1
|
Schmalzing M, Sander O, Seidl M, Marks R, Blank N, Kötter I, Tiemann M, Backhaus M, Manger B, Hübel K, Müller-Ladner U, Henes J. Castleman's disease in the rheumatological practice. Z Rheumatol 2024:10.1007/s00393-024-01560-5. [PMID: 39174716 DOI: 10.1007/s00393-024-01560-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2024] [Indexed: 08/24/2024]
Affiliation(s)
- M Schmalzing
- Department of Medicine and Polyclinic II, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.
| | - O Sander
- Department of Rheumatology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - M Seidl
- Institute of Pathology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - R Marks
- Department of Internal Medicine I, University Hospital Freiburg, Freiburg, Germany
| | - N Blank
- University Hospital Heidelberg, Heidelberg, Germany
| | - I Kötter
- Department of Rheumatology and Immunology, Hospital Bad Bramstedt, Bad Bramstedt, Germany
- Rheumatology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - M Tiemann
- Institute of HematoPathology Hamburg, Hamburg, Germany
| | - M Backhaus
- Dept. of Internal Medicine-Rheumatology and Clinical Immunology, Park-Klinik Weissensee (Berlin), Berlin, Germany
| | - B Manger
- Department of Medicine 3-Rheumatology and Immunology, University Hospital Erlangen, Erlangen, Germany
| | - K Hübel
- Department of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - U Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Kerckhoff Klinik Bad Nauheim, Bad Nauheim, Germany
| | - J Henes
- Department of Medicine II, University Hospital Tübingen, Tübingen, Germany
| |
Collapse
|
2
|
AlSheikh S, Altoijry A, Al-Mubarak H, Alsallum OD, Alakeel F, Alanezi T. A rare presentation of unicentric Castleman's disease in the thigh: A case report and review of literature. World J Clin Cases 2024; 12:4003-4009. [PMID: 38994289 PMCID: PMC11235453 DOI: 10.12998/wjcc.v12.i19.4003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/08/2024] [Accepted: 05/21/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Castleman's disease (CD) is a rare lymphoproliferative, emulating both benign and malignant diseases. The diagnosis of CD is formulated upon the combination of clinical and laboratory criteria and ultimately confirmed by histopathological assessment. Due to its rarity, CD presents a challenge in treatment selection, with available options encompassing surgery, chemotherapy, and autologous stem cell transplantation. However, studies suggest that surgical resection of the lesion is the most effective treatment modality, especially for unicentric CD (UCD). CASE SUMMARY Here, we describe the case of a 25-year-old woman who presented with painless left thigh swelling for 10 wk. She had been following a low-fat diet to lose weight and had normal laboratory results. Magnetic resonance imaging revealed a well-circumscribed, demarcated cystic lesion located in the left inguinal region with eccentrically positioned signal void vascular structures, measuring 4.3 cm × 3 cm × 3.2 cm, likely of lymphoid origin. The patient underwent surgical resection, and the final histopathology showed a vascular proliferation and hyalinization of the vessel walls, along with atretic germinal centers traversed by penetrating vessels, consistent with CD. The patient was discharged home one day after the procedure in good condition, with a follow-up appointment scheduled in our outpatient clinic. CONCLUSION Although surgical resection is the mainstay for UCD, a multidisciplinary approach is needed due the lack of specific diagnostic features and treatments.
Collapse
Affiliation(s)
- Sultan AlSheikh
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
| | - Abdulmajeed Altoijry
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
| | - Husain Al-Mubarak
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
| | - Ofays Dakkam Alsallum
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
- Division of Vascular Surgery, Department of Surgery, King Khalid Hospital Najran, Najran 11321, Saudi Arabia
| | - Fadi Alakeel
- Department of Pathology, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
| | - Tariq Alanezi
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
| |
Collapse
|
3
|
Lorenzi L, Haferlach T, Mori L, Simbeni M, Walter W, Balzarini P, Meggendorfer M, Döring C, Lonardi S, Bugatti M, Agostinelli C, Mehta J, Borges A, Agaimy A, Simonitsch-Klupp I, Cabeçadas J, Campo E, Pileri SA, Facchetti F, Leo Hansmann M, Hartmann S. Massive parallel sequencing unveils homologous recombination deficiency in follicular dendritic cell sarcoma. Haematologica 2024; 109:1815-1824. [PMID: 37994105 PMCID: PMC11141687 DOI: 10.3324/haematol.2023.283669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023] Open
Abstract
Standardized treatment options are lacking for patients with unresectable or multifocal follicular dendritic cell sarcoma (FDCS) and disease-related mortality is as high as 20%. Applying whole-genome sequencing (WGS) in one case and whole-exome sequencing (WES) in additional twelve cases, this study adds information on the molecular landscape of FDCS, expanding knowledge on pathobiological mechanisms and identifying novel markers of potential theragnostic significance. Massive parallel sequencing showed high frequency of mutations on oncosuppressor genes, particularly in RB1, CARS and BRCA2 and unveiled alterations on homologous recombination DNA damage repair-related genes in 70% (9/13) of cases. This indicates that patients with high-stage FDCS may be eligible for poly ADP ribose polymerase inhibition protocols. Low tumor mutational burden was confirmed in this study despite common PDL1 expression in FDCS arguing on the efficacy of immune checkpoint inhibitors. CDKN2A deletion, detected by WGS and confirmed by fluorescence in situ hybridization in 41% of cases (9/22) indicates that impairment of cell cycle regulation may sustain oncogenesis in FDCS. Absence of mutations in the RAS/RAF/MAPK pathway and lack of clonal hematopoiesis-related mutations in FDCS sanction its differences from dendritic cell-derived neoplasms of hematopoietic derivation. WGS and WES in FDCS provides additional information on the molecular landscape of this rare tumor, proposing novel candidate genes for innovative therapeutical approaches to improve survival of patients with multifocal disease.
Collapse
Affiliation(s)
- Luisa Lorenzi
- Pathology Unit, ASST Spedali Civili di Brescia, Department of Molecular and Translational Medicine, University of Brescia, Brescia.
| | | | - Luigi Mori
- Laboratory of Molecular Medicine, Department of Clinical and Experimental Science, University of Brescia, Brescia
| | - Matteo Simbeni
- Pathology Unit, ASST Spedali Civili di Brescia, Department of Molecular and Translational Medicine, University of Brescia, Brescia
| | | | - Piera Balzarini
- Pathology Unit, ASST Spedali Civili di Brescia, Department of Molecular and Translational Medicine, University of Brescia, Brescia
| | | | - Claudia Döring
- Dr Senckenberg Institute of Pathology, Goethe University, Frankfurt
| | - Silvia Lonardi
- Pathology Unit, ASST Spedali Civili di Brescia, Department of Molecular and Translational Medicine, University of Brescia, Brescia
| | - Mattia Bugatti
- Pathology Unit, ASST Spedali Civili di Brescia, Department of Molecular and Translational Medicine, University of Brescia, Brescia
| | - Claudio Agostinelli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy"
| | | | | | - Abbas Agaimy
- Institute of Pathology, University Hospital, Erlangen
| | | | - José Cabeçadas
- Department of Pathology, Portuguese Institute of Oncology, Lisbon, Portugal
| | - Elias Campo
- Hematopathology Section, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Stefano Aldo Pileri
- Division of Haematopathology, European Institute of Oncology (IEO) IRCCS, Milan
| | - Fabio Facchetti
- Pathology Unit, ASST Spedali Civili di Brescia, Department of Molecular and Translational Medicine, University of Brescia, Brescia
| | - Martin Leo Hansmann
- Institute for General Pharmacology and Toxicology, Goethe University, Frankfurt
| | - Sylvia Hartmann
- Dr Senckenberg Institute of Pathology, Goethe University, Frankfurt
| |
Collapse
|
4
|
Chan JY, Loh JW, Lim JQ, Liany H, Lee ECY, Lee JY, Kannan B, Lim BY, Guo Z, Lim K, Ha JCH, Ng CCY, Ko TK, Huang D, Seow DYB, Cheng CL, Chan SH, Ngeow J, Teh BT, Lim ST, Ong CK. Single-cell landscape of idiopathic multicentric Castleman disease in identical twins. Blood 2024; 143:1837-1844. [PMID: 38170173 DOI: 10.1182/blood.2023021992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
ABSTRACT Idiopathic multicentric Castleman disease (iMCD) is a rare cytokine-driven disorder characterized by systemic inflammation, generalized lymphadenopathy, and organ dysfunction. Here, we present an unusual occurrence of iMCD in identical twins and examined the immune milieu within the affected lymphoid organs and the host circulation using multiomic high-dimensional profiling. Using spatial enhanced resolution omics sequencing (Stereo-seq) transcriptomic profiling, we performed unsupervised spatially constrained clustering to identify different anatomic structures, mapping the follicles and interfollicular regions. After a cell segmentation approach, interleukin 6 (IL-6) pathway genes significantly colocalized with endothelial cells and fibroblastic reticular cells, confirming observations using a single-cell sequencing approach (10× Chromium). Furthermore, single-cell sequencing of peripheral blood mononuclear cells revealed an "inflammatory" peripheral monocytosis enriched for the expression of S100A family genes in both twins. In summary, we provided evidence of the putative cell-of-origin of IL-6 signals in iMCD and described a distinct monocytic host immune response phenotype through a unique identical twin model.
Collapse
Affiliation(s)
- Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
- Duke-NUS Medical School, Singapore
| | - Jui Wan Loh
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore
| | - Jing Quan Lim
- Division of Cellular and Molecular Research, Lymphoma Genomic Translational Research Laboratory, National Cancer Centre Singapore, Singapore
| | - Herty Liany
- Division of Cellular and Molecular Research, Lymphoma Genomic Translational Research Laboratory, National Cancer Centre Singapore, Singapore
| | | | - Jing Yi Lee
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore
| | - Bavani Kannan
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore
| | - Boon Yee Lim
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore
| | - Zexi Guo
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore
| | - Kerry Lim
- Division of Cellular and Molecular Research, Lymphoma Genomic Translational Research Laboratory, National Cancer Centre Singapore, Singapore
| | - Jeslin Chian Hung Ha
- Division of Cellular and Molecular Research, Lymphoma Genomic Translational Research Laboratory, National Cancer Centre Singapore, Singapore
| | | | - Tun Kiat Ko
- Cancer Discovery Hub, National Cancer Centre Singapore, Singapore
| | - Dachuan Huang
- Division of Cellular and Molecular Research, Lymphoma Genomic Translational Research Laboratory, National Cancer Centre Singapore, Singapore
| | | | - Chee Leong Cheng
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Sock Hoai Chan
- Cancer Genetics Service, National Cancer Centre Singapore, Singapore
| | - Joanne Ngeow
- Cancer Genetics Service, National Cancer Centre Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Bin Tean Teh
- Duke-NUS Medical School, Singapore
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore, Singapore
- Genome Institute of Singapore, Singapore
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- SingHealth Duke-NUS Blood Cancer Centre, Singapore
- Duke-NUS Medical School, Singapore
| | - Choon Kiat Ong
- Duke-NUS Medical School, Singapore
- Division of Cellular and Molecular Research, Lymphoma Genomic Translational Research Laboratory, National Cancer Centre Singapore, Singapore
- Genome Institute of Singapore, Singapore
| |
Collapse
|
5
|
van Rhee F, Fajgenbaum D. Insights into the etiology of Castleman disease. Blood 2024; 143:1789-1790. [PMID: 38696194 DOI: 10.1182/blood.2023023716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024] Open
|
6
|
Witte H, Künstner A, Gebauer N. Update: The molecular spectrum of virus-associated high-grade B-cell non-Hodgkin lymphomas. Blood Rev 2024; 65:101172. [PMID: 38267313 DOI: 10.1016/j.blre.2024.101172] [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: 12/07/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
The vast spectrum of aggressive B-cell non-Hodgkin neoplasms (B-NHL) encompasses several infrequent entities occurring in association with viral infections, posing diagnostic challenges for practitioners. In the emerging era of precision oncology, the molecular characterization of malignancies has acquired paramount significance. The pathophysiological comprehension of specific entities and the identification of targeted therapeutic options have seen rapid development. However, owing to their rarity, not all entities have undergone exhaustive molecular characterization. Considerable heterogeneity exists in the extant body of work, both in terms of employed methodologies and the scale of cases studied. Presently, therapeutic strategies are predominantly derived from observations in diffuse large B-cell lymphoma (DLBCL), the most prevalent subset of aggressive B-NHL. Ongoing investigations into the molecular profiles of these uncommon virus-associated entities are progressively facilitating a clearer distinction from DLBCL, ultimately paving the way towards individualized therapeutic approaches. This review consolidates the current molecular insights into aggressive and virus-associated B-NHL, taking into consideration the recently updated 5th edition of the WHO classification of hematolymphoid tumors (WHO-5HAEM) and the International Consensus Classification (ICC). Additionally, potential therapeutically targetable susceptibilities are highlighted, offering a comprehensive overview of the present scientific landscape in the field.
Collapse
Affiliation(s)
- H Witte
- Department of Hematology and Oncology, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany; Department of Hematology and Oncology, University Hospital Schleswig-Holstein (UKSH) Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
| | - A Künstner
- University Cancer Center Schleswig-Holstein (UCCSH), Ratzeburger Allee 160, 23538 Lübeck, Germany; Medical Systems Biology Group, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - N Gebauer
- Department of Hematology and Oncology, University Hospital Schleswig-Holstein (UKSH) Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; University Cancer Center Schleswig-Holstein (UCCSH), Ratzeburger Allee 160, 23538 Lübeck, Germany
| |
Collapse
|
7
|
Schmalzing M, Sander O, Seidl M, Marks R, Blank N, Kötter I, Tiemann M, Backhaus M, Manger B, Hübel K, Müller-Ladner U, Henes J. [Castleman's disease in the rheumatological practice]. Z Rheumatol 2024; 83:316-326. [PMID: 37624374 PMCID: PMC11058943 DOI: 10.1007/s00393-023-01393-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2023] [Indexed: 08/26/2023]
Abstract
The term Castleman's disease encompasses a group of rare lymphoproliferative diseases that show histopathological similarities in lymph node biopsy. Diagnostic criteria and a specific ICD-10 code have been available for a few years. Case studies listed at the beginning illustrate that close cooperation between clinicians and pathologists is required to enable a reliable diagnosis. For an optimal histopathological assessment, the pathologist is also dependent on the removal of a complete lymph node. Before distinguishing a potentially fatal multicentric idiopathic Castleman's disease from the resectable unicentric form, which is important in terms of prognosis and treatment, early diagnosis presupposes that Castleman's disease is considered in the differential diagnosis. Various immune phenomena and overlaps with autoimmune diseases can increase the probability of misdiagnosis or undetected cases in the clinical routine of rheumatologists. The intention of the present overview is therefore to point out the similarities with autoimmune diseases that are relevant for differential diagnoses and to point out situations that justify a review of the previous diagnosis.
Collapse
Affiliation(s)
- M Schmalzing
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
| | - O Sander
- Klinik für Rheumatologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - M Seidl
- Institut für Pathologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - R Marks
- Klinik für Innere Medizin I, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - N Blank
- Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - I Kötter
- Klinik für Rheumatologie und Immunologie, Klinikum Bad Bramstedt, Bad Bramstedt, Deutschland
- Rheumatologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - M Tiemann
- Institut für HämatoPathologie Hamburg, Hamburg, Deutschland
| | - M Backhaus
- Abt. Innere Medizin - Rheumatologie und klinische Immunologie, Park-Klinik Weissensee (Berlin), Berlin, Deutschland
| | - B Manger
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - K Hübel
- Klinik I für Innere Medizin, Universitätsklinikum Köln, Köln, Deutschland
| | - U Müller-Ladner
- Abteilung für Rheumatologie und Klinische Immunologie, Kerckhoff Klinik Bad Nauheim, Bad Nauheim, Deutschland
| | - J Henes
- Medizinische Universitätsklinik Abt. II, Universitätsklinikum Tübingen, Tübingen, Deutschland
| |
Collapse
|
8
|
Rodriguez Merino L, Pomares AA, Arce JR, Montes-Moreno S. From Castleman disease histopathological features to idiopathic multicentric Castleman disease: a multiparametric approach to exclude potential iMCD histopathological mimickers. J Clin Pathol 2024; 77:318-323. [PMID: 36690434 DOI: 10.1136/jcp-2022-208696] [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: 11/23/2022] [Accepted: 01/12/2023] [Indexed: 01/24/2023]
Abstract
AIMS International consensus diagnostic criteria for idiopathic multicentric Castleman disease (iMCD) includes lymph node Castleman disease (CD) histopathological features as major criteria. Our aim was to apply those criteria in a series of 42 cases with CD to find differences among unicentric CD, iMCD, HHV-8+multicentric CD (HHV-8+MCD) and POEMS/plasma cell neoplasia (PCN)-associated CD. METHODS Available clinical and laboratory criteria were collected. Histopathological features (germinal centre hyperplasia/regression, plasmacytosis, hypervascularity and follicular dendritic cell (FDC) prominence) were graded and immunohistochemistry with antibodies against CD20, CD3, CD138, HHV-8, Ig isotype (IgG, IgG4, IgA, IgM, IgD), kappa, lambda was performed in all cases. RESULTS Fourteen cases had hyaline-vascular type unicentric CD, 15 were HHV-8+MCD, 7 cases PCN/POEMS-associated CD and 5 cases were iMCD. One case was consistent with systemic lupus erythematosus (SLE) lymphadenopathy. Differences in grading of the CD-associated histopathological features showed that FDC proliferation was prominent in unicentric CD, hypervascularity was increased in HHV-8 positive MCD and germinal centre hyperplasia was restricted to iMCD cases and SLE. Monotypic plasma cells were readily identifiable in the lymph node biopsies in 43% of PCN/POEMS-associated CD. All three cases had lambda light chain restriction with IgA (two cases) and IgG (one case) isotypes. CONCLUSIONS HHV-8+ MCD and PCN/POEMS-related CD are the major mimickers of iMCD in lymph node biopsies. Grading of the five histopathological features for CD might be useful to, in conjunction with complete ancillary testing, suggest for specific disease entities.
Collapse
Affiliation(s)
| | - Aitana Avendaño Pomares
- Translational Hematopathology/IDIVAL, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Jose Revert Arce
- Pathology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - Santiago Montes-Moreno
- Anatomic Pathology, Hospital Universitario Marques de Valdecilla, Universidad de Cantabria (UNICAN), Santander, Spain
| |
Collapse
|
9
|
Wang S, Wang R, Shang P, Zhu X, Chen X, Zhang G, Wang M. Whole-Exome Sequencing Reveals the Genomic Profile and IL6ST Variants as a Prognostic Biomarker of Paraneoplastic Pemphigus-Associated Unicentric Castleman Disease. J Invest Dermatol 2024; 144:585-592.e1. [PMID: 37839777 DOI: 10.1016/j.jid.2023.07.031] [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: 07/04/2023] [Revised: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 10/17/2023]
Abstract
Unicentric Castleman disease (UCD) is a rare lymphoproliferative disorder. Paraneoplastic pemphigus (PNP) is a major complication associated with poor UCD prognosis. However, the genomic profiles and prognostic biomarkers of PNP-associated UCD remain unclear. In this study, we performed whole-exome sequencing analysis for 28 matched tumor-normal pairs and 9 tumor-only samples to define the genomic landscape of Chinese patients with PNP-associated UCD. An integrative analysis was performed to identify somatic variants, the mutational signatures, and key pathways in tumors. Besides, we analyzed the relationship among mutated genes, clinical characteristics, and prognosis. Sixty-one somatic mutant genes were identified in >1 patient with PNP-associated UCD. Specifically, IL6ST and PDGFRB were the most frequently mutated genes (32%), followed by DPP6 (18%) and MUC4 (18%). Signaling molecules and interactions, cellular processes, and signal transduction pathways were enriched. Furthermore, we found that poor overall survival was related to IL6ST variants (P = .02). Finally, we classified PNP-associated UCD into 4 genomic subgroups: IL6ST, PDGFRB, IL6ST-PDGFRB, and an unknown subgroup. In summary, we defined the molecular profile of PNP-associated UCD and identified a potential molecular biomarker for predicting prognosis, which may provide therapeutic targets for treating this severe disorder.
Collapse
Affiliation(s)
- Sai Wang
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Medical Products Administration Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing, China
| | - Rui Wang
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Medical Products Administration Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing, China
| | - Panpan Shang
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Medical Products Administration Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing, China
| | - Xuejun Zhu
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Medical Products Administration Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing, China
| | - Xixue Chen
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Medical Products Administration Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing, China
| | - Guohong Zhang
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Medical Products Administration Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing, China
| | - Mingyue Wang
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Medical Products Administration Key Laboratory for Quality Control and Evaluation of Cosmetics, Beijing, China.
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
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.
Collapse
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)
| |
Collapse
|
12
|
Hu S, Li Z, Wang H, Chen L, Ma Y, Zhu X, Li J, Dong R, Yao W, Dong C, Zhang H, Li K, Dong K, Zhai X. Clinical features and treatment outcomes of Castleman disease in children: a retrospective cohort in China. Eur J Pediatr 2023; 182:5519-5530. [PMID: 37782352 PMCID: PMC10746570 DOI: 10.1007/s00431-023-05235-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 10/03/2023]
Abstract
Castleman disease (CD) is a rare lymphoproliferative disorder of undetermined etiology. Unicentric CD (UCD) and multicentric CD (MCD) are two phenotypes of CD diagnosed by the histopathology of lymph nodes. We attempted to describe a pediatric CD cohort to optimize the management of this disease. We reviewed the medical records of pediatric patients diagnosed with CD between April, 2004, and October, 2022, at the Children's Hospital of Fudan University. Prognosis information was collected in January, 2023, by telephone inquiry. Twenty-two patients with UCD and 2 patients with MCD were identified, all with hyaline vascular (HV) type. The median ages at diagnosis were 10.75 years (IQR 8, 12.81) for UCD and 14.42 years (IQR 13.42, 15.42) for MCD. The most common lesion location of UCD was the neck (9/22, 40.91%) and abdomen (9/22, 40.91%). Systematic symptoms occurred on 10/22 (45.45%) patients with UCD and 1/2 (50%) patients with MCD, and abnormal laboratory indexes were detected in both. Resection and biopsy were performed on all patients. One out of two patients with MCD also received rituximab for upfront therapy. After a median of 4 years (IQR 1.5, 6) of follow-up time, the overall survival was 100% and the complete remission rate in UCD was 63%. There was no relapse or progression. CONCLUSIONS Our series demonstrated that HV-UCD was the most common type in children. Resection and biopsy were used for both deterministic diagnoses and treatments. Despite the high possibility to develop systematic inflammation, children with CD showed promising outcomes. WHAT IS KNOWN • Castleman disease is a rare lymphoproliferative disorder with limited cohort studies, especially in pediatrics. • The ubiquity of delayed confirmations and misdiagnoses points to a lack of knowledge about etiology and characteristics, which is a prerequisite for novel therapeutics. WHAT IS NEW • We retrospectively reviewed and analyzed the clinical and pathological symptoms, laboratory and imaging features, and treatment outcomes of a Chinese pediatric cohort with Castleman disease. • Our work may improve the recognition and optimize the management of this rare disease in children.
Collapse
Affiliation(s)
- Shiwen Hu
- Department of Hematology and Oncology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Zifeng Li
- Department of Pediatric Surgery, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Hongsheng Wang
- Department of Hematology and Oncology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Lian Chen
- Department of Pathology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yangyang Ma
- Department of Pathology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xiaohua Zhu
- Department of Hematology and Oncology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Jun Li
- Department of Hematology and Oncology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Rui Dong
- Department of Pediatric Surgery, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Wei Yao
- Department of Pediatric Surgery, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Chenbin Dong
- Department of Pediatric Surgery, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Huifeng Zhang
- Department of Cardiothoracic Surgery, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Kai Li
- Department of Pediatric Surgery, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Kuiran Dong
- Department of Pediatric Surgery, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xiaowen Zhai
- Department of Hematology and Oncology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
| |
Collapse
|
13
|
Hammer PM, Wang A, Beard C, Zdravkovic S, Tenney T, Liang B, Das I, Bremer R, Wang LC, McCluggage WG, Stewart CJR, Howitt BE. Detection of FOXL2 C134W Mutation Status by a Novel BaseScope In Situ Hybridization Assay is Highly Sensitive and Specific for Adult Granulosa Cell Tumors. Mod Pathol 2023; 36:100318. [PMID: 37634867 DOI: 10.1016/j.modpat.2023.100318] [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: 01/08/2023] [Revised: 07/13/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023]
Abstract
Adult granulosa cell tumors (AGCTs) are a molecularly distinct group of malignant ovarian sex cord-stromal tumors (SCSTs) characterized by a nearly ubiquitous c.402C>G/p.C134W mutation in FOXL2 (hereafter referred to as "C134W"). In some cases, AGCT exhibits marked morphologic overlap with other SCSTs and has an identical immunophenotype, and molecular testing may be necessary to help confirm the diagnosis. However, molecular testing is time consuming, relatively expensive, and unavailable in many pathology laboratories. We describe the development and validation of an in situ hybridization (ISH) custom BaseScope assay for the detection of the FOXL2 C134W mutation. We evaluated 106 ovarian SCSTs, including 78 AGCTs, 9 juvenile granulosa cell tumors, 18 fibromas (cellular and conventional), and 1 SCST, not otherwise specified, as well as 53 epithelial ovarian tumors (42 endometrioid carcinomas and 11 carcinosarcomas) and 1 STK11 adnexal tumor for the presence or absence of FOXL2 wild-type and FOXL2 C134W RNA expression via BaseScope-ISH. Fifty-one tumors had previously undergone DNA sequencing of the FOXL2 gene. Across the entire cohort, the FOXL2 C134W probe staining was positive in 77 of 78 (98.7%) AGCTs. Two of 81 (2.5%) non-AGCTs also showed positive staining, both of which were epithelial ovarian tumors. The assay worked in tissue from blocks >20 years old. There was 100% concordance between the FOXL2 sequencing and BaseScope-ISH results. Overall, assessment of FOXL2 mutation status by custom BaseScope-ISH demonstrated 98.7% sensitivity and 97.5% specificity for the diagnosis of AGCT. BaseScope-ISH for FOXL2 C134W represents a reasonable alternative to sequencing, is quicker and less expensive, and is more easily incorporated than molecular testing into many pathology laboratories. It also has the advantage of requiring less tissue, and the neoplastic cells can be directly visualized on stained sections.
Collapse
Affiliation(s)
- Phoebe M Hammer
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Aihui Wang
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Crystal Beard
- Department of Pathology, Stanford University School of Medicine, Stanford, California; Meharry Medical College, School of Medicine, Nashville, Tennessee
| | - Sabrina Zdravkovic
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Troy Tenney
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Brooke Liang
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Ishani Das
- Advanced Cell Diagnostics-a Bio-Techne brand, Newark, California
| | - Ryan Bremer
- Advanced Cell Diagnostics-a Bio-Techne brand, Newark, California
| | - Li-Chong Wang
- Advanced Cell Diagnostics-a Bio-Techne brand, Newark, California
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Colin J R Stewart
- Department of Histopathology, King Edward Memorial Hospital and School for Women's and Infants' Health, University of Western Australia, Perth, Western Australia, Australia
| | - Brooke E Howitt
- Department of Pathology, Stanford University School of Medicine, Stanford, California.
| |
Collapse
|
14
|
Brandstadter JD, De Martin A, Lϋtge M, Ferreira A, Gaudette BT, Stanossek Y, Wang S, Gonzalez MV, Camiolo E, Wertheim G, Austin B, Allman D, Bagg A, Lim MS, Fajgenbaum DC, Aster JC, Ludewig B, Maillard I. A novel cryopreservation and biobanking strategy to study lymphoid tissue stromal cells in human disease. Eur J Immunol 2023; 53:e2250362. [PMID: 37366295 PMCID: PMC10529925 DOI: 10.1002/eji.202250362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/03/2023] [Accepted: 05/19/2023] [Indexed: 06/28/2023]
Abstract
Nonhematopoietic lymph node stromal cells (LNSCs) regulate lymphocyte trafficking, survival, and function for key roles in host defense, autoimmunity, alloimmunity, and lymphoproliferative disorders. However, the study of LNSCs in human diseases is complicated by a dependence on viable lymphoid tissues, which are most often excised prior to establishment of a specific diagnosis. Here, we demonstrate that cryopreservation can be used to bank lymphoid tissue for the study of LNSCs in human disease. Using human tonsils and lymph nodes (LN), lymphoid tissue fragments were cryopreserved for subsequent enzymatic digestion and recovery of viable nonhematopoietic cells. Flow cytometry and single-cell transcriptomics identified comparable proportions of LN stromal cell types in fresh and cryopreserved tissue. Moreover, cryopreservation had little effect on transcriptional profiles, which showed significant overlap between tonsils and LN. The presence and spatial distribution of transcriptionally defined cell types were confirmed by in situ analyses. Our broadly applicable approach promises to greatly enable research into the roles of LNSCs in human disease.
Collapse
Affiliation(s)
- Joshua D Brandstadter
- Division of Hematology/Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Angelina De Martin
- Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Mechthild Lϋtge
- Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Antonio Ferreira
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian T Gaudette
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yves Stanossek
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Shumei Wang
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael V Gonzalez
- Center for Cytokine Storm Treatment and Laboratory, Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Edward Camiolo
- Children’s Hospital of Philadelphia, Department of Pathology and Laboratory Medicine, Philadelphia, PA, USA
| | - Gerald Wertheim
- Children’s Hospital of Philadelphia, Department of Pathology and Laboratory Medicine, Philadelphia, PA, USA
| | - Bridget Austin
- Center for Cytokine Storm Treatment and Laboratory, Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David Allman
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Megan S Lim
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - David C Fajgenbaum
- Center for Cytokine Storm Treatment and Laboratory, Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jon C Aster
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Burkhard Ludewig
- Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Ivan Maillard
- Division of Hematology/Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
15
|
Dieudonné Y, Silvestrini MA, Dossier A, Meignin V, Jouenne F, Mahévas T, Bouaziz JD, Jackson MA, Mordant P, Poirot J, Onodi F, Calvani J, Hourseau M, Evrard D, Berisha M, Perrin F, Danel C, Borie R, Galicier L, Mourah S, Bengoufa D, Oksenhendler E, Grootenboer-Mignot S, Boutboul D. Paraneoplastic pemphigus uncovers distinct clinical and biological phenotypes of western unicentric Castleman disease. Br J Haematol 2023. [PMID: 37221131 DOI: 10.1111/bjh.18847] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/29/2023] [Accepted: 04/23/2023] [Indexed: 05/25/2023]
Abstract
Unicentric Castleman disease (UCD) is a lymphoproliferative disease of unknown cause. Paraneoplastic pemphigus (PNP) is a major complication shown to be associated with a poor prognosis, with particular severity in patients with bronchiolitis obliterans (BO). This study describes the clinical and biological characteristics of UCD-PNP patients in a large Western cohort. A total of 148 patients diagnosed with UCD were identified, including 14 patients with a defined PNP. PNP was significantly associated with myasthenia gravis (MG) and FDC sarcoma during follow-up (FDCS). PNP was also significantly associated with reduced survival. These data, together with a multivariate analysis by principal components, led to the identification of UCD-PNP as a group at risk of MG, FDCS and death. PDGFRB sequencing performed on UCD lesions from six patients found the gain-of-function p.N666S variant in two. Interestingly, both patients had hyaline-vascular UCD subtype, were in the UCD-PNP subgroup and had FDCS. Sera from 25 UCD-PNP patients and 6 PNP patients without UCD were tested for PNP-associated autoantibodies. Sera from UCD-PNP patients had a strong reactivity against the N-terminal domain of recombinant periplakin (rPPL, 82%) and showed reactivity against at least two domains of rPPL. These features were not found in patients with UCD alone or in the PNP group without UCD. These data indicate that UCD-PNP patients belong to a subgroup sharing strong clinical and biological identity that might help to decipher the different dynamics of UCD natural history.
Collapse
Affiliation(s)
- Yannick Dieudonné
- Department of Clinical Immunology and Internal Medicine, National Reference Centre for Systemic Autoimmune Diseases (CNR RESO), Strasbourg University Hospital, Strasbourg, France
- INSERM UMR-S1109, Université de Strasbourg, Strasbourg, France
| | | | - Antoine Dossier
- Department of Internal Medicine, Hôpital Bichat, Université Paris Cité, Paris, France
| | - Véronique Meignin
- Department of Pathology, Hôpital Saint Louis, Université Paris Cité, Paris, France
| | - Fanélie Jouenne
- Laboratoire de Génomique des Tumeurs et Pharmacologie, INSERM UMR-S976, Hôpital Saint Louis, Université Paris Cité, Paris, France
| | - Thibault Mahévas
- Department of Dermatology, Hôpital Saint Louis, Université Paris Cité, Paris, France
| | - Jean-David Bouaziz
- Department of Dermatology, Hôpital Saint Louis, Université Paris Cité, Paris, France
| | | | - Pierre Mordant
- Department of Thoracic Surgery, Vascular Surgery, and Lung Transplantation, Hôpital Bichat, Université Paris Cité, Paris, France
| | - Justine Poirot
- U976 HIPI, Hôpital Saint Louis, Université Paris Cité, Paris, France
| | - Fanny Onodi
- U976 HIPI, Hôpital Saint Louis, Université Paris Cité, Paris, France
| | - Julien Calvani
- Department of Pathology, Hôpital Saint Louis, Université Paris Cité, Paris, France
| | - Muriel Hourseau
- Department of Pathology, Hôpital Bichat, Université Paris Cité, Paris, France
| | - Diane Evrard
- Department of Otorhinolaryngology, Hôpital Bichat, Université Paris Cité, Paris, France
| | - Mirlinda Berisha
- National Reference Centre for Castleman Disease, Hôpital Saint Louis, Université Paris Cité, Paris, France
| | - François Perrin
- Department of Internal Medicine, Centre Hospitalier de Saint-Nazaire, Saint-Nazaire, France
| | - Claire Danel
- Department of Pathology, Hôpital Bichat, Université Paris Cité, Paris, France
| | - Raphael Borie
- Inserm, PHERE, F-75018 Paris, et Hôpital Bichat, APHP, Service de Pneumologie A, FHU APOLLO, Université Paris Cité, Paris, France
| | - Lionel Galicier
- National Reference Centre for Castleman Disease, Hôpital Saint Louis, Université Paris Cité, Paris, France
- Clinical Immunology Department, Hôpital Saint Louis, Université Paris Cité, Paris, France
| | - Samia Mourah
- Laboratoire de Génomique des Tumeurs et Pharmacologie, INSERM UMR-S976, Hôpital Saint Louis, Université Paris Cité, Paris, France
| | - Djaouida Bengoufa
- Immunology laboratory, Hôpital Saint Louis, Université Paris Cité, Paris, France
| | - Eric Oksenhendler
- National Reference Centre for Castleman Disease, Hôpital Saint Louis, Université Paris Cité, Paris, France
- Clinical Immunology Department, Hôpital Saint Louis, Université Paris Cité, Paris, France
| | - Sabine Grootenboer-Mignot
- Department of Immunology, Auto-Immunity and Hypersensitivity, Hôpital Bichat, Université Paris Cité, Paris, France
| | - David Boutboul
- U976 HIPI, Hôpital Saint Louis, Université Paris Cité, Paris, France
- National Reference Centre for Castleman Disease, Hôpital Saint Louis, Université Paris Cité, Paris, France
- Clinical Immunology Department, Hôpital Saint Louis, Université Paris Cité, Paris, France
| |
Collapse
|
16
|
Temmoku J, Sasajima T, Kuroda T, Sumichika Y, Saito K, Yoshida S, Matsumoto H, Fujita Y, Matsuoka N, Asano T, Sato S, Yamada T, Hashimoto Y, Migita K. Rapid Clinical Improvement of Multicentric Castleman Disease (MCD) with Renal Involvement Following Treatment with Tocilizumab: AA Amyloidosis as a Possible Renal Involvement of MCD. TOHOKU J EXP MED 2023; 259:285-291. [PMID: 36653160 DOI: 10.1620/tjem.2023.j003] [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] [Indexed: 01/19/2023]
Abstract
Castleman disease (CD) is a lymphoproliferative disorder that manifests as hypergammaglobulinemia and severe inflammation with multiorgan involvement. However, renal involvement has been infrequently described in CD. We present a case of a 63-year-old Japanese male patient with multicentric CD (MCD) in whom kidney involvement, including impaired renal function and massive proteinuria, is present. He had a 2-year history of inflammatory arthritis and was referred to our clinic with newly developed proteinuria, renal dysfunction, and elevated levels of acute-phase proteins. Abdominal computed tomography scan revealed hepatosplenomegaly, including mesenteric and inguinal lymph node enlargements. The patient underwent inguinal lymph node resection. Excisional biopsy of the inguinal lymph node showed multiple lymphoid follicles and expansion of interfollicular areas by marked plasmacytosis consistent with mixed type CD. The patient was diagnosed with human herpes virus 8-negative MCD according to the international diagnostic criteria for CD. Diagnostic renal biopsy was not performed following the medical viewpoint. Tocilizumab (TCZ) treatment was highly effective in reducing proteinuria and stabilizing renal function, as well as improving other clinical symptoms. The patient responded to TCZ treatment, and the renal involvement was rapidly improved. Our preliminary immunohistochemical analysis indicated AA amyloid deposits in urinary epithelial cells suggesting a possible renal involvement of AA amyloidosis. TCZ could potentially be one of the therapeutic options in patients with MCD with renal involvement.
Collapse
Affiliation(s)
- Jumpei Temmoku
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | | | - Takeshi Kuroda
- Department of Rheumatology and Nephrology, Niigata University Graduate School of Medical and Dental Sciences
| | - Yuya Sumichika
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Kenji Saito
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Shuhei Yoshida
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Haruki Matsumoto
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Yuya Fujita
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Naoki Matsuoka
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Tomoyuki Asano
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Shuzo Sato
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Toshiyuki Yamada
- Department of Clinical Laboratory Medicine, Jichi Medical University
| | - Yuko Hashimoto
- Department of Pathology, Fukushima Medical University School of Medicine
| | - Kiyoshi Migita
- Department of Rheumatology, Fukushima Medical University School of Medicine
| |
Collapse
|
17
|
Brandstadter JD, De Martin A, Lütge M, Ferreira A, Gaudette BT, Stanossek Y, Wang S, Gonzalez MV, Camiolo E, Wertheim G, Austin B, Allman D, Lim MS, Fajgenbaum DC, Aster JC, Ludewig B, Maillard I. A novel cryopreservation and biobanking strategy to study lymphoid tissue stromal cells in human disease. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.06.525604. [PMID: 36798373 PMCID: PMC9934566 DOI: 10.1101/2023.02.06.525604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Non-hematopoietic lymph node stromal cells (LNSCs) regulate lymphocyte trafficking, survival, and function for key roles in host defense, autoimmunity, alloimmunity, and lymphoproliferative disorders. However, study of LNSCs in human diseases is complicated by a dependence on viable lymphoid tissues, which are most often excised prior to establishment of a specific diagnosis. Here, we demonstrate that cryopreservation can be used to bank lymphoid tissue for the study of LNSCs in human disease. Using human tonsils, lymphoid tissue fragments were cryopreserved for subsequent enzymatic digestion and recovery of viable non-hematopoietic cells. Flow cytometry and single-cell transcriptomics identified comparable proportions of LNSC cell types in fresh and cryopreserved tissue. Moreover, cryopreservation had little effect on transcriptional profiles, which showed significant overlap between tonsils and lymph nodes. The presence and spatial distribution of transcriptionally defined cell types was confirmed by in situ analyses. Our broadly applicable approach promises to greatly enable research into the roles of LNSC in human disease.
Collapse
|
18
|
Ręka G, Stefaniak M, Lejman M. Novel Molecular Therapies and Genetic Landscape in Selected Rare Diseases with Hematologic Manifestations: A Review of the Literature. Cells 2023; 12:cells12030449. [PMID: 36766791 PMCID: PMC9913931 DOI: 10.3390/cells12030449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/03/2023] Open
Abstract
Rare diseases affect less than 1 in 2000 people and are characterized by a serious, chronic, and progressive course. Among the described diseases, a mutation in a single gene caused mastocytosis, thrombotic thrombocytopenic purpura, Gaucher disease, and paroxysmal nocturnal hemoglobinuria (KIT, ADAMTS13, GBA1, and PIG-A genes, respectively). In Castleman disease, improper ETS1, PTPN6, TGFBR2, DNMT3A, and PDGFRB genes cause the appearance of symptoms. In histiocytosis, several mutation variants are described: BRAF, MAP2K1, MAP3K1, ARAF, ERBB3, NRAS, KRAS, PICK1, PIK3R2, and PIK3CA. Genes like HPLH1, PRF1, UNC13D, STX11, STXBP2, SH2D1A, BIRC4, ITK, CD27, MAGT1, LYST, AP3B1, and RAB27A are possible reasons for hemophagocytic lymphohistiocytosis. Among novel molecular medicines, tyrosine kinase inhibitors, mTOR inhibitors, BRAF inhibitors, interleukin 1 or 6 receptor antagonists, monoclonal antibodies, and JAK inhibitors are examples of drugs expanding therapeutic possibilities. An explanation of the molecular basis of rare diseases might lead to a better understanding of the pathogenesis and prognosis of the disease and may allow for the development of new molecularly targeted therapies.
Collapse
Affiliation(s)
- Gabriela Ręka
- Independent Laboratory of Genetic Diagnostics, Medical University of Lublin, A. Gębali 6, 20-093 Lublin, Poland
- Correspondence:
| | - Martyna Stefaniak
- Student Scientific Society of Independent Laboratory of Genetic Diagnostics, Medical University of Lublin, A. Gębali 6, 20-093 Lublin, Poland
| | - Monika Lejman
- Independent Laboratory of Genetic Diagnostics, Medical University of Lublin, A. Gębali 6, 20-093 Lublin, Poland
| |
Collapse
|
19
|
[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.
Collapse
|
20
|
Zhang YH, He YF, Yue H, Zhang YN, Shi L, Jin B, Dong P. Solitary hyoid plasmacytoma with unicentric Castleman disease: A case report and review of literature. World J Clin Cases 2022; 10:13364-13372. [PMID: 36683640 PMCID: PMC9850993 DOI: 10.12998/wjcc.v10.i36.13364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/17/2022] [Accepted: 12/05/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Solitary plasmacytoma and unicentric Castleman disease (UCD) are rare lymphoproliferative disorders characterized by monoclonal plasma cells and a single set of locally enlarged lymph nodes, respectively.
CASE SUMMARY A 48-year-old Han Chinese man presented to our department with a neck mass and progressive foreign body sensation in his throat. 18F-FDG positron emission tomography revealed focally increased radioactivity centered around the hyoid, and computed tomography (CT) revealed osteolytic lesions. Histopathology revealed Castleman-like features and CD138/CD38-positive mature plasma cells. Systemic work-up ruled out the possibility of POEMS syndrome, lymphoma, and multiple myeloma, leading to a final diagnosis of solitary hyoid plasmacytoma with UCD. The patient underwent partial hyoid resection and selective neck dissection, followed by intensity-modulated radiotherapy. 99mTc-MDP single-photon emission computed tomography/CT reevaluation showed neither local recurrence nor distant bone metastasis at the 40-mo follow-up.
CONCLUSION The diagnostic process and differential diagnosis of this rare case provided valuable educational information to clinicians.
Collapse
Affiliation(s)
- Yan-Hui Zhang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Yi-Feng He
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Hao Yue
- Department of Pathology, Shanghai Cancer Center, Fudan University, Shanghai 200032, China
| | - Yue-Ni Zhang
- NHC Key Laboratory of Molecular Probes and Targeted Diagnosis and Therapy, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150028, Heilongjiang Province, China
| | - Lei Shi
- NHC Key Laboratory of Molecular Probes and Targeted Diagnosis and Therapy, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150028, Heilongjiang Province, China
| | - Bin Jin
- Department of Otolaryngology-Head and Neck Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Pin Dong
- Department of Otolaryngology-Head and Neck Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| |
Collapse
|
21
|
Galicier L, Schleinitz N. Approche thérapeutique des maladies de Castleman : l’émergence des thérapies ciblées. Rev Med Interne 2022; 43:10S26-10S33. [PMID: 36657940 DOI: 10.1016/s0248-8663(23)00022-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The spectrum of Castleman disease encompasses several different disorders. Nowadays three different forms of the disease are individualized: unicentric Castleman disease, multicentric HHV-8 associated Castleman disease and idiopathic multicentric Castleman disease. In the latter a severe form called TAFRO syndrome (thrombocytopenia, anasarca, myelofibrosis, renal dysfunction, and organomegaly) tend to be individualized. Improvement in the classification and understanding of the physiopathology of CD have allowed improvement in treatment strategies. Treatment of rare but often severe manifestations, such as paraneoplastic pemphigus and bronchiolitis obliterans in unicentric CD and hemophagocytic syndrome and/or Kaposi' sarcoma in HHV8 associated CD, are better adapted. Most of current treatment strategies are based on retrospective and very few prospective studies. Both anti-IL6/6R and anti-CD20 biotherapies have greatly improved the management of certain forms of the disease. We report in this review the most relevant studies and national or international expert consensus statements for the treatment in the different types of CD. © 2022 Published by Elsevier Masson SAS on behalf of Société nationale française de médecine interne (SNFMI).
Collapse
Affiliation(s)
- L Galicier
- Service d'immunopathologie clinique, hôpital Saint-Louis, 75010 Paris, France.
| | - N Schleinitz
- Service de médecine interne, hôpital La Timone, Aix-Marseille Université, 13005 Marseille, France
| |
Collapse
|
22
|
Nédélec A, Guérit EM, Dachy G, Lenglez S, Wong LS, Arts FA, Demoulin JB. Penttinen syndrome-associated PDGFRB Val665Ala variant causes aberrant constitutive STAT1 signalling. J Cell Mol Med 2022; 26:3902-3912. [PMID: 35689379 PMCID: PMC9279580 DOI: 10.1111/jcmm.17427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/16/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022] Open
Abstract
Penttinen syndrome is a rare progeroid disorder caused by mutations in platelet‐derived growth factor (PDGF) receptor beta (encoded by the PDGFRB proto‐oncogene) and characterized by a prematurely aged appearance with lipoatrophy, skin lesions, thin hair and acro‐osteolysis. Activating mutations in PDGFRB have been associated with other human diseases, including Kosaki overgrowth syndrome, infantile myofibromatosis, fusiform aneurysms, acute lymphoblastic leukaemia and myeloproliferative neoplasms associated with eosinophilia. The goal of the present study was to characterize the PDGFRB p.Val665Ala variant associated with Penttinen syndrome at the molecular level. This substitution is located in a conserved loop of the receptor tyrosine kinase domain. We observed that the mutant receptor was expressed at a lower level but showed constitutive activity. In the absence of ligand, the mutant activated STAT1 and elicited an interferon‐like transcriptional response. Phosphorylation of STAT3, STAT5, AKT and phospholipase Cγ was weak or undetectable. It was devoid of oncogenic activity in two cell proliferation assays, contrasting with classical PDGF receptor oncogenic mutants. STAT1 activation was not sensitive to ruxolitinib and did not rely on interferon‐JAK2 signalling. Another tyrosine kinase inhibitor, imatinib, blocked signalling by the p.Val665Ala variant at a higher concentration compared with the wild‐type receptor. Importantly, this concentration remained in the therapeutic range. Dasatinib, nilotinib and ponatinib also inhibited the mutant receptor. In conclusion, the p.Val665Ala variant confers unique features to PDGF receptor β compared with other characterized gain‐of‐function mutants, which may in part explain the particular set of symptoms associated with Penttinen syndrome.
Collapse
Affiliation(s)
- Audrey Nédélec
- Experimental Medicine Unit, De Duve Institute, Université catholique de Louvain, Brussels, Belgium
| | - Emilie M Guérit
- Experimental Medicine Unit, De Duve Institute, Université catholique de Louvain, Brussels, Belgium
| | - Guillaume Dachy
- Experimental Medicine Unit, De Duve Institute, Université catholique de Louvain, Brussels, Belgium
| | - Sandrine Lenglez
- Experimental Medicine Unit, De Duve Institute, Université catholique de Louvain, Brussels, Belgium
| | - Lok San Wong
- Experimental Medicine Unit, De Duve Institute, Université catholique de Louvain, Brussels, Belgium
| | - Florence A Arts
- Experimental Medicine Unit, De Duve Institute, Université catholique de Louvain, Brussels, Belgium
| | - Jean-Baptiste Demoulin
- Experimental Medicine Unit, De Duve Institute, Université catholique de Louvain, Brussels, Belgium
| |
Collapse
|
23
|
Qian S, Ding M, Hou H, Wang Z, Zhang J, Zhang Y, Dong M, Zhu L, Wang G, Li W, Zhang X. Clinical and Molecular Characteristics of 60 Patients With Human Immunodeficiency Virus-Negative Castleman Disease. Front Immunol 2022; 13:899073. [PMID: 35655778 PMCID: PMC9152317 DOI: 10.3389/fimmu.2022.899073] [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: 03/18/2022] [Accepted: 04/19/2022] [Indexed: 11/29/2022] Open
Abstract
Castleman disease (CD) is a rare lymphoproliferative disorder. The mechanistic target of rapamycin (mTOR) pathway is a key regulator of various cellular functions, which may be related with the potential mechanisms of CD occurrence. We retrospectively collected the clinical information of 60 CD patients diagnosed in the First Affiliated Hospital of Zhengzhou University. And FFPE biopsy specimens were collected from 31 patients (12 unicentric CD patients and 19 multicentric CD patients) to detect the mTOR pathway protein expression. We are the first to demonstrate that thrombocytopenia and hypoalbuminemia are independent poor prognostic factors for CD. Moreover, mTOR activation was higher in CD compared to reactive lymphoid hyperplasia (used as a control group). This study offers some elucidation for the management and treatment of CD patients.
Collapse
Affiliation(s)
- Siyu Qian
- Department of Oncology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Mengjie Ding
- Department of Oncology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Huting Hou
- Department of Oncology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Zeyuan Wang
- Department of Oncology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Jieming Zhang
- Department of Oncology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Yue Zhang
- Department of Oncology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Meng Dong
- Department of Oncology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Linan Zhu
- Department of Oncology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Guannan Wang
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wencai Li
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xudong Zhang
- Department of Oncology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| |
Collapse
|
24
|
Wang XQ, Zhong NN, Sun Q, Yan SC, Xu GC, Wang YG, Peng LW, Liu B, Bu LL. Comprehensive analysis of 65 patients with Castleman disease in a single center in China. Sci Rep 2022; 12:8694. [PMID: 35610300 PMCID: PMC9130315 DOI: 10.1038/s41598-022-12797-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/17/2022] [Indexed: 11/15/2022] Open
Abstract
This study aimed to investigate the epidemiologic, clinical, pathological characteristics, and treatment of patients with Castleman disease (CD) in a single center in China. We retrospectively analyzed the data of 65 Chinese CD patients, divided into unicentric CD (UCD) and multicentric CD (MCD) groups, and also microscopic subtypes as hypervascular (HV), plasmacytic (PC) and Mixed. Based on whether HHV-8 infection existed, MCD was subdivided into HHV-8-associated MCD and idiopathic Castleman disease (iMCD). Detailed epidemiologic, clinicopathological, and treatment data were analyzed and discussed. Of total 65 patients (UCD 33, MCD 32), HV (81.8%) accounted for the most of UCD and total. More females in UCD (60.6%) and more males in MCD (65.6%) were observed. CD occurred in all age groups, most commonly in 40-49 years. The mean age of onset of total was 38.5 years with PC higher than HV (45.5 vs. 35.1 years, P = 0.0413). The median diagnosis delay of MCD was longer than that of UCD (3.00 vs. 1.25 months, P = 0.0436). Abdomen (39.4%) and neck (30.3%) were the most-seen locations of lymphadenopathy in UCD, with neck (65.6%) being predominant in MCD. Mean major diameter of specimens of UCD was greater than MCD (6.4 vs. 3.1 cm, P < 0.0001). These results provided the featured and detailed profile of Castleman disease in Henan province in China with a considerable number of cases, which presented distinct evidence with other studies.
Collapse
Affiliation(s)
- Xi-Qian Wang
- Department of Oral & Maxillofacial Surgery, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, 450003, Henan, China
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, Hubei, China
| | - Nian-Nian Zhong
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, Hubei, China
| | - Qi Sun
- Department of Pathology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, 450003, Henan, China
| | - Si-Chen Yan
- Department of Oral & Maxillofacial Surgery, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, 450003, Henan, China
| | - Guang-Cai Xu
- Department of Oral & Maxillofacial Surgery, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, 450003, Henan, China
| | - Yong-Gong Wang
- Department of Oral & Maxillofacial Surgery, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, 450003, Henan, China
| | - Li-Wei Peng
- Department of Oral & Maxillofacial Surgery, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Zhengzhou, 450003, Henan, China.
| | - Bing Liu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, Hubei, China.
- Department of Oral & Maxillofacial Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, Hubei, China.
| | - Lin-Lin Bu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, Hubei, China.
- Department of Oral & Maxillofacial Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, Hubei, China.
| |
Collapse
|
25
|
Singh KI, Gollapudi S, Kumar J, Butzmann A, Small C, Kreimer S, Saglam EA, Warnke R, Silva O, Ohgami RS. Case Report: Castleman Disease With an Associated Stromal Spindle Cell Proliferation, PDGFRB Mutation and p53 Expression: Clonal Origins of a Rare Disease. Front Oncol 2022; 12:857606. [PMID: 35494027 PMCID: PMC9043324 DOI: 10.3389/fonc.2022.857606] [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: 01/18/2022] [Accepted: 02/22/2022] [Indexed: 11/29/2022] Open
Abstract
Castleman disease (CD) is a rare lymphoproliferative disorder with distinct clinical subtypes. However, our understanding of the underlying pathogenesis of particular subtypes of CD remains unclear. While the characteristic morphologic changes within UCD, including occasional cases of overgrowth of spindled stromal and follicular dendritic cells have been described, the nature and origin of these spindle cells remain elusive. Few reports have suggested that underlying stromal cells in UCD are clonally neoplastic and may be of fibroblastic reticular cell (FRC) or follicular dendritic cell (FDC) origins given their close clonal relationship. Although certain histomorphologic features may aid diagnosis, there are no specific biomarkers that can differentiate a reactive process mimicking UCD from true UCD. Hence, we describe an index case with morphology consistent with the hyaline vascular subtype of UCD with concomitant atypical smooth muscle actin (SMA)-positive stromal spindle cell proliferation containing a recurrent PDGFRB N666S mutation and upregulation of p53 expression. Further analysis of 21 additional cases of UCD identified increased p53 expression by digital image analysis and SMA positive stromal cells predominantly within the paracortical and intrafollicular areas further strengthening the hypothesis of the stromal cellular derivation and origins of UCD.
Collapse
Affiliation(s)
- Kunwar I Singh
- Department of Pathology, University of California, San Francisco, San Francisco, CA, United States
| | - Sumanth Gollapudi
- Department of Pathology, University of California, San Francisco, San Francisco, CA, United States
| | - Jyoti Kumar
- Department of Pathology, Stanford University, Stanford, CA, United States
| | - Alexandra Butzmann
- Department of Pathology, University of California, San Francisco, San Francisco, CA, United States
| | - Corinn Small
- Department of Pathology, University of California, San Francisco, San Francisco, CA, United States
| | - Sara Kreimer
- Department of Pathology, Stanford University, Stanford, CA, United States
| | - Emine Arzu Saglam
- Department of Pathology, University of California, San Francisco, San Francisco, CA, United States
| | - Roger Warnke
- Department of Pathology, Stanford University, Stanford, CA, United States
| | - Oscar Silva
- Department of Pathology, Stanford University, Stanford, CA, United States
| | - Robert S Ohgami
- Department of Pathology, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
26
|
Horna P, King RL, Jevremovic D, Fajgenbaum DC, Dispenzieri A. The lymph node transcriptome of unicentric and idiopathic multicentric Castleman disease. Haematologica 2022; 108:207-218. [PMID: 35484648 PMCID: PMC9827154 DOI: 10.3324/haematol.2021.280370] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Indexed: 02/05/2023] Open
Abstract
Castleman disease is a polyclonal lymphoproliferative disorder characterized by unicentric or multicentric lymphadenopathy with characteristic histomorphological features, in addition to variable inflammatory symptomatology. The molecular mechanisms and etiologies of unicentric Castleman disease (UCD) and idiopathic multicentric Castleman disease (iMCD) are poorly understood, and identification of targetable disease mediators remains an unmet clinical need. We performed whole exome sequencing on lymph node biopsies from patients with UCD and iMCD and compared the transcriptomic profiles to that of benign control lymph nodes. We identified significantly upregulated genes in UCD (n=443), iMCD (n=316) or both disease subtypes (n=51) and downregulated genes in UCD (n=321), iMCD (n=105) or both (n=10). The transcriptomes of UCD and iMCD showed enrichment and upregulation of elements of the complement cascade. By immunohistochemistry, C4d deposits indicative of complement activation were found to be present in UCD and iMCD, mostly within abnormally regressed germinal centers, but also in association with plasma cell clusters, endothelial cells and stroma cell proliferations. Other enriched gene sets included collagen organization, S1P3 pathway and VEGFR pathway in UCD; and humoral response, oxidative phosphorylation and proteosome in iMCD. Analysis of cytokine transcripts showed upregulation of CXCL13 but not IL6 in UCD and iMCD. Among angiogenic mediators, the VEGFR1 ligand placental growth factor (PGF) was upregulated in both disease subtypes. We hereby report for the first time the whole lymph node transcriptomes of UCD and iMCD, underscoring findings that could aid in the discovery of targetable disease mediators.
Collapse
Affiliation(s)
- Pedro Horna
- Division of Hematopathology, Mayo Clinic, Rochester, MN,P. Horna
| | | | | | - David C. Fajgenbaum
- Center for Cytokine Storm Treatment & Laboratory, University of Pennsylvania, Philadelphia, PA
| | | |
Collapse
|
27
|
Transcriptome and unique cytokine microenvironment of Castleman disease. Mod Pathol 2022; 35:451-461. [PMID: 34686774 PMCID: PMC9272352 DOI: 10.1038/s41379-021-00950-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 01/03/2023]
Abstract
Castleman disease (CD) represents a group of rare, heterogeneous and poorly understood disorders that share characteristic histopathological features. Unicentric CD (UCD) typically involves a single enlarged lymph node whereas multicentric CD (MCD) involves multiple lymph node stations. To understand the cellular basis of CD, we undertook a multi-platform analysis using targeted RNA sequencing, RNA in-situ hybridization (ISH), and adaptive immune receptor rearrangements (AIRR) profiling of archived tissue from 26 UCD, 14 MCD, and 31 non-CD reactive controls. UCD showed differential expression and upregulation of follicular dendritic cell markers (CXCL13, clusterin), angiogenesis factors (LPL, DLL4), extracellular matrix remodeling factors (TGFβ, SKIL, LOXL1, IL-1β, ADAM33, CLEC4A), complement components (C3, CR2) and germinal center activation markers (ZDHHC2 and BLK) compared to controls. MCD showed upregulation of IL-6 (IL-6ST, OSMR and LIFR), IL-2, plasma cell differentiation (XBP1), FDC marker (CXCL13, clusterin), fibroblastic reticular cell cytokine (CCL21), angiogenesis factor (VEGF), and mTORC1 pathway genes compared to UCD and controls. ISH studies demonstrated that VEGF was increased in the follicular dendritic cell-predominant atretic follicles and the interfollicular macrophages of MCD compared to UCD and controls. IL-6 expression was higher along interfollicular vasculature-associated cells of MCD. Immune repertoire analysis revealed oligoclonal expansions of T-cell populations in MCD cases (2/6) and UCD cases (1/9) that are consistent with antigen-driven T cell activation. The findings highlight the unique genes, pathways and cell types involved in UCD and MCD. We identify potential novel targets in CD that may be harnessed for therapeutics.
Collapse
|
28
|
Farinha P, Subtil A, Carr A, Rahim K, Rinsma R, Tucker T, Hayes M. ALK+ hyaline-vascular Castleman disease: A new kid on the block. Histopathology 2022; 80:1007-1010. [PMID: 35137445 DOI: 10.1111/his.14624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Pedro Farinha
- BC Cancer Pathology / BC Cancer Center of Lymphoid Cancer / Department Pathology & Laboratory Medicine, University of British Columbia
| | - Antonio Subtil
- Royal Jubilee Hospital / Department Pathology & Laboratory Medicine, University of British Columbia
| | - Amy Carr
- BC Cancer Genetics and Genomics Laboratory
| | - Kaba Rahim
- BC Cancer Genetics and Genomics Laboratory
| | | | - Tracy Tucker
- BC Cancer Genetics and Genomics Laboratory // Department Pathology & Laboratory Medicine, University of British Columbia
| | - Malcolm Hayes
- BC Cancer Pathology / Department Pathology & Laboratory Medicine, University of British Columbia
| |
Collapse
|
29
|
Facchetti F, Simbeni M, Lorenzi L. Follicular dendritic cell sarcoma. Pathologica 2021; 113:316-329. [PMID: 34837090 PMCID: PMC8720404 DOI: 10.32074/1591-951x-331] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 06/21/2021] [Indexed: 12/17/2022] Open
Abstract
Follicular dendritic cells (FDC) are mesenchymal-derived dendritic cells located in B-follicles where they play a pivotal role in triggering and maintaining B-cell adaptive immune response. In 1986 Dr. Juan Rosai first reported a series of neoplasms showing features of FDC and defined it as Follicular Dendritic Cell Tumor, subsequently renamed as "sarcoma" (FDCS). In its seminal and subsequent articles Rosai and colleagues highlighted the heterogeneous microscopic appearance of FDCS and its immunohistochemical and ultrastructural features. FDCS mostly occurs in extranodal sites (79.4% of cases) and lymph nodes (15.1%); in about 7%-10% of cases it is associated with hyaline-vascular Castleman disease. Given its significant growth pattern and cytological variability, FDCS can be confused with various neoplasms and even inflammatory processes. The diagnosis requires the use of a broad spectrum of FDC markers (e.g. CD21, CD23, CD35, clusterin, CXCL13, podoplanin), particularly considering that tumor antigen-loss is frequent. The inflammatory-pseudotumor-like (IPT-like) variant of FDCS, in addition to its peculiar histopathological and clinical features, is characterized by positivity of tumor cells for Epstein-Barr virus, representing a diagnostic requisite. No distinctive genetic and molecular anomalies have been identified in FDCS. It often carries an aberrant clonal karyotype and chromosomal structural alterations, frequently involving onco-suppressor genes. Direct or next generation sequencing showed alterations on genes belonging to the NF-κB regulatory pathway and cell-cycle regulators. In contrast to hematopoietic-derived histiocytic and dendritic cells tumors, FDCS typically lacks mutations in genes related to the MAPK pathway. FDCS recurs locally in 28% and metastasizes in 27% of cases. Extent of the disease, surgical resectability and histopathological features are significantly associated with the outcome. IPT-like FDCS behaves as an indolent tumor, even if it often recurs locally over years. Complete surgical excision is the gold standard of treatment. Data on targeted therapies (e.g.: tyrosine kinase inhibitors) or immune checkpoint inhibitors are very limited and responses are variable. A better understanding of the molecular drivers of this tumor may lead to potential new therapeutic strategies.
Collapse
Affiliation(s)
- Fabio Facchetti
- Department of Molecular and Translational Medicine, Section of Pathology, University of Brescia, Spedali Civili, Brescia (Italy)
| | - Matteo Simbeni
- Department of Molecular and Translational Medicine, Section of Pathology, University of Brescia, Spedali Civili, Brescia (Italy)
| | - Luisa Lorenzi
- Department of Molecular and Translational Medicine, Section of Pathology, University of Brescia, Spedali Civili, Brescia (Italy)
| |
Collapse
|
30
|
Carbone A, Borok M, Damania B, Gloghini A, Polizzotto MN, Jayanthan RK, Fajgenbaum DC, Bower M. Castleman disease. Nat Rev Dis Primers 2021; 7:84. [PMID: 34824298 PMCID: PMC9584164 DOI: 10.1038/s41572-021-00317-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 01/02/2023]
Abstract
Castleman disease (CD), a heterogeneous group of disorders that share morphological features, is divided into unicentric CD and multicentric CD (MCD) according to the clinical presentation and disease course. Unicentric CD involves a solitary enlarged lymph node and mild symptoms and excision surgery is often curative. MCD includes a form associated with Kaposi sarcoma herpesvirus (KSHV) (also known as human herpesvirus 8) and a KSHV-negative idiopathic form (iMCD). iMCD can present in association with severe syndromes such as TAFRO (thrombocytopenia, ascites, fever, reticulin fibrosis and organomegaly) or POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder and skin changes). KSHV-MCD often occurs in the setting of HIV infection or another cause of immune deficiency. The interplay between KSHV and HIV elevates the risk for the development of KSHV-induced disorders, including KSHV-MCD, KSHV-lymphoproliferation, KSHV inflammatory cytokine syndrome, primary effusion lymphoma and Kaposi sarcoma. A CD diagnosis requires a multidimensional approach, including clinical presentation and imaging, pathological features, and molecular virology. B cell-directed monoclonal antibody therapy is the standard of care in KSHV-MCD, and anti-IL-6 therapy is the recommended first-line therapy and only treatment of iMCD approved by the US FDA and EMA.
Collapse
Affiliation(s)
- Antonino Carbone
- Centro di Riferimento Oncologico (CRO), IRCCS, National Cancer Institute, Aviano, Italy.
- S. Maria degli Angeli Hospital, Pordenone, Italy.
| | - Margaret Borok
- Unit of Internal Medicine, University of Zimbabwe Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Blossom Damania
- Department of Microbiology and Immunology and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Annunziata Gloghini
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Mark N Polizzotto
- Clinical Hub for Interventional Research, John Curtin School of Medical Research, The Australian National University, Canberra, NSW, Australia
| | - Raj K Jayanthan
- Castleman Disease Collaborative Network, Philadelphia, PA, USA
| | - David C Fajgenbaum
- Center for Cytokine Storm Treatment & Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark Bower
- National Centre for HIV Malignancy, Chelsea & Westminster Hospital, London, UK
| |
Collapse
|
31
|
Nishimura MF, Nishimura Y, Nishikori A, Maekawa Y, Maehama K, Yoshino T, Sato Y. Clinical and Pathological Characteristics of Hyaline-Vascular Type Unicentric Castleman Disease: A 20-Year Retrospective Analysis. Diagnostics (Basel) 2021; 11:diagnostics11112008. [PMID: 34829355 PMCID: PMC8618395 DOI: 10.3390/diagnostics11112008] [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: 09/20/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 12/11/2022] Open
Abstract
The first case of hyaline vascular type of unicentric Castleman disease (HV-UCD) was reported more than six decades ago. Since patients with HV-UCD are often asymptomatic and this condition is generally discovered incidentally on imaging tests, most of the previous reports were of mediastinal origin detected by chest radiography. In recent years, improved access to imaging modalities has provided new insights in the diagnosis of this condition. In this study, we reviewed the detailed clinical and pathological findings of 38 HV-UCD cases (20 males and 18 females, mean age: 42.8 years). The most common site involved was the abdominal cavity (34.2%), followed by mediastinum (23.7%) and retroperitoneum (15.8%). In the abdominal cavity, mesenteric origin was the most common. The mean size of masses was 4.8 cm. Pathologically, thick hyalinized collagen fibers surrounding large blood vessels and calcification were observed (81.6% and 23.7%, respectively). Multinucleated giant cells resembling Warthin–Finkeldey cell were also observed in occasional cases (23.7%). This is a unique paper that summarizes detailed clinical and pathological findings of a large series of a rare disease. The clinical information presented in this paper is more plausible than previous views and is useful for accurate diagnosis and understanding of the disease.
Collapse
Affiliation(s)
- Midori Filiz Nishimura
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan; (M.F.N.); (T.Y.)
| | - Yoshito Nishimura
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan;
- Department of Medicine, John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI 96813, USA
| | - Asami Nishikori
- Division of Pathophysiology, Okayama University Graduate School of Health Sciences, Okayama 700-8558, Japan; (A.N.); (Y.M.); (K.M.)
| | - Yukina Maekawa
- Division of Pathophysiology, Okayama University Graduate School of Health Sciences, Okayama 700-8558, Japan; (A.N.); (Y.M.); (K.M.)
| | - Kanna Maehama
- Division of Pathophysiology, Okayama University Graduate School of Health Sciences, Okayama 700-8558, Japan; (A.N.); (Y.M.); (K.M.)
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan; (M.F.N.); (T.Y.)
| | - Yasuharu Sato
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan; (M.F.N.); (T.Y.)
- Division of Pathophysiology, Okayama University Graduate School of Health Sciences, Okayama 700-8558, Japan; (A.N.); (Y.M.); (K.M.)
- Correspondence: ; Tel.: +81-86-235-7150
| |
Collapse
|
32
|
Yue B, Huang J, Jing L, Yu H, Wei D, Zhang J, Chen W, Chen J. Bilateral lung transplantation for Castleman disease with end-stage bronchiolitis obliterans. Clin Transplant 2021; 36:e14496. [PMID: 34590355 DOI: 10.1111/ctr.14496] [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: 07/26/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022]
Abstract
Bronchiolitis obliterans (BO) is a severe complication of Castleman disease (CD), a rare lymphoproliferative disease with unclear pathogenesis. Currently, there are no reports on the safety or outcomes of bilateral lung transplantation in patients with BO due to CD. This study aimed to characterize the clinical manifestations and features of BO and CD. We retrospectively analyzed the medical records of six consecutive patients with BO and CD who underwent bilateral lung transplantation between December 2012 and December 2020. The average age of patients at lung transplantation was 33 ± 15 years, and the age range of patients at diagnosis of CD was about 9-56 years. The body mass index was 15.2 ± 1.9 kg/m2 . The average time from diagnosis to lung transplantation was 4.1 ± 2.7 years. All the patients had unicentric CD (UCD); five had concomitant paraneoplastic pemphigus, and four received extracorporeal membrane oxygenation during surgery. The average hospital stay was 51 ± 53 days. Infection was the most common postoperative complication. CD did not recur in any of the patients. Thus, bilateral lung transplantation is a viable and safe treatment for selected patients with CD and BO, which can improve the quality of life and prolong survival.
Collapse
Affiliation(s)
- Bingqing Yue
- Wuxi Lung Transplant Center, Department of Thoracic Surgery, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi, China
| | - Jian Huang
- Wuxi Lung Transplant Center, Department of Thoracic Surgery, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi, China
| | - Lei Jing
- Department of Lung Transplantation, Center of Lung Transplantation, Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Huaqing Yu
- Wuxi Lung Transplant Center, Department of Thoracic Surgery, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi, China
| | - Dong Wei
- Wuxi Lung Transplant Center, Department of Thoracic Surgery, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi, China
| | - Ji Zhang
- Wuxi Lung Transplant Center, Department of Thoracic Surgery, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi, China
| | - Wenhui Chen
- Department of Lung Transplantation, Center of Lung Transplantation, Center of Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Jingyu Chen
- Wuxi Lung Transplant Center, Department of Thoracic Surgery, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi, China
| |
Collapse
|
33
|
Goodman AM, Jeong AR, Phillips A, Wang HY, Sokol ES, Cohen PR, Sicklick J, Fajgenbaum DC, Kurzrock R. Novel somatic alterations in unicentric and idiopathic multicentric Castleman disease. Eur J Haematol 2021; 107:642-649. [PMID: 34431136 DOI: 10.1111/ejh.13702] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/21/2021] [Accepted: 08/23/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Castleman disease (CD) is a heterogeneous group of disorders involving systemic inflammation and lymphoproliferation. Recently, clonal mutations have been identified in unicentric CD (UCD) and idiopathic multicentric CD (iMCD), suggesting a potential underlying neoplastic process. METHODS Patients with UCD or iMCD with next generation sequencing (NGS) data on tissue DNA and/or circulating tumor DNA (ctDNA) were included. RESULTS Five patients were included, 4 with iMCD and 1 with UCD. Four patients (80%) were women; median age was 40 years. Three of five patients (60%) had ≥1 clonal mutation detected on biopsy among the genes included in the panel. One patient with iMCD had a 14q32-1p35 rearrangement and a der(1)dup(1)(q42q21)del(1)(q42) (1q21 being IL-6R locus) on karyotype. This patient also had a NF1 K2459fs alteration on ctDNA (0.3%). Another patient with iMCD had a KDM5C Q836* mutation, and one patient with UCD had a TNS3-ALK fusion but no ALK expression by immunohistochemistry. CONCLUSIONS We report 4 novel somatic alterations found in patients with UCD or iMCD. The 1q21 locus contains IL-6R, and duplication of this locus may increase IL-6 expression. These findings suggest that a clonal process may be responsible for the inflammatory phenotype in some patients with UCD and iMCD.
Collapse
Affiliation(s)
- Aaron M Goodman
- Division of Blood and Marrow Transplantation, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Ah-Reum Jeong
- Division of Hematology and Oncology, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Alexis Phillips
- Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Huan-You Wang
- Division of Laboratory and Genomic Medicine, Department of Pathology, University of California San Diego, La Jolla, California, USA
| | - Ethan S Sokol
- Cancer Genomics Research, Foundation Medicine, Cambridge, Massachusetts, USA
| | - Philip R Cohen
- Department of Dermatology, University of California Davis Medical Center, Sacramento, California, USA.,Department of Dermatology, Touro University California College of Osteopathic Medicine, Vallejo, California, USA
| | - Jason Sicklick
- Division of Surgical Oncology, Department of Surgery, University of California San Diego, La Jolla, California, USA
| | - David C Fajgenbaum
- Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Razelle Kurzrock
- Division of Hematology and Oncology, Department of Medicine, Center for Personalized Cancer Therapy, University of California San Diego, La Jolla, California, USA
| |
Collapse
|
34
|
[The consensus of the diagnosis and treatment of Castleman disease in China (2021)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2021; 42:529-534. [PMID: 34455738 PMCID: PMC8408489 DOI: 10.3760/cma.j.issn.0253-2727.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
35
|
International evidence-based consensus diagnostic and treatment guidelines for unicentric Castleman disease. Blood Adv 2021; 4:6039-6050. [PMID: 33284946 DOI: 10.1182/bloodadvances.2020003334] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/09/2020] [Indexed: 02/06/2023] Open
Abstract
Castleman disease (CD) includes a group of rare and heterogeneous disorders with characteristic lymph node histopathological abnormalities. CD can occur in a single lymph node station, which is referred to as unicentric CD (UCD). CD can also involve multicentric lymphadenopathy and inflammatory symptoms (multicentric CD [MCD]). MCD includes human herpesvirus-8 (HHV-8)-associated MCD, POEMS-associated MCD, and HHV-8-/idiopathic MCD (iMCD). The first-ever diagnostic and treatment guidelines were recently developed for iMCD by an international expert consortium convened by the Castleman Disease Collaborative Network (CDCN). The focus of this report is to establish similar guidelines for the management of UCD. To this purpose, an international working group of 42 experts from 10 countries was convened to establish consensus recommendations based on review of treatment in published cases of UCD, the CDCN ACCELERATE registry, and expert opinion. Complete surgical resection is often curative and is therefore the preferred first-line therapy, if possible. The management of unresectable UCD is more challenging. Existing evidence supports that asymptomatic unresectable UCD may be observed. The anti-interleukin-6 monoclonal antibody siltuximab should be considered for unresectable UCD patients with an inflammatory syndrome. Unresectable UCD that is symptomatic as a result of compression of vital neighboring structures may be rendered amenable to resection by medical therapy (eg, rituximab, steroids), radiotherapy, or embolization. Further research is needed in UCD patients with persisting constitutional symptoms despite complete excision and normal laboratory markers. We hope that these guidelines will improve outcomes in UCD and help treating physicians decide the best therapeutic approach for their patients.
Collapse
|
36
|
UCD with MCD-like inflammatory state: surgical excision is highly effective. Blood Adv 2021; 5:122-128. [PMID: 33570636 DOI: 10.1182/bloodadvances.2020003607] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/29/2020] [Indexed: 12/11/2022] Open
Abstract
Unicentric Castleman disease (UCD) is a rare lymphoproliferative disorder presenting as a single nodal mass with characteristic histopathology. Patients with UCD are typically asymptomatic with normal laboratory markers, whereas patients with multicentric Castleman disease (MCD) demonstrate multicentric lymphadenopathy and cytokine storm-induced systemic inflammatory symptoms. This retrospective analysis of 116 UCD cases identified 19 (16.4%) cases with an MCD-like inflammatory state (UCD-MIS). We compared treatments and outcomes between cases of UCD-MIS and UCD-non-MIS to evaluate the role of surgery and illuminate biological behavior of UCD-MIS. There were differences in the distribution of histopathological subtypes (plasmacytic histopathology was more frequently seen, 52.6% vs 13.4%; P < .001) between the 2 groups. However, both groups demonstrated good responses to surgical treatment, suggesting that UCD-MIS in some patients still shared common biological behavior with UCD in other patients. Sixteen (94.2%) patients with UCD-MIS underwent complete surgical excision alone, and the systemic inflammation resolved completely in all of them. This high response rate suggests surgical treatment as a potential cure for this unique subset of patients. After a median follow-up duration of 64 months (range, 2-239 months), neither lymphadenopathy nor the inflammatory state recurred. However, inflammation may progress in patients with irresectable disease, and treatment options other than surgery should be considered in these patients.
Collapse
|
37
|
Massoth LR, Hung YP, Ferry JA, Hasserjian RP, Nardi V, Nielsen GP, Sadigh S, Venkataraman V, Selig M, Friedmann AM, Samore W, Killian JK, Milante R, Giessinger J, Foley-Peres K, Marcus C, Severson E, Duncan D, Sivakumar S, Ross JS, Desphande V, Ramkissoon SH, Vergilio JA, Louissaint A, Zukerberg LR, Williams EA. Histiocytic and Dendritic Cell Sarcomas of Hematopoietic Origin Share Targetable Genomic Alterations Distinct from Follicular Dendritic Cell Sarcoma. Oncologist 2021; 26:e1263-e1272. [PMID: 33904632 PMCID: PMC8265357 DOI: 10.1002/onco.13801] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/16/2021] [Indexed: 12/18/2022] Open
Abstract
Background Histiocytic and dendritic cell neoplasms are a diverse group of tumors arising from monocytic or dendritic cell lineage. Whereas the genomic features for Langerhans cell histiocytosis and Erdheim‐Chester disease have been well described, other less common and often aggressive tumors in this broad category remain poorly characterized, and comparison studies across the World Health Organization diagnostic categories are lacking. Methods Tumor samples from a total of 102 patient cases within four major subtypes of malignant histiocytic and dendritic cell neoplasms, including 44 follicular dendritic cell sarcomas (FDCSs), 41 histiocytic sarcomas (HSs), 7 interdigitating dendritic cell sarcomas (IDCSs), and 10 Langerhans cell sarcomas (LCSs), underwent hybridization capture with analysis of up to 406 cancer‐related genes. Results Among the entire cohort of 102 patients, CDKN2A mutations were most frequent across subtypes and made up 32% of cases, followed by TP53 mutations (22%). Mitogen‐activated protein kinase (MAPK) pathway mutations were present and enriched among the malignant histiocytosis (M) group (HS, IDCS, and LCS) but absent in FDCS (72% vs. 0%; p < .0001). In contrast, NF‐κB pathway mutations were frequent in FDCSs but rare in M group histiocytoses (61% vs. 12%; p < .0001). Tumor mutational burden was significantly higher in M group histiocytoses as compared with FDCSs (median 4.0/Mb vs. 2.4/Mb; p = .012). We also describe a pediatric patient with recurrent secondary histiocytic sarcoma treated with targeted therapy and interrogated by molecular analysis to identify mechanisms of therapeutic resistance. Conclusion A total of 42 patient tumors (41%) harbored pathogenic mutations that were potentially targetable by approved and/or investigative therapies. Our findings highlight the potential value of molecular testing to enable precise tumor classification, identify candidate oncogenic drivers, and define personalized therapeutic options for patients with these aggressive tumors. Implications for Practice This study presents comprehensive genomic profiling results on 102 patient cases within four major subtypes of malignant histiocytic and dendritic cell neoplasms, including 44 follicular dendritic cell sarcomas (FDCSs), 41 histiocytic sarcomas (HSs), 7 interdigitating dendritic cell sarcomas (IDCSs), and 10 Langerhans cell sarcomas (LCSs). MAPK pathway mutations were present and enriched among the malignant histiocytosis (M) group (HS, IDCS, and LCS) but absent in FDCSs. In contrast, NF‐κB pathway mutations were frequent in FDCSs but rare in M group histiocytosis. A total of 42 patient tumors (41%) harbored pathogenic mutations that were potentially targetable by approved and/or investigative therapies. Histiocytic and dendritic cell neoplasms are a diverse group of tumors arising from the monocytic or dendritic cell lineage. This article presents the molecular characteristics of the four major subtypes of malignant histiocytic and dendritic cell neoplasms, focusing on genomic alterations that could represent therapeutic targets.
Collapse
Affiliation(s)
- Lucas R Massoth
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Yin P Hung
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Judith A Ferry
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Robert P Hasserjian
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Valentina Nardi
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - G Petur Nielsen
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sam Sadigh
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Vinayak Venkataraman
- Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Martin Selig
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Alison M Friedmann
- Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Wesley Samore
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Riza Milante
- Department of Dermatology, Jose R. Reyes Memorial Medical Center, Manila, Philippines
| | - Joseph Giessinger
- A.T. Still University School of Osteopathic Medicine, Mesa, Arizona, USA
| | - Kathleen Foley-Peres
- Department of Biology, Bristol Community College, Fall River, Massachusetts, USA
| | - Chelsea Marcus
- Foundation Medicine, Inc., Cambridge, Massachusetts, USA
| | - Eric Severson
- Foundation Medicine, Inc., Cambridge, Massachusetts, USA
| | - Daniel Duncan
- Foundation Medicine, Inc., Cambridge, Massachusetts, USA
| | | | - Jeffrey S Ross
- Foundation Medicine, Inc., Cambridge, Massachusetts, USA.,Department of Pathology, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Vikram Desphande
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Shakti H Ramkissoon
- Foundation Medicine, Inc., Cambridge, Massachusetts, USA.,Wake Forest Comprehensive Cancer Center and Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Abner Louissaint
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Lawrence R Zukerberg
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Erik A Williams
- Foundation Medicine, Inc., Cambridge, Massachusetts, USA.,Department of Pathology, Department of Dermatology, UCSF Dermatopathology Service, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
38
|
Guérit E, Arts F, Dachy G, Boulouadnine B, Demoulin JB. PDGF receptor mutations in human diseases. Cell Mol Life Sci 2021; 78:3867-3881. [PMID: 33449152 PMCID: PMC11072557 DOI: 10.1007/s00018-020-03753-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/16/2020] [Accepted: 12/29/2020] [Indexed: 12/16/2022]
Abstract
PDGFRA and PDGFRB are classical proto-oncogenes that encode receptor tyrosine kinases responding to platelet-derived growth factor (PDGF). PDGFRA mutations are found in gastrointestinal stromal tumors (GISTs), inflammatory fibroid polyps and gliomas, and PDGFRB mutations drive myofibroma development. In addition, chromosomal rearrangement of either gene causes myeloid neoplasms associated with hypereosinophilia. Recently, mutations in PDGFRB were linked to several noncancerous diseases. Germline heterozygous variants that reduce receptor activity have been identified in primary familial brain calcification, whereas gain-of-function mutants are present in patients with fusiform aneurysms, Kosaki overgrowth syndrome or Penttinen premature aging syndrome. Functional analysis of these variants has led to the preclinical validation of tyrosine kinase inhibitors targeting PDGF receptors, such as imatinib, as a treatment for some of these conditions. This review summarizes the rapidly expanding knowledge in this field.
Collapse
Affiliation(s)
- Emilie Guérit
- De Duve Institute, Université Catholique de Louvain, Avenue Hippocrate 75, Box B1.74.05, 1200, Brussels, Belgium
| | - Florence Arts
- De Duve Institute, Université Catholique de Louvain, Avenue Hippocrate 75, Box B1.74.05, 1200, Brussels, Belgium
| | - Guillaume Dachy
- De Duve Institute, Université Catholique de Louvain, Avenue Hippocrate 75, Box B1.74.05, 1200, Brussels, Belgium
| | - Boutaina Boulouadnine
- De Duve Institute, Université Catholique de Louvain, Avenue Hippocrate 75, Box B1.74.05, 1200, Brussels, Belgium
| | - Jean-Baptiste Demoulin
- De Duve Institute, Université Catholique de Louvain, Avenue Hippocrate 75, Box B1.74.05, 1200, Brussels, Belgium.
| |
Collapse
|
39
|
A Review of Genetic Abnormalities in Unicentric and Multicentric Castleman Disease. BIOLOGY 2021; 10:biology10040251. [PMID: 33804823 PMCID: PMC8063830 DOI: 10.3390/biology10040251] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 12/12/2022]
Abstract
Castleman disease (CD) is a rare lymphoproliferative disorder known to represent at least four distinct clinicopathologic subtypes. Large advancements in our clinical and histopathologic description of these diverse diseases have been made, resulting in subtyping based on number of enlarged lymph nodes (unicentric versus multicentric), according to viral infection by human herpes virus 8 (HHV-8) and human immunodeficiency virus (HIV), and with relation to clonal plasma cells (POEMS). In recent years, significant molecular and genetic abnormalities associated with CD have been described. However, we continue to lack a foundational understanding of the biological mechanisms driving this disease process. Here, we review all cases of CD with molecular abnormalities described in the literature to date, and correlate cytogenetic, molecular, and genetic abnormalities with disease subtypes and phenotypes. Our review notes complex karyotypes in subsets of cases, specific mutations in PDGFRB N666S in 10% of unicentric CD (UCD) and NCOA4 L261F in 23% of idiopathic multicentric CD (iMCD) cases. Genes affecting chromatin organization and abnormalities in methylation are seen more commonly in iMCD while abnormalities within the mitogen-activated protein kinase (MAPK) and interleukin signaling pathways are more frequent in UCD. Interestingly, there is a paucity of genetic studies evaluating HHV-8 positive multicentric CD (HHV-8+ MCD) and POEMS-associated CD. Our comprehensive review of genetic and molecular abnormalities in CD identifies subtype-specific and novel pathways which may allow for more targeted treatment options and unique biologic therapies.
Collapse
|
40
|
Koa B, Borja AJ, Aly M, Padmanabhan S, Tran J, Zhang V, Rojulpote C, Pierson SK, Tamakloe MA, Khor JS, Werner TJ, Fajgenbaum DC, Alavi A, Revheim ME. Emerging role of 18F-FDG PET/CT in Castleman disease: a review. Insights Imaging 2021; 12:35. [PMID: 33709329 PMCID: PMC7952491 DOI: 10.1186/s13244-021-00963-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/04/2021] [Indexed: 12/11/2022] Open
Abstract
Castleman disease (CD) describes a group of rare hematologic conditions involving lymphadenopathy with characteristic histopathology and a spectrum of clinical abnormalities. CD is divided into localized or unicentric CD (UCD) and multicentric CD (MCD) by imaging. MCD is further divided based on etiological driver into human herpesvirus-8-associated MCD, POEMS-associated MCD, and idiopathic MCD. There is notable heterogeneity across MCD, but increased level of pro-inflammatory cytokines, particularly interleukin-6, is an established disease driver in a portion of patients. FDG-PET/CT can help determine UCD versus MCD, evaluate for neoplastic conditions that can mimic MCD clinico-pathologically, and monitor therapy responses. CD requires more robust characterization, earlier diagnosis, and an accurate tool for both monitoring and treatment response evaluation; FDG-PET/CT is particularly suited for this. Moving forward, future prospective studies should further characterize the use of FDG-PET/CT in CD and specifically explore the utility of global disease assessment and dual time point imaging. Trial registration ClinicalTrials.gov, NCT02817997, Registered 29 June 2016, https://clinicaltrials.gov/ct2/show/NCT02817997
Collapse
Affiliation(s)
- Benjamin Koa
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.,Drexel University College of Medicine, Philadelphia, PA, USA
| | - Austin J Borja
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mahmoud Aly
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sayuri Padmanabhan
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph Tran
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Vincent Zhang
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Sheila K Pierson
- Department of Medicine, Division of Translational Medicine and Human Genetics, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark-Avery Tamakloe
- Department of Medicine, Division of Translational Medicine and Human Genetics, University of Pennsylvania, Philadelphia, PA, USA
| | - Johnson S Khor
- Department of Medicine, Division of Translational Medicine and Human Genetics, University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas J Werner
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - David C Fajgenbaum
- Department of Medicine, Division of Translational Medicine and Human Genetics, University of Pennsylvania, Philadelphia, PA, USA
| | - Abass Alavi
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Mona-Elisabeth Revheim
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA. .,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway. .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Problemveien 7, 0316, Oslo, Norway.
| |
Collapse
|
41
|
Liu HL, Fan L, Li JY. [Progress in the diagnosis and treatment of Castleman disease]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2021; 41:697-700. [PMID: 32942829 PMCID: PMC7525180 DOI: 10.3760/cma.j.issn.0253-2727.2020.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- H L Liu
- Department of Hematology, the First Affiliated Hospital with Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - L Fan
- Department of Hematology, the First Affiliated Hospital with Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - J Y Li
- Department of Hematology, the First Affiliated Hospital with Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| |
Collapse
|
42
|
Fang X, Sun Z, Xu-Monette ZY, Young KH. Predictive Model for Idiopathic Multicentric Castleman Disease Supporting Treatment Decisions. Oncologist 2020; 26:4-6. [PMID: 33215784 DOI: 10.1002/onco.13605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/28/2020] [Indexed: 01/04/2023] Open
Affiliation(s)
- Xiaosheng Fang
- Department of Pathology, Hematopathology Division, Duke University Medical Center, Durham, North Carolina, USA.,Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
| | - Zhongling Sun
- Department of Neurology, The People's Hospital of Zhaoyuan City, Shandong, People's Republic of China
| | - Zijun Y Xu-Monette
- Department of Pathology, Hematopathology Division, Duke University Medical Center, Durham, North Carolina, USA.,Duke Cancer Institute, Durham, North Carolina, USA
| | - Ken H Young
- Department of Pathology, Hematopathology Division, Duke University Medical Center, Durham, North Carolina, USA.,Duke Cancer Institute, Durham, North Carolina, USA
| |
Collapse
|
43
|
Overview of Castleman disease. Blood 2020; 135:1353-1364. [PMID: 32106302 DOI: 10.1182/blood.2019000931] [Citation(s) in RCA: 214] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/03/2020] [Indexed: 01/02/2023] Open
Abstract
Castleman disease (CD) describes a group of at least 4 disorders that share a spectrum of characteristic histopathological features but have a wide range of etiologies, presentations, treatments, and outcomes. CD includes unicentric CD (UCD) and multicentric CD (MCD), the latter of which is divided into idiopathic MCD (iMCD), human herpes virus-8 (HHV8)-associated MCD (HHV8-MCD), and polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, skin changes (POEMS)-associated MCD (POEMS-MCD). iMCD can be further subclassified into iMCD-thrombocytopenia, ascites, reticulin fibrosis, renal dysfunction, organomegaly (iMCD-TAFRO) or iMCD-not otherwise specified (iMCD-NOS). Advances in diagnosis, classification, pathogenesis, and therapy are substantial since the original description of UCD by Benjamin Castleman in 1954. The advent of effective retroviral therapy and use of rituximab in HHV8-MCD have improved outcomes in HHV8-MCD. Anti-interleukin-6-directed therapies are highly effective in many iMCD patients, but additional therapies are required for refractory cases. Much of the recent progress has been coordinated by the Castleman Disease Collaborative Network (CDCN), and further progress will be made by continued engagement of physicians, scientists, and patients. Progress can also be facilitated by encouraging patients to self-enroll in the CDCN's ACCELERATE natural history registry (#NCT02817997; www.CDCN.org/ACCELERATE).
Collapse
|
44
|
Briani C, Visentin A, Cerri F, Quattrini A. From pathogenesis to personalized treatments of neuropathies in hematological malignancies. J Peripher Nerv Syst 2020; 25:212-221. [PMID: 32686258 DOI: 10.1111/jns.12405] [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: 06/08/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 12/21/2022]
Abstract
The peripheral nervous system may be involved at any stage in the course of several hematological diseases, the most common being monoclonal gammopathies (of undetermined significance or malignant) or lymphomas. The underlying pathogenic mechanisms are different and therapies aim at targeting the dangerous either B-cell or plasma cell clones. Recently, high-throughput technologies, and next-generation sequencing have increased our knowledge of hematological diseases pathogenesis by the identification of somatic mutation affecting pivotal signaling pathways. Accordingly, new target therapies are used that may also be borrowed for treatment of neuropathies in hematological diseases.
Collapse
Affiliation(s)
- Chiara Briani
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Federica Cerri
- Experimental Neuropathology Unit, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Angelo Quattrini
- Experimental Neuropathology Unit, Institute of Experimental Neurology (INSPE), Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
45
|
Nguyen H, Song JY. Mimickers of pulmonary lymphoma. Semin Diagn Pathol 2020; 37:283-295. [PMID: 32586652 DOI: 10.1053/j.semdp.2020.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 12/16/2022]
Abstract
There are multiple entities that involve the lung that have radiographic, clinical, and morphologic overlaps with pulmonary lymphoma. In this review, we will discuss these entities in detail and provide relevant updates.
Collapse
Affiliation(s)
- Ha Nguyen
- Department of Pathology, City of Hope, Duarte, CA, USA
| | - Joo Y Song
- Department of Pathology, City of Hope, Duarte, CA, USA.
| |
Collapse
|
46
|
Wenger TL, Bly RA, Wu N, Albert CM, Park J, Shieh J, Chenbhanich J, Heike CL, Adam MP, Chang I, Sun A, Miller DE, Beck AE, Gupta D, Boos MD, Zackai EH, Everman D, Ganapathi S, Wilson M, Christodoulou J, Zarate YA, Curry C, Li D, Guimier A, Amiel J, Hakonarson H, Webster R, Bhoj EJ, Perkins JA, Dahl JP, Dobyns WB. Activating variants in PDGFRB result in a spectrum of disorders responsive to imatinib monotherapy. Am J Med Genet A 2020; 182:1576-1591. [PMID: 32500973 DOI: 10.1002/ajmg.a.61615] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/25/2020] [Accepted: 04/20/2020] [Indexed: 11/09/2022]
Abstract
More than 50 individuals with activating variants in the receptor tyrosine kinase PDGFRB have been reported, separated based on clinical features into solitary myofibromas, infantile myofibromatosis, Penttinen syndrome with premature aging and osteopenia, Kosaki overgrowth syndrome, and fusiform aneurysms. Despite their descriptions as distinct clinical entities, review of previous reports demonstrates substantial phenotypic overlap. We present a case series of 12 patients with activating variants in PDGFRB and review of the literature. We describe five patients with PDGFRB activating variants whose clinical features overlap multiple diagnostic entities. Seven additional patients from a large family had variable expressivity and late-onset disease, including adult onset features and two individuals with sudden death. Three patients were treated with imatinib and had robust and rapid response, including the first two reported infants with multicentric myofibromas treated with imatinib monotherapy and one with a recurrent p.Val665Ala (Penttinen) variant. Along with previously reported individuals, our cohort suggests infants and young children had few abnormal features, while older individuals had multiple additional features, several of which appeared to worsen with advancing age. Our analysis supports a diagnostic entity of a spectrum disorders due to activating variants in PDGFRB. Differences in reported phenotypes can be dramatic and correlate with advancing age, genotype, and to mosaicism in some individuals.
Collapse
Affiliation(s)
- Tara L Wenger
- Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Randall A Bly
- Department of Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Natalie Wu
- Division of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Catherine M Albert
- Division of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Julie Park
- Division of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Joseph Shieh
- Division of Medical Genetics, Benioff Children's Hospital and Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA
| | - Jirat Chenbhanich
- Division of Medical Genetics, Benioff Children's Hospital and Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA
| | - Carrie L Heike
- Division of Craniofacial Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Margaret P Adam
- Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Irene Chang
- Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Angela Sun
- Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Danny E Miller
- Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Anita E Beck
- Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Deepti Gupta
- Division of Dermatology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Markus D Boos
- Division of Dermatology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Elaine H Zackai
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - David Everman
- Greenwood Genetics Center, Greenville, South Carolina, USA
| | - Shireen Ganapathi
- Division of Hematology/Oncology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Meredith Wilson
- Department of Clinical Genetics, Sydney Children's Hospitals Network-Westmead, University of Sydney, Sydney, New South Wales, Australia.,Division of Genetic Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - John Christodoulou
- Murdoch Children's Research Institute, Parkville, Department of Paediatrics, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Yuri A Zarate
- Section of Genetics and Metabolism, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Cynthia Curry
- Division of Medical Genetics, Benioff Children's Hospital and Institute for Human Genetics, University of California San Francisco, San Francisco, California, USA
| | - Dong Li
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Anne Guimier
- Département de Génétique, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France
| | - Jeanne Amiel
- Département de Génétique, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France
| | - Hakon Hakonarson
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Richard Webster
- Department of Neurology, Sydney Children's Hospital Network, Westmead, New South Wales, Australia
| | - Elizabeth J Bhoj
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jonathan A Perkins
- Department of Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - John P Dahl
- Department of Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA
| | - William B Dobyns
- Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| |
Collapse
|
47
|
Chisholm KM, Fleming MD. Histologic and Laboratory Characteristics of Symptomatic and Asymptomatic Castleman Disease in the Pediatric Population. Am J Clin Pathol 2020; 153:821-832. [PMID: 32112075 DOI: 10.1093/ajcp/aqaa011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Compare the morphologic, laboratory, and clinical features of asymptomatic and symptomatic Castleman disease in the pediatric population. METHODS We reviewed clinical records and histopathology of patients with Castleman disease from 2 pediatric institutions. RESULTS Of 39 patients with pediatric Castleman disease, 37 had unicentric disease, all classified with the hyaline vascular variant of Castleman disease, 8 of which were clinically symptomatic. These 8 patients demonstrated abnormal laboratory findings, including microcytic anemia, elevated erythrocyte sedimentation rate and C-reactive protein, and hypoalbuminemia. In addition, histopathologic evaluation showed that the 8 symptomatic cases had more hyperplastic germinal centers, fewer atrophic or regressed germinal centers, fewer mantle zones containing multiple germinal centers, reduced "onion skinning" of mantle zones, and fewer "lollipop" formations compared with the asymptomatic cases. CONCLUSIONS This series of pediatric Castleman disease showed that lymph nodes from asymptomatic patients generally demonstrated the more classic hyaline vascular histology, whereas those with symptoms could lack or have only focal classic findings. As such, reactive lymph nodes with subtle Castleman-like features should prompt clinical correlation to ensure proper diagnosis.
Collapse
Affiliation(s)
- Karen M Chisholm
- Department of Laboratories, Seattle Children’s Hospital, Seattle, WA
- Department of Laboratory Medicine, University of Washington, Seattle
| | - Mark D Fleming
- Department of Pathology, Boston Children’s Hospital, Boston, MA
| |
Collapse
|
48
|
Yoshimi A, Trippett TM, Zhang N, Chen X, Penson AV, Arcila ME, Pichardo J, Baik J, Sigler A, Harada H, Fajgenbaum DC, Dogan A, Abdel-Wahab O, Xiao W. Genetic basis for iMCD-TAFRO. Oncogene 2020; 39:3218-3225. [PMID: 32051554 PMCID: PMC7148173 DOI: 10.1038/s41388-020-1204-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/20/2020] [Accepted: 01/30/2020] [Indexed: 12/22/2022]
Abstract
TAFRO syndrome, a clinical subtype of idiopathic multicentric Castleman disease (iMCD), consists of a constellation of symptoms/signs including thrombocytopenia, anasarca, fever, reticulin fibrosis/renal dysfunction, and organomegaly. The etiology of iMCD-TAFRO and the basis for cytokine hypersecretion commonly seen in iMCD-TAFRO patients has not been elucidated. Here, we identified a somatic MEK2P128L mutation and a germline RUNX1G60C mutation in two patients with iMCD-TAFRO, respectively. The MEK2P128L mutation, which has been identified previously in solid tumor and histiocytosis patients, caused hyperactivated MAP kinase signaling, conferred IL-3 hypersensitivity and sensitized the cells to various MEK inhibitors. The RUNX1G60C mutation abolished the transcriptional activity of wild-type RUNX1 and functioned as a dominant negative form of RUNX1, resulting in enhanced self-renewal activity in hematopoietic stem/progenitor cells. Interestingly, ERK was heavily activated in both patients, highlighting a potential role for activation of MAPK signaling in iMCD-TAFRO pathogenesis and a rationale for exploring inhibition of the MAPK pathway as a therapy for iMCD-TAFRO. Moreover, these data suggest that iMCD-TAFRO might share pathogenetic features with clonal inflammatory disorders bearing MEK and RUNX1 mutations such as histiocytoses and myeloid neoplasms.
Collapse
Affiliation(s)
- Akihide Yoshimi
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Tanya M Trippett
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Nan Zhang
- Department of Pathology, Buffalo General Medical Center, SUNY at Buffalo, Buffalo, NY, 14206, USA
- Department of Pathology, Rochester General Hospital, Rochester, NY, 14621, USA
| | - Xueyan Chen
- Department of Laboratory Medicine, University of Washington, Seattle, WA, 98109, USA
| | - Alexander V Penson
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Maria E Arcila
- Department of Pathology, Hematopathology service, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
- Department of Pathology, Diagnostic Molecular laboratory, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Janine Pichardo
- Department of Pathology, Hematopathology service, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Jeeyeon Baik
- Department of Pathology, Hematopathology service, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Allison Sigler
- Department of Pathology, Hematopathology service, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Hironori Harada
- Laboratory of Oncology, School of Life Sciences, Tokyo University of Pharmacy and Life Sciences, Hachioji, Tokyo, 192-0392, Japan
| | | | - Ahmet Dogan
- Department of Pathology, Hematopathology service, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Omar Abdel-Wahab
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Wenbin Xiao
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
- Department of Pathology, Hematopathology service, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| |
Collapse
|