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Zhao D, Ozdemirli M, Nayar V. Intracranial Castleman disease: Illustrative case and literature review. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Matsumoto N, Hishikawa N, Ikegami K, Sato K, Omote Y, Takemoto M, Yamashita T, Taniguchi K, Abe K. A Unique Case of Encephalopathy with an Elevated IgG-4 and Extremely High Interleukin-6 Level and Delayed Myelodysplastic Syndrome. Intern Med 2021; 60:2125-2128. [PMID: 33390491 PMCID: PMC8313933 DOI: 10.2169/internalmedicine.6098-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We herein report a 75-year-old man who developed disturbed consciousness with polynuclear cell dominant pleocytosis and low glucose and extremely high interleukin (IL)-6 levels in his cerebrospinal fluid. The biopsy specimen from his right supraclavicular lymph node showed the infiltration of inflammatory cells positive for IgG, IgG4 and IL-6. Prednisolone and azathioprine administered under suspicion of IgG4-related disease (IgG4-RD) or multicentric Castleman's disease (MCD) successfully remitted the symptoms. However, he developed myelodysplastic syndrome (MDS) and died 18 months later. The extremely high IL-6 may have been related to the rare neurological manifestations and development of MDS in the present case.
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Affiliation(s)
- Namiko Matsumoto
- Departments of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Nozomi Hishikawa
- Departments of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Ken Ikegami
- Departments of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Kota Sato
- Departments of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Yoshio Omote
- Departments of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Mami Takemoto
- Departments of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Toru Yamashita
- Departments of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Kohei Taniguchi
- Departments of Pathology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Koji Abe
- Departments of Neurology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
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Alhoulaiby S, Okar L, Samaan H, Qalaani H. Castleman disease and SLE in a G6PD-deficient Marfan patient: a case report and literature review. AUTOIMMUNITY HIGHLIGHTS 2020; 11:16. [PMID: 33143705 PMCID: PMC7640440 DOI: 10.1186/s13317-020-00138-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 08/14/2020] [Indexed: 11/18/2022]
Abstract
Introduction Marfan syndrome, G6PD deficiency, systemic lupus erythematosus (SLE), and Castleman disease are four distinctive, thoroughly investigated entities whose coincidence was never reported. However, occurrence in pairs was sporadically mentioned in literature. Case presentation We report a 15-year-old Caucasian G6PD deficient Marfan male patient, who presented with tonic–clonic seizures, fever, a hemolytic episode, and general symptoms. After the discovery of hepatosplenomegaly, malar rash, and painless lymphadenopathy, further testing diagnosed a multifocal Castleman disease of the hyaline vascular subtype and systemic lupus erythematosus with lupus nephritis that got 35 points on the 2019 EULAR/ACR criteria. G6PD deficiency, SLE & Castleman disease, and seizures were handled medically with eventual improvement in the patient’s condition. Discussion and conclusion It is extremely rare to discover the gathering of these four diseases in the same patient. Marfan syndrome and G6PD deficiency were proven by respective clinical and laboratory examinations. Castleman disease that tends to occur in older age groups was confirmed via pathological study of a lymph node biopsy, which was compatible with the HHV-8 negative type reported in Asian countries. SLE is part of the differential diagnosis for Castleman disease, yet the newest evidence strongly supports its presence as a distinct entity. However, no concrete proof is available to suggest a causative relationship between the four of them, rather than a coincidental occurrence.
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Affiliation(s)
- Sami Alhoulaiby
- Department of General Surgery, Faculty of Medicine, Damascus University, Damascus, Syria.
| | - Lina Okar
- Department of Neurology, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Haya Samaan
- Department of Hematology, Internal Medicine, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Hisham Qalaani
- Department of Neurology, Faculty of Medicine, Damascus University, Damascus, Syria
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Rusconi A, Dario A, Agresta G, Balbi S. Acute Hydrocephalus Caused by Cerebellar Abscess in HIV-Negative Castleman's Disease. Asian J Neurosurg 2019; 14:1037-1039. [PMID: 31497160 PMCID: PMC6703033 DOI: 10.4103/ajns.ajns_32_17] [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] [Indexed: 11/16/2022] Open
Abstract
Castleman's disease (CD) is a rare and indolent hematologic disorder characterized by solitary bulky adenopathy. Multiple nodal nonbulky localizations are described, while central nervous system involvement is rare. Immunodeficiency is associated with higher incidence of CD, and HIV serology should be performed at initial diagnosis. We report the case of a 64-year-old HIV-negative man affected by CD, presenting with acute hydrocephalus caused by a large cerebellar abscess.
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Affiliation(s)
- Angelo Rusconi
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | | | - Gianluca Agresta
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Sergio Balbi
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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Radiologic and Histopathologic Features in an Intracranial Localized Castleman Disease: A Case Report and Review of Literature. Neurologist 2018; 24:33-36. [PMID: 30586033 DOI: 10.1097/nrl.0000000000000203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Castleman disease (CD) is a rare pathologic process of unknown etiology, characterized by non-neoplastic lymph node enlargement. Two distinct histologic patterns are recognized; the hyaline-vascular type and the less common plasma cells type. Another intermediate type has been described. The clinical features are classified into 2 categories, localized (unicentric) and generalized (multicentric), the later associated with systemic manifestations and poor prognosis. CD affecting the central nervous system is extremely rare. We report a new case of localized intracranial CD and we accomplish a review of the literature. CASE REPORT A 30-year-old man presented with a generalized tonic-clonic seizure. Computerized tomography and magnetic resonance imaging showed a small mass in the right temporoparietal convexity with homogenous enhancement after contrast administration. Extensive vasogenic edema in comparison with the size of the mass was also identified and based on the neuroradiologic finding, a suspected diagnosis of meningoangiomatosis was formulated. The mass was completely resected and his histologic examination identified the hyaline-vascular type of CD. One year after surgery, the patient remains seizure free, without evidence of systemic involvement or recurrence of the mass. CONCLUSIONS Our case and review of the literature show the value of the extensive brain edema on neuroimaging finding to the differential diagnosis for a solitary mass arising from the meninges. We emphasize on the need for histologic examination when the diagnosis of meningioma is not entirely clear.
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Rao VR, Lim LE, Fong D, Garga NI, Parko KL. Multicentric Castleman's disease with voltage-gated potassium channel antibody-positive limbic encephalitis: a case report. BMC Neurol 2015; 15:4. [PMID: 25648431 PMCID: PMC4320461 DOI: 10.1186/s12883-015-0266-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 01/21/2015] [Indexed: 12/27/2022] Open
Abstract
Background Castleman’s disease is a rare lymphoproliferative disorder which occurs in localized and multicentric forms and can mimic lymphoma. Despite its well-known association with certain autoimmune diseases, including paraneoplastic pemphigus and myasthenia gravis, Castleman’s disease has not previously been associated with limbic encephalitis. Case presentation We report the case of a 47-year old Caucasian man who presented with subacute onset of constitutional symptoms, diffuse lymphadenopathy, and stereotyped spells involving olfactory aura, nausea, disorientation, and unresponsiveness. He was found to have focal dyscognitive seizures of temporal lobe origin, cerebrospinal fluid with lymphocytic pleocytosis, hyponatremia, and serum positive for voltage-gated potassium channel antibodies, consistent with limbic encephalitis. An extensive infectious workup was unrevealing, but lymph node biopsy revealed multicentric Castleman’s disease. His symptoms improved with antiepileptic drugs and immunotherapy. Conclusion This case highlights the clinical diversity of voltage-gated potassium channel autoimmunity and expands the association of Castleman’s disease and autoimmune syndromes to include limbic encephalitis. Clinicians should be aware that paraneoplastic disorders of the central nervous system can be related to underlying hematologic disorders such as Castleman’s disease.
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Affiliation(s)
- Vikram R Rao
- Department of Neurology, University of California, San Francisco, 400 Parnassus Ave, 8th Floor, San Francisco, CA, 94143, USA.
| | - Leland E Lim
- Neurology Service, Department of Veteran Affairs, Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA, 94304, USA. .,Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA.
| | - Dean Fong
- Pathology and Laboratory Medicine Service, Department of Veteran Affairs, Palo Alto Health Care System (113), 3801 Miranda Avenue, Palo Alto, CA, 94304, USA.
| | - Nina I Garga
- Epilepsy Center of Excellence, San Francisco Veteran Affairs Medical Center, 4150 Clement Street, Box 127E, San Francisco, CA, 94121, USA.
| | - Karen L Parko
- Epilepsy Center of Excellence, San Francisco Veteran Affairs Medical Center, 4150 Clement Street, Box 127E, San Francisco, CA, 94121, USA.
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Mahan M, Karl M, Gordon S. Neuroimaging of viral infections of the central nervous system. HANDBOOK OF CLINICAL NEUROLOGY 2014; 123:149-73. [PMID: 25015484 DOI: 10.1016/b978-0-444-53488-0.00006-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Mathur Mahan
- Department of Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Muchantef Karl
- Department of Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Sze Gordon
- Department of Radiology, Yale University School of Medicine, New Haven, CT, USA.
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Abstract
Castleman disease (CD) is a rare atypical lymphoproliferative process of obscure pathogenesis. An intracranial localization of the condition is extremely rare. We present a case of a 29-year-old man, who harbored an intracranial plasma cell variant of CD in the form of a tumor mimicking meningioma and was followed up to 10 years after surgical excision of the lesion. The histopathological examination showed massive infiltration of mononuclear cells, composed mainly of lymphocytes and matured plasmocytes, as well as many small thin-walled vessels surrounded with plasma cells and lymphocytes. This picture was consistent with a plasma cell type of CD. Ten-year follow-up supports a notion that total surgical excision of the solitary intracranial infiltration is curative in plasma cell type of CD.
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Multicentric Castleman's disease of the central nervous system : evaluation with dynamic susceptibility contrast perfusion magnetic resonance imaging. Clin Neuroradiol 2011; 22:245-51. [PMID: 21837500 DOI: 10.1007/s00062-011-0090-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 07/07/2011] [Indexed: 10/17/2022]
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Kaito M, Iwao H, Kinoshita E, Funaki H, Tachibana O, Matsui M. [A case of Castleman disease with status epileptics originating from focal cortical dysplasia]. Rinsho Shinkeigaku 2011; 51:487-492. [PMID: 21823508 DOI: 10.5692/clinicalneurol.51.487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 55-year-old man was admitted to our hospital because of prolonged consciousness disturbance after generalized convulsions. He had been afflicted with chronic inflammatory symptoms since 43 years of age, while multiple abdominal lymphadenopathy with a high level of serum IL-6 was revealed at the age of 53. FDG-PET/CT showed hypermetabolism in the left medial portion of the frontal lobe. Biopsy specimens of this lesion revealed a pathology of focal cortical dysplasia (FCD). Non-convulsive status epileptics continued despite enhanced treatment with antiepileptic drugs, while cortical T2 hyperintense lesions developed and expanded. Castleman disease was confirmed by pathological findings of abdominal lymph node biopsy specimens. The patient showed a higher level of IL-6 in cerebrospinal fluid (1,400 pg/dl) than in serum (720 pg/dl), thus indicating intrathecal production of this proinflammatory cytokine. We concluded that continuous exposure of FCD tissue to IL-6 may have augmented epileptogenesis of the originally silent congenital lesion.
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Affiliation(s)
- Muichi Kaito
- Department of Neurology, Kanazawa Medical University
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Stevens EA, Strowd RE, Mott RT, Oaks TE, Wilson JA. Angiofollicular lymph node hyperplasia resembling a spinal nerve sheath tumor: a rare case of Castleman's disease. Spine J 2009; 9:e18-22. [PMID: 19482516 DOI: 10.1016/j.spinee.2009.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 03/31/2009] [Accepted: 04/13/2009] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Angiofollicular lymph node hyperplasia (Castleman's disease) is a lymphoproliferative disorder of unknown etiology. Although uncommon, the localized form of this disease can manifest in the central nervous system, typically as a meningeal-based intracranial lesion. Castleman's disease involving the spine is exceedingly rare. This represents only the second reported case of a patient with Castleman's disease whose presentation mimicked that of a spinal nerve sheath tumor. PURPOSE We report a rare case of angiofollicular lymph node hyperplasia that mimicked a spinal nerve sheath tumor and was treated with gross total resection. STUDY DESIGN Case report. PATIENT SAMPLE A 31-year-old female with angiofollicular lymph node hyperplasia presenting with a paraspinal mass. OUTCOME MEASURES The patient's outcome was based on clinical history, physical and radiographic examinations. METHODS A 31-year-old woman with a mediastinal mass previously diagnosed as sarcoid via biopsy presented with the new onset of radicular pain and radiographic enlargement of her mass. Magnetic resonance imaging demonstrated a 4.3x5.7x6.0 cm homogenously enhancing soft-tissue lesion that emanated from and widened the T3/T4 neural foramen on the left. The differential diagnosis based on the location of the lesion and imaging characteristics included schwannoma, neurofibroma, paraganglioma, sarcoid, and lymphoma. Gross total resection was performed via thoracotomy. Histological examination identified angiofollicular lymph node hyperplasia (Castleman's disease) of the hyaline-vascular subtype. The patient did not receive adjuvant chemotherapy or radiation therapy. RESULTS The patient had resolution of her symptoms without any clinical or radiographic evidence of recurrence at 1-year follow-up using magnetic resonance imaging with and without contrast. CONCLUSIONS Castleman's disease is a rare pathologic entity that should be considered in the differential diagnosis of a patient with a paraspinal mass. Spine surgeons should be aware of this diagnosis as it has treatment and follow-up implications that differ from the neoplasms it can mimic. Complete surgical excision is an effective treatment for solitary lesions. Screening for concurrent and future malignancies in these patients is prudent.
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Affiliation(s)
- E Andrew Stevens
- Department of Neurosurgery, Wake Forest University Baptist Medical Center, 100 Medical Center Blvd., Winston-Salem, NC, 27157, USA.
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Cunliffe CH, Fischer I, Monoky D, Law M, Revercomb C, Elrich S, Kopp MJ, Zagzag D. Intracranial lesions mimicking neoplasms. Arch Pathol Lab Med 2009; 133:101-23. [PMID: 19123722 DOI: 10.5858/133.1.101] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2008] [Indexed: 11/06/2022]
Abstract
CONTEXT A broad spectrum of nonneoplastic conditions can mimic a brain tumor, both clinically and radiologically. In this review we consider these, taking into consideration the following etiologic categories: infection, demyelination, vascular diseases, noninfectious inflammatory disorders, and iatrogenic conditions. We give an overview of such diseases, which represent a potential pitfall for pathologists and other clinicians involved in patient care, and present selected cases from each category. OBJECTIVE To illustrate the radiologic and pathologic features of nontumoral intracranial lesions that can clinically and radiologically mimic neoplasia. DATA SOURCES Case-derived material and literature review. CONCLUSIONS A variety of nonneoplastic lesions can present clinically and radiologically as primary or metastatic central nervous system tumors and result in surgical biopsy or resection of the lesion. In such situations, the pathologist has an important role to play in correctly determining the nature of these lesions. Awareness of the entities that can present in this way will assist the pathologist in the correct diagnosis of these lesions.
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Affiliation(s)
- Clare H Cunliffe
- Department of Pathology, Division of Neuropathology, New York University Medical Center, New York, NY, USA.
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Coca S, Salas I, Martínez R, Saez MA, Vaquero J. Meningeal Castleman’s disease with multifocal involvement: a case report and review of literature. J Neurooncol 2008; 88:37-41. [DOI: 10.1007/s11060-008-9528-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2007] [Accepted: 01/07/2008] [Indexed: 11/24/2022]
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Abstract
✓ Castleman disease is a rare lymphoproliferative disease of unknown cause. In most cases, afflicted patients present with a mediastinal mass although the disease may manifest in numerous other sites, including intracranially and rarely intraspinally. The authors report on the case of a 19-year-old woman who presented with a large paraspinal mass emanating from the T7–8 neural foramen. The morphological and signal characteristics revealed on magnetic resonance imaging were similar to those of nerve sheath tumors. The patient underwent open biopsy sampling of the lesion, and results of a pathological evaluation revealed hyaline-vascular type Castleman disease. She underwent radiotherapy and remains symptom-free with a radiographically stable lesion 1 year later. Although the disease has been reported to mimic a meningioma when encountered in intracranial locations, to the authors' knowledge, this is the first case of the disorder mimicking a nerve sheath tumor. When the diagnosis of Castleman disease is made, good results can be obtained with partial resection and radiotherapy.
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Affiliation(s)
- Michael A Finn
- Spinal Oncology Service, Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah 84132-2303, USA
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Mallik AA, Katchy KC, Clotan N. Solitary intracranial Castleman's disease, plasma cell variant: a case report. Med Princ Pract 2007; 16:226-9. [PMID: 17409759 DOI: 10.1159/000100395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2006] [Accepted: 05/09/2006] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We report a case of plasma cell variant of Castleman's disease confined to the meninges. CLINICAL PRESENTATION AND INTERVENTION A 53-year-old woman presented with severe headache lasting a few months, which was insidious in onset but followed a progressive course with associated vomiting, blurring of vision and diplopia. Investigations revealed a dural-based mass that was considered both radiologically and intraoperatively as a meningioma. Total surgical excision of the mass was performed. Histologically, it was a plasma cell variant of Castleman's disease with kappa light chain restriction. Laboratory investigations and whole body computerized tomography scan showed no significant abnormality. A short course of local radiotherapy was given. The patient is well 2 years after treatment. CONCLUSION This report highlights the rarity of solitary intracranial Castleman's disease and the difficulty in radiological and intraoperative diagnosis.
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Affiliation(s)
- A A Mallik
- Department of Pathology, Al-Sabah Hospital, Safat, Kuwait.
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Huang J, Wang L, Zhou W, Jin J. Hyaline vascular Castleman disease associated with POEMS syndrome and cerebral infarction. Ann Hematol 2006; 86:59-61. [PMID: 16953376 DOI: 10.1007/s00277-006-0188-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2006] [Accepted: 08/07/2006] [Indexed: 12/31/2022]
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