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Shrestha AL, Mishra A, Khadka S, Dhakhwa R. Retroperitoneal Castleman's disease in a young Nepalese girl: A rare cause of childhood abdominal mass. Ann Med Surg (Lond) 2024; 86:1080-1084. [PMID: 38333308 PMCID: PMC10849377 DOI: 10.1097/ms9.0000000000001579] [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: 08/16/2023] [Accepted: 11/22/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction Castleman's disease (CD), or benign angio-follicular lymph node hyperplasia, is an uncommon condition in childhood. When a child presents with a huge retroperitoneal mass and inconclusive findings on clinico-radiological evaluation or tissue sampling, management becomes exceedingly difficult. CD herein becomes an uncommon presentation of an uncommon diagnosis. Case presentation A six-year-old girl with no past medical problems presented to the office with a slowly progressive, painless mass over the right lumbar region for a year. Abdominal ultrasound showed a well-defined oval mass in the right periumbilical region, further evaluation of which with a computed tomography scan suggested lymphoma. A preoperative core-cut biopsy could not confirm the findings and suggested a neoplastic lesion, probably an inflammatory myofibroblastic tumour or small round cell tumour. She underwent an exploratory laparotomy with in-toto excision of the mass. Intraoperatively, a solid retroperitoneal tumour measuring 8×8×6 cm was found. Histopathology and immunohistochemistry confirmed a unicentric CD of the hyaline-vascular type. At two years of follow-up, she remained asymptomatic and disease-free. Conclusion While CD in children is rare, retroperitoneal localization of the same can further add to the diagnostic conundrum. However, if carefully considered, an en-bloc surgical resection offers complete treatment.
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Affiliation(s)
| | - Aakash Mishra
- Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
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Irrera M, Bozzola E, Cardoni A, DeVito R, Diociaiuti A, Hachem ME, Girardi K, Marchesi A, Villani A. Paraneoplastic pemphigus and Castleman's disease: a case report and a revision of the literature. Ital J Pediatr 2023; 49:33. [PMID: 36941723 PMCID: PMC10029234 DOI: 10.1186/s13052-023-01442-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/08/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND In literature, a few reports described an association between paraneoplastic pemphigus (PNP) and Castelman's disease (CD), but no consensus have been proposed for the diagnostic-therapeutical approach. Aim of this study is to present a case report and explore the relationship between PNP and CD in pediatric patients, focusing on clinical manifestations, histopathological findings, treatment and outcome to find elements for an early diagnosis. CASE PRESENTATION We present the clinical case of a 13 years old girl with a challenging diagnosis of PNP and CD who underwent therapy at first with Rituximab and then with Siltuximab, for the control of symptoms. CONCLUSIONS Reviewing literature, 20 clinical cases have been described in the pediatric age. Diagnosis may be challenging, requiring an average of 3 months (range from 3 weeks to 2 years). In all cases, the initial manifestations were mucocutaneous lesions, especially oral lesions with poor response to conventional treatment. Systemic symptoms may be present as well. Therapeutical approach is still discussed with no consensus. Almost all patients received corticosteroids with poor response. Other drugs including azathioprine, methotrexate, cyclosporine and monoclonal antibodies have been evaluated for the control of the disease. Further studies and experimental trials urge to define the diagnostic criteria and therapy protocol.
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Affiliation(s)
| | - Elena Bozzola
- Pediatric Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy.
| | - Antonello Cardoni
- Unity of Pathology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Rita DeVito
- Unity of Pathology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Andrea Diociaiuti
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Maya El Hachem
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Katia Girardi
- Department of Pediatric Hematology/Oncology and Cell and Gene Therapy, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Alberto Villani
- Pediatric Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
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Tagliati C, Rizzetto G, Lanni G, Marcucci M, Argalia G, Lucidi Pressanti G, Simonetti O, Offidani A. Thoracoabdominal computed tomography neoplasia detection in patients with paraneoplastic pemphigus: the importance of collaboration between specialists. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2022. [DOI: 10.15570/actaapa.2022.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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18F-FDG PET/CT in Follicular Dendritic Cell Sarcoma With Paraneoplastic Pemphigus as the First Manifestation. Clin Nucl Med 2020; 45:572-574. [PMID: 32371617 DOI: 10.1097/rlu.0000000000003065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
A 48-year-old woman presented with refractory oral ulcers and skin rashes on the palms and trunk, diagnosed as paraneoplastic pemphigus. The chest x-ray revealed a mass in the right lower chest, and the F-FDG PET/CT scan showed the lesion in the right anterior-inferior mediastinum with intense F-FDG uptake, accompanied by right parasternal adenopathy and pleural effusion. The surgical pathology proved a follicular dendritic cell sarcoma, with right parasternal lymph node metastasis.
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Srivastava H, Reddy DS, Shah SN, Shah V. Castleman's disease. J Oral Maxillofac Pathol 2020; 24:593. [PMID: 33967527 PMCID: PMC8083446 DOI: 10.4103/jomfp.jomfp_283_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/01/2020] [Accepted: 09/05/2020] [Indexed: 01/06/2023] Open
Abstract
Castleman's disease, a type of lymph node hyperplasia, usually occurs in the mediastinum and rarely presents in the cervical region as an asymptomatic solitary mass. Clinically, they are of two types-solitary and multi-centric. Most of the solitary types are asymptomatic with no associated symptoms, whereas the multi-centric type is associated with systemic symptoms and has a poor prognosis. Histologically, they can be classified as-Hyaline vascular, plasma cell, transitional and stromal rich type. We report a case of Castleman's disease involving the submandibular lymph node in a 75-year-old male patient whose definitive diagnosis was made only on histological examination. Isolated Castleman's disease of the submandibular node is rare and a thorough clinical and histological examination is necessary to rule out the systemic form of the disease and other diseases with manifestations as a cervical lymph node enlargement.
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Affiliation(s)
- Himanshu Srivastava
- Department of Oral and Maxillofacial Pathology and Microbiology, Aditya Dental College, Beed, Maharashtra, India
| | - Dulganti Santosh Reddy
- Department of Oral and Maxillofacial Pathology and Microbiology, Aditya Dental College, Beed, Maharashtra, India
| | - Shreyas N Shah
- Department of Oral and Maxillofacial Pathology and Microbiology, K.M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Vandana Shah
- Department of Oral and Maxillofacial Pathology and Microbiology, K.M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
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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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Han SP, Fu LS, Chen LJ. Masked pemphigus among pediatric patients with Castleman’s disease. Int J Rheum Dis 2018; 22:121-131. [DOI: 10.1111/1756-185x.13407] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 06/05/2018] [Accepted: 09/14/2018] [Indexed: 01/18/2023]
Affiliation(s)
- Shu-Ping Han
- Department of Pediatrics; Taichung Veterans General Hospital; Taichung Taiwan
| | - Lin-Shien Fu
- Department of Pediatrics; Taichung Veterans General Hospital; Taichung Taiwan
- Department of Pediatrics; National Yang-Ming University; Taipei Taiwan
| | - Lu-Jen Chen
- Department of Pathology; Taichung Veterans General Hospital; Taichung Taiwan
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Bracale U, Pacelli F, Milone M, Bracale UM, Sodo M, Merola G, Troiani T, Di Salvo E. Laparoscopic treatment of abdominal unicentric castleman's disease: a case report and literature review. BMC Surg 2017; 17:38. [PMID: 28403848 PMCID: PMC5389156 DOI: 10.1186/s12893-017-0238-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 04/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background Castleman’s disease is a rare lymphoproliferative disorder of unknown etiology that most commonly presents as a mediastinal nodal mass. It is exceptionally uncommon for Castleman’s disease to present in the mesentery and, only 53 cases have ever been described in the literature. Standard treatment for this lymphoproliferative disorder involving a single node is a complete “en bloc” surgical resection which has proven to be a curative approach in almost all cases without recurrence after 20 years of follow up. All 53 reported cases of mesenteric Castleman’s disease, except one, were treated with laparotomy. Case presentation We report on a case of mesenteric Castleman’s disease localized in the mesentery which is the second reported case if its kind and was treated by a laparoscopic-assisted procedure. Our female patient had an uneventful postoperative course and was discharged in the 5th post-operative day. No signs of recurrence were present as evidenced by physical examination and total body CT scan 24 months after the operation. We compare our case with the other reported cases in which Castleman’s disease presented as an isolated mass in the abdomen. Conclusion Although a rare disease, Unicentric Castleman’s disease should always be considered when a solid asymptomatic abdominal mass is occasionally presented. The laparoscopic approach (LA) allows for the achievement of better results than open surgery, including a reduction in postoperative pain and length of hospital stay. In cases of masses of an uncertain nature, LA must be considered the last diagnostic tool and the first treatment one.
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Affiliation(s)
- Umberto Bracale
- Department of Surgical Specialities and Nefrology, University "Federico II" of Naples, Via Pansini, 5, Naples, 80100, Italy.
| | - Francesco Pacelli
- Department of Surgical Specialities and Nefrology, University "Federico II" of Naples, Via Pansini, 5, Naples, 80100, Italy
| | - Marco Milone
- Department of Surgical Specialities and Nefrology, University "Federico II" of Naples, Via Pansini, 5, Naples, 80100, Italy
| | - Umberto Marcello Bracale
- Department of Surgical Specialities and Nefrology, University "Federico II" of Naples, Via Pansini, 5, Naples, 80100, Italy
| | - Maurizio Sodo
- Department of Surgical Specialities and Nefrology, University "Federico II" of Naples, Via Pansini, 5, Naples, 80100, Italy
| | - Giovanni Merola
- Department of Surgical Specialities and Nefrology, University "Federico II" of Naples, Via Pansini, 5, Naples, 80100, Italy
| | - Teresa Troiani
- Department of Clinical and Experimental Medicine 'F. Magrassi', Second University of Naples, Naples, Italy
| | - Enrico Di Salvo
- Department of Surgical Specialities and Nefrology, University "Federico II" of Naples, Via Pansini, 5, Naples, 80100, Italy
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Kartan S, Shi VY, Clark AK, Chan LS. Paraneoplastic Pemphigus and Autoimmune Blistering Diseases Associated with Neoplasm: Characteristics, Diagnosis, Associated Neoplasms, Proposed Pathogenesis, Treatment. Am J Clin Dermatol 2017; 18:105-126. [PMID: 27878477 DOI: 10.1007/s40257-016-0235-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Autoimmune paraneoplastic and neoplasm-associated skin syndromes are characterized by autoimmune-mediated cutaneous lesions in the presence of a neoplasm. The identification of these syndromes provides information about the underlying tumor, systemic symptoms, and debilitating complications. The recognition of these syndromes is particularly helpful in cases of skin lesions presenting as the first sign of the malignancy, and the underlying malignancy can be treated in a timely manner. Autoimmune paraneoplastic and neoplasm-associated bullous skin syndromes are characterized by blister formation due to an autoimmune response to components of the epidermis or basement membrane in the context of a neoplasm. The clinical manifestations, histopathology and immunopathology findings, target antigens, associated neoplasm, current diagnostic criteria, current understanding of pathogenesis, and treatment options for a selection of four diseases are reviewed. Paraneoplastic pemphigus manifests with clinically distinct painful mucosal erosions and polymorphic cutaneous lesions, and is often associated with lymphoproliferative neoplasm. In contrast, bullous pemphigoid associated with neoplasm presents with large tense subepidermal bullae of the skin, and mild mucosal involvement, but without unique clinical features. Mucous membrane pemphigoid associated with neoplasm is a disorder of chronic subepithelial blisters that evolve into erosions and ulcerations that heal with scarring, and involves stratified squamous mucosal surfaces. Linear IgA dermatosis associated with neoplasm is characterized by annularly grouped pruritic papules, vesicles, and bullae along the extensor surfaces of elbows, knees, and buttocks. Physicians should be aware that these autoimmune paraneoplastic and neoplasm-associated syndromes can manifest distinct or similar clinical features as compared with the non-neoplastic counterparts.
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Abstract
Bullous diseases may be rare; however, this does not preclude the clinician from being familiar with their manifestations and treatment. After ruling out infection, genetically inherited blistering diseases are more likely to be the cause of blistering or erosions in the neonatal period, whereas immunobullous diseases are more common in adults. Published literature on immunobullous disorders reflects information gleaned from case reports and open-label case series; prospective studies and evidence-based treatments are limited. Although there may be overlapping clinical features, significant clinical differences exist between adults and children. Evidence-based treatment guidelines are limited, and information from the adult literature cannot be readily generalized to the pediatric population. This paper reviews the approach to blistering conditions and the differences among bullous pemphigoid, linear immunoglobulin A disease, dermatitis herpetiformis, pemphigus foliaceus, pemphigus vulgaris, and paraneoplastic pemphigus in adult versus pediatric patients.
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Affiliation(s)
- Kalyani Marathe
- Department of Dermatology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Avenue, 12th Floor, New York, NY, 10032, USA
| | - Jun Lu
- Department of Dermatology, University of Connecticut School of Medicine, 21 South Road, Farmington, CT, 06032, USA
| | - Kimberly D Morel
- Departments of Dermatology & Pediatrics, Columbia University College of Physicians and Surgeons, 161 Fort Washington Avenue, 12th Floor, New York, NY, 10032, USA.
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Fetica B, Pop B, Lisencu C, Rancea AC, Coman A, Cucuianu A, Petrov L. Castleman Disease. A Report of Six Cases. ACTA ACUST UNITED AC 2014; 87:192-7. [PMID: 26528023 PMCID: PMC4508595 DOI: 10.15386/cjmed-302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 09/01/2014] [Accepted: 09/02/2014] [Indexed: 12/16/2022]
Abstract
Background and aims: Castleman’s disease is a rare disorder situated at the boundary between reactive and neoplastic conditions. The pathogenesis is a subject of debate and the limited number of cases renders the study of the disease difficult. In our paper we present a series of six cases of Castleman disease with emphasis on the clinical presentation, pathology examination and the use of immunohistochemistry in the final diagnosis of the cases. Patients and method: The classification of the disease was based on clinical, imaging and pathological assessment. Specimens were obtained by surgical excision and were routinely processed for the pathology examination. Results: All cases were unicentric disease. Two cases were locally extensive. The clinical symptoms were related mostly to compression effects. Five case were of the hyaline-vascular type and one was included in the plasma cell variant. One case showed angiomyoid differentiation. Conclusions: We strongly believe that by understanding the pathogenesis of the precursor lesions we will gain better understanding of the pathways that lead to neoplasia and that Castleman disesase is a very interesting ”natural experiment” illustrating the progression from chronic antigen stimulation to reactive lymphoid hyperplasia and finally to overt lymphoid neoplasia.
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Affiliation(s)
- Bogdan Fetica
- Department of Pathology, "Prof. Dr. I. Chiricuta" Oncology Institute, Cluj-Napoca, Romania
| | - Bogdan Pop
- Department of Pathology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cosmin Lisencu
- Department of Surgery, "Prof. Dr. I. Chiricuta" Oncology Institute, Cluj-Napoca, Romania ; Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alin Cristian Rancea
- Department of Surgery, "Prof. Dr. I. Chiricuta" Oncology Institute, Cluj-Napoca, Romania ; Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Aurel Coman
- Department of Surgery Polisano Clinic Sibiu, Romania
| | - Andrei Cucuianu
- Department of Hematology, "Prof. Dr. I. Chiricuta" Oncology Institute, Cluj-Napoca, Romania ; Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ljubomir Petrov
- Department of Hematology, "Prof. Dr. I. Chiricuta" Oncology Institute, Cluj-Napoca, Romania ; Department of Hematology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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