. The success of antiherpesvirus agents in controlling active disease is limited, but valganciclovir may have a role as maintenance therapy in the future.
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17
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FDG-PET/CT imaging in the management of HIV-associated multicentric Castleman’s disease. Eur J Nucl Med Mol Imaging 2008; 36:648-52. [DOI: 10.1007/s00259-008-0998-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Accepted: 10/17/2008] [Indexed: 12/26/2022]
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18
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Parker MS. Multicentric hyaline-vascular Castleman's disease. Clin Radiol 2007; 62:707-10. [PMID: 17556043 DOI: 10.1016/j.crad.2007.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Revised: 02/01/2007] [Accepted: 02/04/2007] [Indexed: 12/14/2022]
Affiliation(s)
- M S Parker
- Medical College of Virginia Hospitals-VCU Health Systems, Richmond, Virginia, USA.
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19
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Guihot A, Couderc LJ, Rivaud E, Galicier L, Bossi P, Oksenhendler E, Scherrer A. Thoracic Radiographic and CT Findings of Multicentric Castleman Disease in HIV-infected Patients. J Thorac Imaging 2007; 22:207-11. [PMID: 17527132 DOI: 10.1097/01.rti.0000213560.48291.08] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Multicentric HIV-related Castleman disease (MCD) is a rare and severe disorder of lymphoid tissue inducing high-grade fever, hepatosplenomegaly, and diffuse peripheral lymphadenopathy. During clinical exacerbations, bilateral interstitial pneumonia may occur. In this pictorial essay, we describe different thoracic imaging of MCD, with particular emphasis on computed tomography findings, in 13 HIV-infected patients with histologically proved MCD.
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Affiliation(s)
- Amélie Guihot
- Service de Pneumologie, Hôpital Foch, Suresnes, France.
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20
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Abstract
Because there are more than one million Americans with HIV, intensive care units continue to see frequent patients with HIV infection. In the era of highly active antiretroviral therapy, clinicians must be aware of drug toxicities and drug interactions. They must also recognize traditional opportunistic infections, as well as newer syndromes such as immune reconstitution syndrome, multicentric Castleman's disease, and primary pleural cell lymphoma.
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Affiliation(s)
- Henry Masur
- Chief, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA.
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21
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Grubb JR, Moorman AC, Baker RK, Masur H. The changing spectrum of pulmonary disease in patients with HIV infection on antiretroviral therapy. AIDS 2006; 20:1095-107. [PMID: 16691060 DOI: 10.1097/01.aids.0000226949.64600.f9] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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22
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Bacon CM, Miller RF, Noursadeghi M, McNamara C, Du MQ, Dogan A. Pathology of bone marrow in human herpes virus-8 (HHV8)-associated multicentric Castleman disease. Br J Haematol 2004; 127:585-91. [PMID: 15566362 DOI: 10.1111/j.1365-2141.2004.05230.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Human herpes virus-8 (HHV8)-associated multicentric Castleman disease (MCD) is an unusual systemic lymphoid hyperplasia induced by HHV8-infected B cells. Most cases develop in the background of human immunodeficiency virus (HIV) infection. Despite the haematological problems at presentation and the difficulties in the initial diagnosis, the bone marrow appearances of MCD have not been described. In this study we examined the pathology of bone marrow in MCD with a view to identify the features that may be helpful in early diagnosis. Bone marrow aspirates and biopsies from 13 cases of MCD (11 of which were HIV+) and 66 control bone marrow biopsies from HIV-infected cases were studied. The specimens were routinely processed and stained. Immunohistochemistry for HHV8, immunoglobulin light chains, B-cell and plasma-cell markers was performed. The most important features were the presence of characteristic MCD lymphoid follicles containing HHV8+ plasmablasts in three of 13 cases of MCD and scattered interstitial HHV8+ plasmablasts in 11 of 13 cases. In control cases, no such follicles were seen and interstitial HHV8+ plasmablasts were rarely detected (four of 66 cases). Our results suggest that the presence of HHV8+ plasmablasts within lymphoid follicles and/or interstitium of the bone marrow are helpful features for the early diagnosis of MCD.
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Affiliation(s)
- Chris M Bacon
- Department of Histopathology, Royal Free and University College Medical School, London, UK
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