Hyaline-vascular type Castleman's disease involving both orbits

Idiopathic Multicentric Castleman's Disease Presenting with Chorioretinal Undulation: A Case Report

PURPOSE

To describe a case of idiopathic multicentric Castleman's disease (iMCD) with initial ocular involvement, presenting with chorioretinal undulation.

METHODS

Observational case report of iMCD patient with ocular manifestation on fundus photography, auto-fluorescein and swept-source optical coherence tomography (SS-OCT), initially and after treatment.

RESULTS

A 75-year-old patient with painless vision loss for 2 years right eye (RE) and 3-month left eye (LE). Fundus examination revealed several yellow-white lesions along with the inferior arcade, with extensive pigment disturbance of the right eye and exudative retinal detachment of the left eye. SS-OCT showed choroid and retinal pigment epithelium (RPE) undulations, choroid thickening and hyperreflective dots at the choroidal level. Interleukin-6 (IL-6) in the anterior chamber was very high (1595 pg/ml RE and 749.3 pg/ml LE). After cervical lymph node biopsy, the patient was finally diagnosed with iMCD. Siltuximab, an interleukin-6 inhibitor, was administered. After two cycles of therapy, the patient's ocular manifestations improved significantly, the choroid and RPE undulation and the ERD resolved without local treatment.

CONCLUSION

Chorioretinal undulation and elevated IL-6 in intraocular fluid could be ocular manifestations of MCD.

Plasma cell type Castleman's disease of lacrimal gland: a case report and literature review

BACKGROUND

Orbital Castleman's disease is a rare benign lymphoproliferative disorder of extranodal origin.

CASE PRESENTATION

A 72-year-old man presented with bilateral upper eyelid swelling. Radiology revealed enlarged lacrimal glands in both eyes. Castleman's disease (plasma cell type) was confirmed by histo-immunochemical examinations after excision of the left orbital mass. No extraorbital involvement was found in systemic evaluation. Postoperatively, corticosteroid therapy was given. After 1 year of follow-up, there was no recurrence in the left orbit, and the swelling of the right eyelid was improved.

CONCLUSIONS

Here, we report a case of orbital Castleman's disease involving the lacrimal gland bilaterally and summarize previously reported cases. For bilateral orbital masses, the possibility of Castleman's disease should be considered. Before the diagnosis, it is necessary to fully distinguish from other diseases such as IgG4-related eye diseases.

Unicentric Castleman's disease in the orbit: A case report

A 53-year-old man presented with a palpable mass on the left lower eyelid and occasional diplopia. Under suspicion of orbital lymphoma, an excisional biopsy was performed, and histopathology revealed Castleman's disease. Castleman's disease is a rare disorder of the lymphoid system, and only a few cases of Castleman's disease in the orbit have been reported.

Exudative retinal detachment in castleman disease

PURPOSE

To describe the course of a case of Castleman disease (CD) that presented with visual symptoms and retinal disease.

METHODS

Clinical examination, fundus photography, and fluorescein and indocyanine green angiography were used to characterize the presence of bilateral exudative retinal detachments in a patient who was subsequently identified as having systemic lymphadenopathy.

RESULTS

After an extensive medical workup including CT scans, blood testing, and a lymph node and renal biopsy, the patient was diagnosed with CD. Steroids were administered to treat CD. During the course of treatment, the patient developed renal failure, which was successfully treated with plasmapheresis. Four weeks later, the bilateral retinal detachments had resolved without local treatment.

CONCLUSION

Exudative retinal detachments as manifestations of CD may be observed under systemic treatment for resolution before considering local therapy.

Castleman's disease in the orbit of a 17-year-old girl: a case report

Castleman's disease is an atypical lympho proliferative disorder comprising hyaline vascular elements, plasma cells, or a mixture of both, which can present in unicentric or multicentric fashion. Resection of unicentric lesions is typically curative, but multicentric disease, also characterized by constitutional symptoms and a poorer prognosis, often requires treatment with chemotherapy, radiation, steroids, or immune modulators. Castleman's disease is rarely diagnosed in the orbit. The authors present the clinical and histopathological findings of a 17-year-old who was found to have a focal lesion in her orbit. She was successfully treated with surgical resection and was free of disease recurrence or other sequelae at 10-months follow up.

A rare case of bilateral orbital Castleman disease

Castleman disease is a non-neoplastic cause of lymphadenopathy, first described in 1956 by Dr. Benjamin Castleman. Orbital involvement in Castleman disease is extremely rare. We report a case of bilateral orbital Castleman disease in a 48-year-old Asian male who presented with bilateral inferior dystopia. MRI revealed bilateral extraconal superior orbital mass. Histopathology and immunohistochemistry of the mass revealed features of Castleman disease of hyaline vascular type. Castleman disease should be a differential in suspected idiopathic orbital inflammatory disease and lymphoproliferative disorders.

Unifocal and multifocal reactive lymphoid hyperplasia vs follicular lymphoma of the ocular adnexa

PURPOSE

To characterize the differentiating histopathologic and immunophenotypic features of reactive lymphoid hyperplasia (RLH) and follicular lymphoma of the ocular adnexa.

DESIGN

Retrospective case study with clinical follow-up and review of the literature.

METHODS

Clinical records of 9 cases of RLH and 6 cases of follicular lymphoma from 2 institutions were reviewed. Light microscopic evaluation and immunohistochemical stains including CD20, CD3, CD5, CD21, CD23, BCL-2, BCL-6, CD10, kappa, lambda, and Ki67 were used to distinguish the 2 categories.

RESULTS

RLH preferentially involved the conjunctiva, whereas follicular lymphoma had a propensity to involve the lacrimal gland. Microscopic analysis with immunohistochemical staining distinguished RLH from follicular lymphoma. BCL-2 was positive in follicular centers of follicular lymphoma but not in RLH. CD10 identified follicular center cells and Ki67 quantified cells in S-phase. CD21 and CD23 detected dendritic cell scaffoldings of indistinct germinal centers. None of the patients with RLH developed lymphoma during their clinical courses (up to 18 years). However, 3 patients with orbital, but not conjunctival, RLH developed immunohistochemically proven multifocal nonophthalmic supradiaphragmatic adnexal RLH (sites included lung, parotid, axillary nodes, and uvea). All 6 patients with follicular lymphoma had disseminated disease.

CONCLUSIONS

A correct diagnosis of RLH vs follicular lymphoma can be reliably established employing immunohistochemical methods. A heretofore undescribed "multifocal RLH" syndrome must be distinguished from follicular lymphoma. Conjunctival RLH can usually be managed surgically without radiotherapy, but "multifocal RLH" required systemic treatment in 2 of 3 patients. Follicular lymphoma requires systemic chemotherapy if discovered beyond stage 1E.

Localized Intraorbital Castleman's disease: a case report

A 69-year-old man was found to have a right orbital soft-tissue mass on imaging as an incidental finding. Excisional biopsy revealed a well-circumscribed mass encasing the infraorbital nerve, consistent with Castleman's disease (CD) on histopathology. In the orbit, CD is extremely rare with few reported cases. We report this patient with localized intraorbital Castleman's disease.

Hyaline vascular-type Castleman disease presenting as an esophageal submucosal tumor: case report

Castleman disease is a relatively rare disorder of lymphoid tissue that involves the gastrointestinal tract in a variety of clinical and pathologic manifestations. A submucosal location has never been described in the medical literature. We report a case of esophageal Castleman disease involving thesubmucosal layer in a 62-year-old man, which was confirmed on pathology. Esophagography and CT demonstrated an intramural tumor, and a leiomyoma or leiomyosarcoma was suspected based on the known incidence of such tumors.

Orbital Pseudotumor as an Initial Manifestation of Multicentric Castleman's Disease

BACKGROUND

To report on a patient with multicentric Castleman's disease (MCD) who showed an orbital pseudotumor as an initial manifestation.

CASE

A Japanese male patient, 65 years old, initially exhibited swelling of the left eyelid. Computed tomography and magnetic resonance imaging showed an infiltrating orbital mass around the left eye.

OBSERVATIONS

The patient was treated several times with short courses of oral corticosteroids without significant response. Eight years after the first examination, he was referred to our neuroophthalmology clinic owing to persistent eyelid swelling. He exhibited an accelerated erythrosedimentation rate, polyclonal hypergammaglobulinemia, and multiple cervical and thoracic mediastinal lymphadenopathies. Histopathological examination revealed mixed-type MCD from a cervical lymph node and chronic inflammatory cell infiltration from eyelid swelling. Four months after his first visit, the patient's condition was complicated by fever, general fatigue, and hypoxemia. A cell marker study of the swollen lymph node showed monoclonality, indicating the development of non-Hodgkin's lymphoma.

CONCLUSIONS

The clinical course in this case suggests that an inflammatory reaction in the orbital tissue was initially present, before MCD, and that non-Hodgkin's lymphoma subsequently developed.