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Pelliccia S, Rogges E, Cardoni A, Lopez G, Conte E, Faccini AL, De Vito R, Girardi K, Bianchi A, Annibali O, Fratoni S, Remotti D, De Angelis G, Giordano C, Palumbo G, Scarpino S, Del Porto F, Bianchi MP, Di Gregorio F, Tafuri A, Di Napoli A. The application of a multidisciplinary approach in the diagnosis of Castleman disease and Castleman-like lymphadenopathies: A 20-year retrospective analysis of clinical and pathological features. Br J Haematol 2024; 204:534-547. [PMID: 37953489 DOI: 10.1111/bjh.19171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Castleman disease (CD) comprises a group of rare and heterogeneous haematological disorders, including unicentric (UCD) and multicentric (MCD) forms, the latter further subdivided into HHV8-MCD, POEMS-MCD and idiopathic-MCD (iMCD). However, according to the Castleman Disease Collaborative Network guidelines, the diagnosis of CD can only be achieved through collaboration between clinicians and pathologists. METHODS We applied these clinical and pathological criteria and implement with clonality testing to a retrospective cohort of 48 adult and paediatric Italian patients diagnosed with reactive lymphadenitis with CD-like histological features. RESULTS We confirmed the diagnosis of CD in 60% (29/48) of the cases, including 12 (41%) UCD and 17 (59%; five HHV8-MCD, three POEMS-MCD and nine iMCD) MCD. Of the remaining 19 cases (40%) with multiple lymphadenopathy, 5 (26%) were classified as autoimmune diseases, 1 (5%) as autoimmune lymphoproliferative disorder, 1 (5%) as IgG4-related disease, 11 (83%) as reactive lymphadenitis and 1 (5%) as nodal marginal zone lymphoma. CONCLUSIONS Our study emphasizes the importance of the multidisciplinary approach to reactive lymphadenitis with CD-like features in order to achieve a definitive diagnosis and choose the appropriate treatment.
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Affiliation(s)
- Sabrina Pelliccia
- Haematology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Evelina Rogges
- Pathology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | | | - Gianluca Lopez
- Pathology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Esmeralda Conte
- Haematology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Anna Laura Faccini
- Haematology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Rita De Vito
- Pathology Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Katia Girardi
- Department of Pediatric Hematology and Oncology and Cell and Gene Therapy, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Ombretta Annibali
- Haematology Stem Cell Transplantation Unit, Campus Biomedico University Hospital, Campus Bio Medico University, Rome, Italy
| | - Stefano Fratoni
- Surgical Pathology Department, Sant' Eugenio Hospital, Rome, Italy
| | | | | | - Carla Giordano
- Department of Translational and Precision Medicine, A.O.U. Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Giovanna Palumbo
- Haematology Unit, Department of Translational and Precision Medicine, A.O.U Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Stefania Scarpino
- Pathology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Flavia Del Porto
- Internal Medicine Unit, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Maria Paola Bianchi
- Haematology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Francesca Di Gregorio
- Radiology Unit, Department of Surgical-Medical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Agostino Tafuri
- Haematology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Arianna Di Napoli
- Pathology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
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Kishore A, Rana N, Kumar A, Kashyap V, Jebaying Y. Hyaline Vascular Variant of Castleman Disease of the Tonsil in an Adolescent: A case Report. Indian J Otolaryngol Head Neck Surg 2024; 76:1062-1065. [PMID: 38440559 PMCID: PMC10909062 DOI: 10.1007/s12070-023-04114-4] [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: 05/23/2023] [Accepted: 07/24/2023] [Indexed: 03/06/2024] Open
Abstract
Castleman disease (CD) is a lymphoproliferative disorder classified into two categories as unicentric Castleman disease (UCD) or localized type and multicentric Castleman disease (MCD). A rare case of hyaline vascular variant of tonsil has been presented in which a 14 years old male presented with symptomatic unilateral hypertrophy of right tonsil. A right tonsillectomy was done and surgical pathology report was concluded as hyaline vascular variant of Castleman's disease.Castleman disease (CD) is a rare lymphoproliferative disorder also called as giant lymph node hyperplasia, angiofollicular lymph node hyperplasia (AFH), angiomatous lymphoid hematoma and follicular lymphoreticuloma. The treatment of symptomatic patients with UCD is complete surgical excision (as in present case). In cases with incomplete resection, adjuvant radiotherapy can be given.
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El Hussein S, Evans AG, Fang H, Wang W, Medeiros LJ. Unicentric Castleman Disease: Illustration of Its Morphologic Spectrum and Review of the Differential Diagnosis. Arch Pathol Lab Med 2024; 148:99-106. [PMID: 36920021 DOI: 10.5858/arpa.2022-0404-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 03/16/2023]
Abstract
CONTEXT.— Unicentric Castleman disease (UCD) is a dynamic entity with a wide spectrum of morphologic findings. UCD can be further subdivided into hyaline-vascular and mixed/plasmacytic variants. Hyaline-vascular UCD has both follicular and interfollicular (stromal) changes, and occasionally these lesions show a skewed representation of either the follicular or stromal compartments. Plasmacytosis is usually minimal in the hyaline-vascular variant. The mixed/plasmacytic variant of UCD is composed of sheets of plasma cells often associated with a variable number of follicles with regressive changes. OBJECTIVE.— To illustrate the differential diagnosis of UCD, as it is quite broad and includes lymphomas, plasma cell neoplasms, stromal neoplasms such as follicular dendritic cell sarcoma and vascular neoplasms, immunoglobulin G4-related disease, infections, and other rare lesions. An additional objective is to enhance awareness of the morphologic features of UCD in excisional and in small core-needle biopsy specimens, the latter of which may inadvertently target follicle- or stroma-rich areas, causing diagnostic challenges. DATA SOURCES.— In this review, we provide readers a concise illustration of the morphologic spectrum of UCD that we have encountered in our practice and a brief discussion of entities in the differential diagnosis. CONCLUSIONS.— UCD exhibits a broad spectrum of morphologic changes, and awareness of these morphologic variations is key to avoid misdiagnosis.
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Affiliation(s)
- Siba El Hussein
- From the Department of Pathology, University of Rochester Medical Center, Rochester, New York (El Hussein, Evans)
| | - Andrew G Evans
- From the Department of Pathology, University of Rochester Medical Center, Rochester, New York (El Hussein, Evans)
| | - Hong Fang
- the Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston (Fang, Wang, Medeiros)
| | - Wei Wang
- the Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston (Fang, Wang, Medeiros)
| | - L Jeffrey Medeiros
- the Department of Hematopathology, University of Texas MD Anderson Cancer Center, Houston (Fang, Wang, Medeiros)
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Guo M, Nong L, Wang M, Zhang Y, Wang L, Sun Y, Wang Q, Liu H, Ou J, Cen X, Ren H, Dong Y. Retrospective cohort evaluation of non-HIV Castleman disease from a single academic center in Beijing, China. Ann Hematol 2024; 103:153-162. [PMID: 37749319 DOI: 10.1007/s00277-023-05472-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/20/2023] [Indexed: 09/27/2023]
Abstract
The purpose is to ascertain the clinical impact of Castleman disease (CD) by reassessment of the real-world data from Peking University First Hospital (PKUFH). The results will contribute to the standardization of diagnosis and treatment on CDs. Based on the last 15-year retrospective real-world data from Peking University First Hospital (PKUFH), we reclassified and re-evaluated the clinical and pathological information of patients with pathologically suspected diagnosis of CD. A total of 203 patients were included in our study, in which the diagnosis of CD was confirmed in 189 cases, including 118 patients with unicentric CD (UCD, n = 118, 62.4%) and 71 patients with multicentric CD (MCD, n = 71, 37.6%). A total of 44.1% (n = 52) of UCDs in our cohort were complicated with paraneoplastic pemphigus (PNP). The treatment of UCD is primarily surgical, with a 5-year overall survival (OS) of 88.1%. Patients with PNP had a poorer prognosis than those without PNP (82.9% (95% CI 123-178) vs 92.8% (95% CI 168-196), log-rank p = 0.041). The rate of concurrent systemic symptoms was 74.6% (n = 53), and renal involvement occurred in 49.3% (n = 35) MCD patients. The MCD treatments were mainly chemotherapy regimens, with a 5-year OS of 77.6% (95% CI, 143-213). Patients with UCD demonstrate a better overall prognosis than patients with MCD. But the prognosis of those complicated with PNP was poor. The differential diagnosis of MCD is extensive. MCD treatment in China is heterogeneous. The inaccessibility of anti-IL-6-targeted drugs in China may contribute to the poor prognosis for patients with MCD.A preprint has previously been published (Guo et al. 34).
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Affiliation(s)
- Meiyu Guo
- Department of Hematology, Peking University First Hospital, No. 7 Xishiku St. Xicheng District, Beijing, 100034, China
| | - Lin Nong
- Department of Pathology, Peking University First Hospital, Beijing, China
| | - Mingyue Wang
- Department of Dermatology, Peking University First Hospital, Beijing, China
| | - Yang Zhang
- Department of Hematology, Peking University First Hospital, No. 7 Xishiku St. Xicheng District, Beijing, 100034, China
| | - Lihong Wang
- Department of Hematology, Peking University First Hospital, No. 7 Xishiku St. Xicheng District, Beijing, 100034, China
| | - Yuhua Sun
- Department of Hematology, Peking University First Hospital, No. 7 Xishiku St. Xicheng District, Beijing, 100034, China
| | - Qingyun Wang
- Department of Hematology, Peking University First Hospital, No. 7 Xishiku St. Xicheng District, Beijing, 100034, China
| | - Huihui Liu
- Department of Hematology, Peking University First Hospital, No. 7 Xishiku St. Xicheng District, Beijing, 100034, China
| | - Jinping Ou
- Department of Hematology, Peking University First Hospital, No. 7 Xishiku St. Xicheng District, Beijing, 100034, China
| | - Xinan Cen
- Department of Hematology, Peking University First Hospital, No. 7 Xishiku St. Xicheng District, Beijing, 100034, China
| | - Hanyun Ren
- Department of Hematology, Peking University First Hospital, No. 7 Xishiku St. Xicheng District, Beijing, 100034, China
| | - Yujun Dong
- Department of Hematology, Peking University First Hospital, No. 7 Xishiku St. Xicheng District, Beijing, 100034, China.
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[Castleman disease]. Ann Pathol 2023; 43:13-24. [PMID: 36192235 DOI: 10.1016/j.annpat.2022.07.013] [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: 02/14/2022] [Revised: 06/13/2022] [Accepted: 07/05/2022] [Indexed: 01/25/2023]
Abstract
The term "Castleman disease" covers a variety of entities that have very different clinical, biological, pathological and physiopathological features. In this issue, we review the characteristics of the unicentric Castleman disease, of the HHV8 associated multicentric Castleman disease and the idiopathic multicentric Castleman disease associated or not with TAFRO syndrome ("thrombocytopenia, anasarca, fever, reticulin myelofibrosis and/or renal insufficiency, organomegaly"). We detail the differential diagnostics of these entities.
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Necrotizing Follicular Lymphoma of the Inguinal Region with Sternbergoid Cells: Clinical–Pathological Features of a Challenging Entity. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Follicular lymphoma (FL) is one of the most common B-cell malignancies worldwide. While the diagnosis of conventional cases is straightforward, rare clinical–pathological variants may be challenging due to their misleading morphology, aberrant phenotype and/or atypical presentation. To add to the spectrum of unusual FLs, we report on a rare disease pattern characterized by (i) inguinal presentation, (ii) massive necrosis, (iii) Hodgkin/Reed–Sternberg (HRS)-like cells, and (iv) adjacent areas of diffuse large B-cell lymphoma evolution. All cases occurred in elderly patients (median age at diagnosis: 69.5 years), disclosed a low stage at diagnosis (Ann Arbor stage IA-IIA), and had deceiving clinical features. Despite the alarming histology, excellent responses to conventional therapies were reported in all patients. In conclusion, necrotizing FL of the inguinal region is a rare neoplasm characterized by peculiar clinical and histological features. This lymphoma should always be considered in the differential diagnosis of massively necrotic inguinal lesions.
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Khanlari M, Chapman JR. Follicular lymphoma: updates for pathologists. J Pathol Transl Med 2021; 56:1-15. [PMID: 34942689 PMCID: PMC8743801 DOI: 10.4132/jptm.2021.09.29] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/29/2021] [Indexed: 11/17/2022] Open
Abstract
Follicular lymphoma (FL) is the most common indolent B-cell lymphoma and originates from germinal center B-cells (centrocytes and centroblasts) of the lymphoid follicle. Tumorigenesis is believed to initiate early in precursor B-cells in the bone marrow (BM) that acquire the t(14;18)(q32;q21). These cells later migrate to lymph nodes to continue their maturation through the germinal center reaction, at which time they acquire additional genetic and epigeneticabnormalities that promote lymphomagenesis. FLs are heterogeneous in terms of their clinicopathologic features. Most FLs are indolent and clinically characterized by peripheral lymphadenopathy with involvement of the spleen, BM, and peripheral blood in a substantial subset of patients, sometimes accompanied by constitutional symptoms and laboratory abnormalities. Diagnosis is established by the histopathologic identification of a B-cell proliferation usually distributed in an at least partially follicular pattern, typically, but not always, in a lymph node biopsy. The B-cell proliferation is biologically of germinal center cell origin, thus shows an expression of germinal center-associated antigens as detected by immunophenotyping. Although many cases of FLs are typical and histopathologic features are straightforward, the biologic and histopathologic variability of FL is wide, and an accurate diagnosis of FL over this disease spectrum requires knowledge of morphologic variants that can mimic other lymphomas, and rarely non-hematologic malignancies, clinically unique variants, and pitfalls in the interpretation of ancillary studies. The overall survival for most patients is prolonged, but relapses are frequent. The treatment landscape in FL now includes the application of immunotherapy and targeted therapy in addition to chemotherapy.
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Affiliation(s)
- Mahsa Khanlari
- Department of Pathology and Hematopathology, St. Jude Children's Research Hospital, Memphis, TN, USA
- Corresponding Author: Mahsa Khanlari, MD, Department of Pathology and Hematopathology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA Tel: +1-901-595-0394, Fax: +1-901-595-3100, E-mail:
| | - Jennifer R. Chapman
- Department of Pathology, Division of Hematopathology, University of Miami, Sylvester Comprehensive Cancer Center, and Jackson Memorial Hospitals, Miami, FL, USA
- Corresponding Author: Jennifer R. Chapman, MD, Department of Pathology, University of Miami Hospital, 4th floor, room 4076, 1400 NW 12th Ave., Miami, FL 33138, USA Tel: +1-305-689-1332, E-mail:
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Zhou T, Wang HW, Pittaluga S, Jaffe ES. Multicentric Castleman disease and the evolution of the concept. Pathologica 2021; 113:339-353. [PMID: 34837092 PMCID: PMC8720411 DOI: 10.32074/1591-951x-351] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 12/29/2022] Open
Abstract
The term multicentric Castleman disease (MCD) encompasses a spectrum of conditions that share some overlapping clinicopathological manifestations. The fundamental pathogenetic mechanism involves dysregulated cytokine activity, causing systemic inflammatory symptoms as well as lymphadenopathy. Some of the histological changes in lymph nodes resemble the histology of unicentric Castleman disease (UCD). However, based on current knowledge, the use of this shared nomenclature is unfortunate, since these disorders differ in pathogenesis and prognosis. In Kaposi sarcoma-associated herpesvirus (KSHV)-associated MCD, cytokine overactivity is caused by viral products, which can also lead to atypical lymphoproliferations and potential progression to lymphoma. In idiopathic MCD, the hypercytokinemia can result from various mechanisms, which ultimately lead to different constellations of clinical presentations and varied pathology in lymphoid tissues. The authors review the evolving concepts and definitions of the various conditions under the eponym of multicentric Castleman disease.
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Affiliation(s)
- Ting Zhou
- Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Hao-Wei Wang
- Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Stefania Pittaluga
- Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Elaine S Jaffe
- Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Shiroshita K, Kikuchi T, Okayama M, Kasahara H, Kamiya T, Shimizu T, Kurose N, Masaki Y, Okamoto S. Interleukin-6-producing Intravascular Large B-cell Lymphoma with Lymphadenopathy Mimicking the Histology of Multicentric Castleman Disease. Intern Med 2020; 59:3061-3065. [PMID: 32759587 PMCID: PMC7759707 DOI: 10.2169/internalmedicine.5046-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
An inguinal lymph node biopsy of a woman with a one-month history of a progressive fever, fatigue, dyspnea, skin rash, and lymphadenopathy revealed a well-preserved basic structure, hyperplastic germinal centers, and an interfollicular region containing polyclonal plasma cell sheets, suggesting plasma cell-type multicentric Castleman disease (MCD). We initiated prednisolone and anti-interleukin (IL)-6 antibody (tocilizumab), without success. A biopsy specimen re-evaluation detected CD20-positive atypical large B cells infiltrating the small vessels within and around the lymph node and its capsule. We diagnosed her with intravascular large B-cell lymphoma (IVLBCL). Lymphoma cells were weakly positive for IL-6 by immunohistochemical staining. IL-6 from lymphoma cells may have caused the MCD-like presentation as a paraneoplastic etiology. Malignant lymphoma should be excluded before diagnosing MCD.
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Affiliation(s)
- Kohei Shiroshita
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| | - Taku Kikuchi
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| | - Mikio Okayama
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| | - Hidenori Kasahara
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| | - Takahiro Kamiya
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| | - Takayuki Shimizu
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| | - Nozomu Kurose
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Japan
| | - Yasufumi Masaki
- Department of Hematology and Immunology, Kanazawa Medical University, Japan
| | - Shinichiro Okamoto
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
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Classic Hodgkin lymphoma and Castleman disease: an entity appears to be emerging. Virchows Arch 2020; 477:437-444. [PMID: 32152665 DOI: 10.1007/s00428-020-02788-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/13/2020] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
Abstract
Hodgkin lymphoma is a B cell neoplasm characterized by Hodgkin and Reed-Sternberg (HRS) cells in an inflammatory background. Classic Hodgkin lymphoma (CHL) accounts for approximately 90% of all cases of HL and four types are recognized in the World Health Organization (WHO) classification: lymphocyte-rich, nodular sclerosis, mixed cellularity, and lymphocyte depleted. Castleman disease (CD) is a designation used for a heterogeneous group of diseases that involve lymph nodes. Histologically, there are hyaline vascular and plasma cell variants, the latter including human herpes virus 8 (HHV8)-positive and HHV8-negative subsets. In this study, we describe three men, 45-57 years of age, one HIV-positive, who had coexistent CHL and CD. All patients had the interfollicular variant of CHL and HHV8-negative plasma cell variant CD. Immunohistochemical analysis supported the diagnosis of CHL; the HRS cells were positive for CD15, CD30, and PAX-5 (dim). In two cases, the HRS cells and the plasma cells of CD expressed interleukin-6 (IL-6). Our review of the literature identified 34 cases of coexistent CHL and CD reported previously. In aggregate, about two-thirds of all cases of CHL have been the interfollicular variant and around 90% of CD cases were plasma cell variant, HHV8-negative in the subset of cases tested. We suggest that interfollicular variant CHL and plasma cell variant CD may be a distinct entity with a common pathogenesis, possibly related to IL-6 dysregulation. The few cases in the literature describing other forms of CHL and hyaline vascular variant CD are different from the entity reported here, with a different pathogenesis, likely similar to focal Castleman-like changes that have been described in association with various types of non-Hodgkin lymphoma.
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Koh J, Jeon YK. Morphologic variant of follicular lymphoma reminiscent of hyaline-vascular Castleman disease. J Pathol Transl Med 2020; 54:253-257. [PMID: 32013324 PMCID: PMC7253963 DOI: 10.4132/jptm.2019.12.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/17/2019] [Indexed: 01/10/2023] Open
Abstract
Follicular lymphoma (FL) with hyaline-vascular Castleman disease (FL-HVCD)-like features is a rare morphologic variant, with fewer than 20 cases in the literature. Herein, we report a case of FL-HVCD in a 37-year-old female who presented with isolated neck lymph node enlargement. The excised lymph node showed features reminiscent of HVCD, including regressed germinal centers (GCs) surrounded by onion skin-like mantle zones, lollipop lesions composed of hyalinized blood vessels penetrating into regressed GCs, and hyalinized interfollicular stroma. In addition, focal areas of abnormally conglomerated GCs composed of homogeneous, small centrocytes with strong BCL2, CD10, and BCL6 expression were observed, indicating partial involvement of the FL. Several other lymphoid follicles showed features of in situ follicular neoplasia. Based on the observations, a diagnosis of FL-HVCD was made. Although FLHVCD is very rare, the possibility of this variant should be considered in cases resembling CD. Identification of abnormal, neoplastic follicles and ancillary immunostaining are helpful for proper diagnosis.
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Affiliation(s)
- Jiwon Koh
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Yoon Kyung Jeon
- Department of Pathology, Seoul National University Hospital, Seoul, Korea.,Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
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Randall C, Fedoriw Y. Pathology and diagnosis of follicular lymphoma and related entities. Pathology 2019; 52:30-39. [PMID: 31791624 DOI: 10.1016/j.pathol.2019.09.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 02/06/2023]
Abstract
Follicular lymphoma (FL) is an indolent, mature B-cell neoplasm classically characterised by the t(14;18)(q32;q21) with constitutive overexpression of the anti-apoptotic protein, BCL2. Most cases present in older adults with slowly progressive lymphadenopathy and follow an indolent clinical course. Typical morphology shows an expansile follicular proliferation with tumour expression of germinal centre markers, and bone marrow involvement at diagnosis is frequent. However, in the recent past, efforts to understand the biological and clinical heterogeneity of FL has effected significant change to the diagnostic approach. While morphological grade, assessed by enumerating large 'centroblasts' in the neoplastic follicles, generally correlates with outcome in systemic nodal FL, variants with high-grade morphology but indolent clinical behaviour have been identified. Given the clinical implications of these FL variants, knowledge of their clinical and histopathological defining features is of paramount importance to the pathologist. Furthermore, as with many areas of diagnostic oncology, precursors to FL have been identified and described with measurable rates of progression to bona fide lymphoma. Accurate diagnosis of these early lesions can often prevent unnecessary therapy and guide appropriate monitoring for disease progression. This review aims to summarise these key pathological and diagnostic features of FL. We further highlight the biological underpinnings of FL that will likely affect the classification, diagnosis, and treatment of patients with lymphoma.
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Affiliation(s)
- Cara Randall
- Department of Pathology and Laboratory Medicine, Division of Hematopathology, University of North Carolina, NC Cancer Hospital, Chapel Hill, NC, USA
| | - Yuri Fedoriw
- Department of Pathology and Laboratory Medicine, Division of Hematopathology, University of North Carolina, NC Cancer Hospital, Chapel Hill, NC, USA.
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14
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Li Y, Zhao H, Su B, Yang C, Li S, Fu W. Primary hyaline vascular Castleman disease of the kidney: case report and literature review. Diagn Pathol 2019; 14:94. [PMID: 31439011 PMCID: PMC6706926 DOI: 10.1186/s13000-019-0870-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 08/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Castleman's disease (CD) is an uncommon type of benign proliferation of the lymphoid tissue, characterized by local or systemic lymphadenopathy that most frequently appears in the mediastinum; involvement of the kidney is uncommon, and proliferation originating from the kidney is extremely rare. Herein, we report a rare case of hyaline vascular Castleman's disease (HV-CD) in a 56-year-old male patient and discuss its morphological characteristics and differential diagnoses including mantle cell lymphoma (MCL), follicular lymphoma (FL), and nodal marginal zone lymphoma (NMZL). CASE PRESENTATION A right upper-middle renal mass was detected after physical examination in a 56-year-old man without any clinical symptoms and a previous partial resection of the right kidney. Microscopically, the lymphoid follicles were increased in number and had expanded mantle zones and atrophic germinal centers. Vascular proliferation and hyalinization in the interfollicular zones were observed. Immunohistochemical staining showed CD20-positive cells in the mantle zones; CD21 and CD35 were expressed in the dendritic cells, CD3 was positive in a small number of T cells, and CD38 and CD138 were positive in the plasma cells. Additionally, Ki-67 expression was positive in the follicle centers. In contrast, staining for Bcl-2 in the germinal centers and cyclin D1 were negative. The immunohistochemical analysis combined with the morphological results supported the diagnosis of HV-CD. The patient recovered well after surgery. CONCLUSIONS Primarily renal HV-CD without lymph node hyperplasia or clinical symptoms is extraordinarily rare and different from the multicentric-type CD (MCD) with kidney involvement. Therefore, it is extremely important to improve the awareness of this diagnosis. Attention should be paid to the difference between HV-CD and common lymph node reactive hyperplasia, MCL, FL, NMZL, and so on. To avoid misdiagnosis as a renal malignant tumor requiring radical resection, distinguishing these diseases is crucial.
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Affiliation(s)
- Yunzhu Li
- Department of Pathology, Xinqiao Hospital of Army Medicine University, Chongqing, 400037, China
- Development and Regeneration Key Lab of Sichuan Province of Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Haixia Zhao
- Development and Regeneration Key Lab of Sichuan Province of Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Bingyin Su
- Development and Regeneration Key Lab of Sichuan Province of Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Chan Yang
- Development and Regeneration Key Lab of Sichuan Province of Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Shurong Li
- Development and Regeneration Key Lab of Sichuan Province of Chengdu Medical College, Chengdu, 610500, Sichuan, China.
| | - Wanlei Fu
- Department of Pathology, Xinqiao Hospital of Army Medicine University, Chongqing, 400037, China.
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Li P, Liu H, Li H, Li A, Yu G, Yin W. Hyaline vascular variant of unicentric Castleman disease of the tonsil: a case report. Diagn Pathol 2019; 14:70. [PMID: 31253137 PMCID: PMC6599372 DOI: 10.1186/s13000-019-0836-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/06/2019] [Indexed: 11/10/2022] Open
Abstract
Background Castleman disease (CD) is a lymphoproliferative disorder with an unknown etiology. The disease may be unicentric (UCD) or multicentric (MCD), and three histopathologic variants have been described: hyaline vascular (HV), plasma cell (PC), and mixed type. Extranodal CD is rare. Herein, we report a case of CD presenting as a tonsillar mass, which has not been documented in the literature. Case presentation The patient was a 32-year-old man. Laryngoscopy revealed tonsillar hypertrophy, and the patient underwent a low-temperature plasma tonsillectomy. Microscopic examination of permanent sections showed lymphoid follicular hyperplasia, a portion of which appeared to be a fusion of nodular hyperplasia (composed of lymphoid follicles of variable size and shape). These distinctive follicles with atrophic hyalinized germinal centers and a broad mantle zone of small lymphocytes formed concentric rings (so-called onion-skin arrangement). Medium-sized vessels and a plethora of capillaries were present in the center of the lymphatic follicles, mantle zones, and interfollicular areas. A characteristic lollipop appearance was also observed due to the onion-skin arrangement of the expanded mantle zone lymphocytes with a vessel penetrating the germinal center. No aberrant lymphoid population was present based on CD3, CD5, CD20, CD79α, CD21, CD23, bcl-2, cyclin D1, and ki-67 immunostaining. Tests for human herpesvirus (HHV)-8 and Epstein Barr virus (EBV)-encoded small RNA (EBER) were negative. Therefore, a diagnosis of an HV variant UCD was rendered. The patient was treated by local excision without any other therapy based on the diagnosis. At the 7-month follow up, the patient had no recurrent symptoms or masses. Conclusion We present an unusual case of a tonsil presenting hyaline vascular Castleman disease (HVCD). This study aims to highlight CD as a differential diagnosis that should be considered by otolaryngologists and pathologists for lymphoproliferative disorders of the tonsil.
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Affiliation(s)
- Ping Li
- Department of Pathology, Shenzhen Hospital of Peking University, 1120 Lianhua road, Shenzhen, 518036, China
| | - Huaipu Liu
- Department of Cardiothoracic Surgery, Shenzhen Children's Hospital, 7019 Yitian road, Shenzhen, 518038, China
| | - Hao Li
- Department of Pathology, Shenzhen Hospital of Peking University, 1120 Lianhua road, Shenzhen, 518036, China
| | - Ang Li
- Department of Pathology, Shenzhen Hospital of Peking University, 1120 Lianhua road, Shenzhen, 518036, China
| | - Guangyin Yu
- Department of Pathology, Shenzhen Hospital of Peking University, 1120 Lianhua road, Shenzhen, 518036, China
| | - Weihua Yin
- Department of Pathology, Shenzhen Hospital of Peking University, 1120 Lianhua road, Shenzhen, 518036, China.
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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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