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Liapis K, Bouzani M, Petrakis V, Anagnostopoulos NI, Kotsianidis I. A variant of KSHV-associated inflammatory cytokine syndrome in elderly men of Mediterranean descent. Infection 2024; 52:1175-1180. [PMID: 38113021 DOI: 10.1007/s15010-023-02155-z] [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: 11/05/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023]
Abstract
The spectrum of HHV-8-associated disorders includes Kaposi's sarcoma, primary effusion lymphoma, multicentric Castleman's disease, and the recently described KSHV inflammatory cytokine syndrome (KICS), a life-threatening disorder complicating HIV infection. There have been no reports in the literature concerning non-immunosuppressed individuals affected with KICS. We report here a KICS-like illness occurring in two elderly Greek men without HIV infection or other recognizable cause of immunosuppression.
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Affiliation(s)
- Konstantinos Liapis
- Department of Hematology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria Bouzani
- Department of Hematology, Evangelismos Hospital, Athens, Greece
| | - Vasileios Petrakis
- Department of Infectious Diseases, Second University Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, 681 00, Alexandroupolis, Greece.
| | | | - Ioannis Kotsianidis
- Department of Hematology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
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Pathak P, Abandeh L, Aboughalia H, Pooyan A, Mansoori B. Overview of F18-FDG uptake patterns in retroperitoneal pathologies: imaging findings, pitfalls, and artifacts. Abdom Radiol (NY) 2024; 49:1677-1698. [PMID: 38652126 DOI: 10.1007/s00261-023-04139-x] [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: 09/03/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Retroperitoneum can be the origin of a wide variety of pathologic conditions and potential space for disease spread to other compartments of the abdomen and pelvis. Computed tomography (CT) and magnetic resonance imaging (MRI) are often the initial imaging modalities to evaluate the retroperitoneal pathologies, however given the intrinsic limitations, F18-FDG PET/CT provides additional valuable metabolic information which can change the patient management and clinical outcomes. We highlight the features of retroperitoneal pathologies on F18-FDG PET/CT and the commonly encountered imaging artifacts and pitfalls. The aim of this review is to characterize primary and secondary retroperitoneal pathologies based on their metabolic features, and correlate PET findings with anatomic imaging. CONCLUSION Retroperitoneal pathologies can be complex, ranging from oncologic to a spectrum of non-oncologic disorders. While crosse-sectional imaging (CT and MRI) are often the initial imaging modalities to localize and characterize pathologies, metabolic information provided by F18-FDG PET/CT can change the management and clinical outcome in many cases.
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Affiliation(s)
- Priya Pathak
- Abdominal Imaging and Nuclear Medicine Divisions, Department of Radiology, University of Minnesota, 420 Delaware St SE, Minneapolis, MN, 55455, USA.
| | - Laith Abandeh
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Hassan Aboughalia
- Department of Radiology, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Atefe Pooyan
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Bahar Mansoori
- Abdominal Imaging Division, Department of Radiology, University of Washington, Seattle, WA, USA
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Li C, Li W, Shang M, Wang P, Hu X. Case report: detection of multiple sporadic gastrointestinal stromal tumors by dual-time 18 F-FDG PET/CT. Front Oncol 2024; 14:1321179. [PMID: 38606109 PMCID: PMC11007083 DOI: 10.3389/fonc.2024.1321179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/18/2024] [Indexed: 04/13/2024] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors affecting the gastrointestinal tract. Typically, GISTs are solitary; however, in rare cases, they may be multiple and appear in one or more organs. Multiple GISTs can appear in familial GISTs, children, or certain tumor syndromes such as neurofibromatosis type 1, Carney syndrome, and Carney-Stratakis syndrome. However, the diagnosis of primary multiple sporadic GISTs is often more difficult than that of these diseases. Herein, we report a case of multiple primary sporadic GISTs in a 64-year-old man, affecting the abdominal cavity and retroperitoneum, as identified through dual-time point positron emission tomography (PET) with 18F-labeled fluoro-2-deoxyglucose (18F-FDG) and computed tomography (18F-FDG PET/CT). Notably, the dual-time-point PET/CT revealed the migration of masses near the lower abdomen into the abdominal cavity. Furthermore, a significant increase in radioactive uptake of the mass 3 h after 18F-FDG injection compared with that 1 h after injection may be an important cue for its diagnosis.
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Affiliation(s)
| | | | | | - Pan Wang
- Affiliated Hospital of Zunyi Medical University, Department of Nuclear Medicine, Zunyi, China
| | - Xianwen Hu
- Affiliated Hospital of Zunyi Medical University, Department of Nuclear Medicine, Zunyi, China
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Pitot MA, Tahboub Amawi AD, Alexander LF, LeGout JD, Walkoff L, Navin PJ, Kawashima A, Wood AJ, Dispenzieri A, Venkatesh SK. Imaging of Castleman Disease. Radiographics 2023; 43:e220210. [PMID: 37471247 DOI: 10.1148/rg.220210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Castleman disease (CD) is a group of rare and complex lymphoproliferative disorders that can manifest in two general forms: unicentric CD (UCD) and multicentric CD (MCD). These two forms differ in clinical manifestation, imaging appearances, treatment options, and prognosis. UCD typically manifests as a solitary enlarging mass that is discovered incidentally or after development of compression-type symptoms. MCD usually manifests acutely with systemic symptoms including fever and weight loss. As a whole, CD involves lymph nodes throughout the chest, neck, abdomen, pelvis, and axilla and can have a wide variety of imaging appearances. Most commonly, lymph nodes or masses in UCD occur in the chest, classically with well-defined borders, hyperenhancement, and possible characteristic patterns of calcification and/or feeding vessels. Lymph nodes affected by MCD, while also hyperenhancing, tend to involve multiple nodal chains and manifest alongside anasarca or hepatosplenomegaly. The polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, and skin changes (POEMS) subtype of MCD may demonstrate lytic or sclerotic osseous lesions in addition to features typical of MCD. Since a diagnosis of CD based solely on imaging findings is often not possible, pathologic confirmation with core needle biopsy and/or surgical excision is necessary. Nevertheless, imaging plays a crucial role in supporting the diagnosis of CD, guiding appropriate regions for biopsy, and excluding other potential causes or mimics of disease. CT is frequently the initial imaging technique used in evaluating potential CD. MRI and PET play important roles in thoroughly evaluating the disease and determining its extent, especially the MCD form. Complete surgical excision is typically curative for UCD. MCD usually requires systemic therapy. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Marika A Pitot
- From the Department of Radiology (M.A.P., A.D.T.A., L.W., P.J.N., S.K.V.), Department of Laboratory Medicine and Pathology (A.J.W.), and Department of Hematology-Oncology (A.D.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Mayo Clinic, Jacksonville, Fla (L.F.A., J.D.L.); and Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.K.)
| | - Ali D Tahboub Amawi
- From the Department of Radiology (M.A.P., A.D.T.A., L.W., P.J.N., S.K.V.), Department of Laboratory Medicine and Pathology (A.J.W.), and Department of Hematology-Oncology (A.D.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Mayo Clinic, Jacksonville, Fla (L.F.A., J.D.L.); and Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.K.)
| | - Lauren F Alexander
- From the Department of Radiology (M.A.P., A.D.T.A., L.W., P.J.N., S.K.V.), Department of Laboratory Medicine and Pathology (A.J.W.), and Department of Hematology-Oncology (A.D.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Mayo Clinic, Jacksonville, Fla (L.F.A., J.D.L.); and Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.K.)
| | - Jordan D LeGout
- From the Department of Radiology (M.A.P., A.D.T.A., L.W., P.J.N., S.K.V.), Department of Laboratory Medicine and Pathology (A.J.W.), and Department of Hematology-Oncology (A.D.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Mayo Clinic, Jacksonville, Fla (L.F.A., J.D.L.); and Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.K.)
| | - Lara Walkoff
- From the Department of Radiology (M.A.P., A.D.T.A., L.W., P.J.N., S.K.V.), Department of Laboratory Medicine and Pathology (A.J.W.), and Department of Hematology-Oncology (A.D.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Mayo Clinic, Jacksonville, Fla (L.F.A., J.D.L.); and Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.K.)
| | - Patrick J Navin
- From the Department of Radiology (M.A.P., A.D.T.A., L.W., P.J.N., S.K.V.), Department of Laboratory Medicine and Pathology (A.J.W.), and Department of Hematology-Oncology (A.D.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Mayo Clinic, Jacksonville, Fla (L.F.A., J.D.L.); and Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.K.)
| | - Akira Kawashima
- From the Department of Radiology (M.A.P., A.D.T.A., L.W., P.J.N., S.K.V.), Department of Laboratory Medicine and Pathology (A.J.W.), and Department of Hematology-Oncology (A.D.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Mayo Clinic, Jacksonville, Fla (L.F.A., J.D.L.); and Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.K.)
| | - Adam J Wood
- From the Department of Radiology (M.A.P., A.D.T.A., L.W., P.J.N., S.K.V.), Department of Laboratory Medicine and Pathology (A.J.W.), and Department of Hematology-Oncology (A.D.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Mayo Clinic, Jacksonville, Fla (L.F.A., J.D.L.); and Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.K.)
| | - Angela Dispenzieri
- From the Department of Radiology (M.A.P., A.D.T.A., L.W., P.J.N., S.K.V.), Department of Laboratory Medicine and Pathology (A.J.W.), and Department of Hematology-Oncology (A.D.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Mayo Clinic, Jacksonville, Fla (L.F.A., J.D.L.); and Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.K.)
| | - Sudhakar K Venkatesh
- From the Department of Radiology (M.A.P., A.D.T.A., L.W., P.J.N., S.K.V.), Department of Laboratory Medicine and Pathology (A.J.W.), and Department of Hematology-Oncology (A.D.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Radiology, Mayo Clinic, Jacksonville, Fla (L.F.A., J.D.L.); and Department of Radiology, Mayo Clinic, Phoenix, Ariz (A.K.)
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Zinzani PL, Paulli M, Arcaini L, Della Torre E, Ferrero S, Figuera A, Frigeri F, Martelli M, Sabattini E, Scarpa R, Barosi G. Unmet Clinical Needs in the Management of Idiopathic Multicentric Castleman Disease: A Consensus-based Position Paper From an ad hoc Expert Panel. Hemasphere 2023; 7:e891. [PMID: 37234822 PMCID: PMC10208718 DOI: 10.1097/hs9.0000000000000891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/11/2023] [Indexed: 05/28/2023] Open
Abstract
Castleman disease describes a group of heterogeneous clinicopathological disorders now included in the tumor-like lesions with B-cell predominance of the World Health Organization classification. Managing idiopathic multicentric Castleman disease (iMCD) is challenging, because few systematic studies or comparative randomized clinical trials have been conducted. International, consensus evidence-based guidelines for iMCD were published in 2018, but gaps in the therapeutic options for difficult-to-treat patients, who do not respond to siltuximab and other conventional therapies, still exist. This article presents the results of group discussion among an ad hoc constituted Panel of Italian experts to identify and address unmet clinical needs (UCNs) in managing iMCD. Recommendations on the appropriateness of clinical decisions and proposals for new research concerning the identified UCNs were issued through formalized multiple-step procedures after a comprehensive analysis of the scientific literature. The following key UCNs were addressed: strengthening the diagnostic certainty in iMCD patients before planning first-line therapy; management of siltuximab therapy; choice and management of immune-modulating, or chemotherapy agents in patients resistant/intolerant to siltuximab therapy. While most of the conclusions reached by the Panel are consistent with the existing guidelines, some alternative therapeutic options were stressed, and the discussion contributed to bringing forth the issues that need further investigation. Hopefully, this comprehensive overview will improve the practice of iMCD and inform the design and implementation of new studies in the field.
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Affiliation(s)
- Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli,” Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Italy
| | - Marco Paulli
- Unit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luca Arcaini
- Department of Molecular Medicine, University of Pavia, Italy
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Emanuel Della Torre
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simone Ferrero
- Department of Molecular Biotechnologies and Health Sciences, Hematology Division, University of Torino, Italy
- Hematology Division, AOU “Città della Salute e della Scienza di Torino,” Torino, Italy
| | - Amalia Figuera
- Division of Hematology, AOU Policlinico “G. Rodolico-S. Marco,” Catania, Italy
| | - Ferdinando Frigeri
- UOC Ematologia a Indirizzo Oncologico, AORN “Sant’Anna e San Sebastiano,” Caserta, Italy
| | - Maurizio Martelli
- Hematology Unit, Department of Translational and Precision Medicine, “Sapienza” University, Rome, Italy
| | - Elena Sabattini
- Hemathopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policinico di S. Orsola, Bologna, Italy
| | - Riccardo Scarpa
- Department of Medicine-DIMED, University of Padova, Padua, Italy
- Internal Medicine I, Ca’ Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Giovanni Barosi
- Center for the Study of Myelofibrosis, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
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He L, Chen Y, Tan X, Sun X, Zhang Q, Luo H, Jiang L. 18F-FDG PET/CT and contrast-enhanced CT in the diagnosis of Castleman disease. Jpn J Radiol 2023; 41:98-107. [PMID: 35895223 DOI: 10.1007/s11604-022-01318-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/19/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Castleman disease (CD) is a rare group of lymphoproliferative disorders, which is easily confused with lymphoma or other solid tumors. Hence, this study aimed to investigate the diagnostic role of 18F-FDG PET/CT and contrast-enhanced CT (CECT) in patients with CD. METHODS Clinicopathological characteristics, and 18F-FDG PET/CT and CECT findings and parameters were retrospectively reviewed in 32 patients with CD. RESULTS These 32 patients (12 males, 20 females; median age, 41 years) consisted of 17 unicentric CD (UCD) patients and 15 multicentric CD (MCD) patients. Compared with MCD, UCD had a higher prevalence in female (82.4% vs. 40.0%) and hyaline vascular subtype (94.1% vs. 40.0%) (P < 0.05). FDG uptake was avid in all cases, including moderate uptake in 7 cases and intense uptake in 25 cases. The median SUVmax, SUVmean, MLV, and TLG of all cases were 4.4 (range, 1.4-23.6), 2.7 (range, 1.1-15.2), 26.6 (range, 4.8-393.0), and 78.8 (range, 9.4-1545.6), respectively. The lesions of 29 cases showed homogeneous enhancement, and marked enhancement was observed in 27 cases. 18F-FDG PET/CT corrected 6.3% CECT diagnoses, while CECT corrected 37.5% PET/CT diagnosis. The accuracy of combined PET/CT and CECT was superior to PET/CT or CECT alone (78.1%, 31.3%, and 62.5%). Besides, higher SUVmax and SUVmean were found in male subjects, MCD, and plasma cell subtype (P < 0.05), while higher MLV and TLG were observed in larger lesion size and volume (P < 0.05). CONCLUSION Castleman disease most commonly appears as marked and homogeneous enhancement meanwhile with moderate or intense FDG uptake. 18F-FDG PET/CT combined with CECT was the effectively diagnostic modality for CD. The glucose metabolism of CD was associated with gender, clinical classification, histopathological classification, and lesion size and volume.
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Affiliation(s)
- Li He
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Yu Chen
- Department of Pathology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiaoyue Tan
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Xiaolin Sun
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Qing Zhang
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China
| | - Haiying Luo
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lei Jiang
- PET Center, Department of Nuclear Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China.
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
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Chen H, Pang X, Li J, Xu B, Liu Y. Case Report: A rare case of primary hepatic Castleman’s disease mimicking a liver tumor. Front Oncol 2022; 12:974263. [PMID: 36110955 PMCID: PMC9468333 DOI: 10.3389/fonc.2022.974263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
Castleman’s disease (CD) is a primary lymphoproliferative disorder of the lymph nodes with rare extra-nodal primary affection. Solid organ involvement is rare, and isolated liver involvement is extremely rare. Here we presented a case of a 59-year-old woman with a hepatic lesion accidentally found by ultrasound. The MRI result indicated primary liver malignancy or liver metastases. 18F-FDG PET/CT could not exclude hepatic malignant tumor due to its high metabolism. Finally, the hepatic CD was confirmed by postoperative pathology.
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Affiliation(s)
- Hong Chen
- Department of Nuclear Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Xiaoxi Pang
- Department of Nuclear Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Jie Li
- Department of Pathology, Chinese PLA General Hospital, Beijing, China
| | - Baixuan Xu
- Department of Nuclear Medicine, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Baixuan Xu, ; Yachao Liu,
| | - Yachao Liu
- Department of Nuclear Medicine, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Baixuan Xu, ; Yachao Liu,
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Fuentes GC, López SS, González AS, Cerro AJB. Unicentric Castleman’s disease mimicking an hilar lung cancer. CIRUGÍA ESPAÑOLA (ENGLISH EDITION) 2022; 101:298-300. [PMID: 35660093 DOI: 10.1016/j.cireng.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022]
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Enfermedad de Castleman unicéntrica simulando un cáncer de pulmón hiliar. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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