1
|
Kishore A, Rana N, Kumar A, Kashyap V, Jebaying Y. Hyaline Vascular Variant of Castleman Disease of the Tonsil in an Adolescent: A case Report. Indian J Otolaryngol Head Neck Surg 2024; 76:1062-1065. [PMID: 38440559 PMCID: PMC10909062 DOI: 10.1007/s12070-023-04114-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/24/2023] [Indexed: 03/06/2024] Open
Abstract
Castleman disease (CD) is a lymphoproliferative disorder classified into two categories as unicentric Castleman disease (UCD) or localized type and multicentric Castleman disease (MCD). A rare case of hyaline vascular variant of tonsil has been presented in which a 14 years old male presented with symptomatic unilateral hypertrophy of right tonsil. A right tonsillectomy was done and surgical pathology report was concluded as hyaline vascular variant of Castleman's disease.Castleman disease (CD) is a rare lymphoproliferative disorder also called as giant lymph node hyperplasia, angiofollicular lymph node hyperplasia (AFH), angiomatous lymphoid hematoma and follicular lymphoreticuloma. The treatment of symptomatic patients with UCD is complete surgical excision (as in present case). In cases with incomplete resection, adjuvant radiotherapy can be given.
Collapse
|
2
|
Wang L, Nong L, Li F, Wang X, Wang R, Chen X, Tu P, Dong Y, Li T, Zhu X, Wang M. Predominant Stroma-Rich Feature in Hyaline Vascular Variant of Castleman Disease Is Associated With Paraneoplastic Pemphigus. Am J Clin Pathol 2020; 154:403-413. [PMID: 32459333 DOI: 10.1093/ajcp/aqaa053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES We aimed to describe the clinical and histopathologic features of Castleman disease (CD), particularly emphasizing its associations with paraneoplastic pemphigus (PNP) and prognosis. METHODS We retrospectively enrolled 123 CD patients at our center. Clinical, pathologic, and laboratory data were reviewed. RESULTS Fifty percent of the patients had PNP. Compared with those without PNP, patients with PNP-associated CD had more hyaline vascular (HV) variants (83.9% vs 57.4%), fewer mixed cellular variants (16.1% vs 24.6%), and no plasmacytic variants (0% vs 18.0%). Thirty-eight of 87 patients with the HV variant of CD (HV-CD) had stroma-rich (SR) features, and the incidence rate was higher in those with PNP-associated CD than in those without PNP (48.4% vs 13.1%, P < .001). The SR variant was associated with higher PNP-associated IgG titers than SR absence before surgery (median 1:160 vs 1:80, P = .019) or after surgery (median 1:160 vs 1:40, P = .013). The SR variant was also an unfavorable prognostic factor for CD survival in univariate analysis. The 3-year survival rates were 47.5% among those with PNP and 87.7% among those without PNP (P < .001). CONCLUSIONS PNP is associated with specific subtypes of CD and affects survival. The SR variant of HV-CD positively correlates with the incidence of PNP.
Collapse
Affiliation(s)
- Leyi Wang
- Department of Dermatology, 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
| | - Lin Nong
- Department of Pathology, Peking University First Hospital, Beijing, China
| | - Furong Li
- Department of Dermatology, 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
| | - Xue Wang
- Department of Dermatology, 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
| | - Rui Wang
- Department of Dermatology, 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
| | - Xixue Chen
- Department of Dermatology, 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
| | - Ping Tu
- Department of Dermatology, 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
| | - Yujun Dong
- Department of Hematology, Peking University First Hospital, Beijing, China
| | - Ting Li
- Department of Pathology, Peking University First Hospital, Beijing, China
| | - Xuejun Zhu
- Department of Dermatology, 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
| | - Mingyue Wang
- Department of Dermatology, 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
| |
Collapse
|
3
|
Li P, Liu H, Li H, Li A, Yu G, Yin W. Hyaline vascular variant of unicentric Castleman disease of the tonsil: a case report. Diagn Pathol 2019; 14:70. [PMID: 31253137 PMCID: PMC6599372 DOI: 10.1186/s13000-019-0836-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/06/2019] [Indexed: 11/10/2022] Open
Abstract
Background Castleman disease (CD) is a lymphoproliferative disorder with an unknown etiology. The disease may be unicentric (UCD) or multicentric (MCD), and three histopathologic variants have been described: hyaline vascular (HV), plasma cell (PC), and mixed type. Extranodal CD is rare. Herein, we report a case of CD presenting as a tonsillar mass, which has not been documented in the literature. Case presentation The patient was a 32-year-old man. Laryngoscopy revealed tonsillar hypertrophy, and the patient underwent a low-temperature plasma tonsillectomy. Microscopic examination of permanent sections showed lymphoid follicular hyperplasia, a portion of which appeared to be a fusion of nodular hyperplasia (composed of lymphoid follicles of variable size and shape). These distinctive follicles with atrophic hyalinized germinal centers and a broad mantle zone of small lymphocytes formed concentric rings (so-called onion-skin arrangement). Medium-sized vessels and a plethora of capillaries were present in the center of the lymphatic follicles, mantle zones, and interfollicular areas. A characteristic lollipop appearance was also observed due to the onion-skin arrangement of the expanded mantle zone lymphocytes with a vessel penetrating the germinal center. No aberrant lymphoid population was present based on CD3, CD5, CD20, CD79α, CD21, CD23, bcl-2, cyclin D1, and ki-67 immunostaining. Tests for human herpesvirus (HHV)-8 and Epstein Barr virus (EBV)-encoded small RNA (EBER) were negative. Therefore, a diagnosis of an HV variant UCD was rendered. The patient was treated by local excision without any other therapy based on the diagnosis. At the 7-month follow up, the patient had no recurrent symptoms or masses. Conclusion We present an unusual case of a tonsil presenting hyaline vascular Castleman disease (HVCD). This study aims to highlight CD as a differential diagnosis that should be considered by otolaryngologists and pathologists for lymphoproliferative disorders of the tonsil.
Collapse
Affiliation(s)
- Ping Li
- Department of Pathology, Shenzhen Hospital of Peking University, 1120 Lianhua road, Shenzhen, 518036, China
| | - Huaipu Liu
- Department of Cardiothoracic Surgery, Shenzhen Children's Hospital, 7019 Yitian road, Shenzhen, 518038, China
| | - Hao Li
- Department of Pathology, Shenzhen Hospital of Peking University, 1120 Lianhua road, Shenzhen, 518036, China
| | - Ang Li
- Department of Pathology, Shenzhen Hospital of Peking University, 1120 Lianhua road, Shenzhen, 518036, China
| | - Guangyin Yu
- Department of Pathology, Shenzhen Hospital of Peking University, 1120 Lianhua road, Shenzhen, 518036, China
| | - Weihua Yin
- Department of Pathology, Shenzhen Hospital of Peking University, 1120 Lianhua road, Shenzhen, 518036, China.
| |
Collapse
|
4
|
Mukta V, Susmitha C, Kar R, Basu D, Das AK. Multicentric, Hyaline Vascular Variant of Castleman's Syndrome. Indian J Hematol Blood Transfus 2014; 30:126-30. [PMID: 25332557 DOI: 10.1007/s12288-013-0284-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Accepted: 06/26/2013] [Indexed: 11/24/2022] Open
Abstract
Castleman's disease is a nonneoplastic adenopathy, also known as angiofollicular or giant lymphnode hyperplasia. Its multicentric form presents with wide spread lymphadenopathy and systemic symptoms. POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes) is observed in 11-30 % of the patients with Castleman's disease (Dispenzieri et al., Blood 101:2496-2506, 2003). Tuberculosis and lymphoma are the common diagnosis in patients with clinical features of weight loss, lymphadenopathy, hepatosplenomegaly and lymphocyte predominant ascites. We had a similar presentation in a young male, who was a diabetic, with clinical features suggestive of probable tuberculous infiltration of abdomen and adrenals causing addisonian features, lymphocyte predominant ascites, hepatosplenomegaly and generalized lymphadenopathy. However, a pathological diagnosis of hyaline vascular variant of Castleman's disease was obtained on lymphnode biopsy, which propelled us into doing a skeletal survey and bonemarrow biopsy. A final diagnosis of multicentric Castleman's disease with reactive plasmacytosis was achieved. Patient had osteosclerotic lesion in the right femur with evidence of polyneuropathy, organomegaly, endocrinopathies and skin hyperpigmentation. He has improved on chemotherapy with melphan and dexamethasone. Hyaline vascular variant of Castleman's disease rarely presents with systemic symptoms. Follow up is essential, as they can manifest with complications like POEMS and lymphoma.
Collapse
Affiliation(s)
- V Mukta
- Department of Medicine, JIPMER, Puducherry, 605006 India
| | | | - Rakhee Kar
- Department of Pathology, JIPMER, Puducherry, 605006 India
| | - Debdatta Basu
- Department of Pathology, JIPMER, Puducherry, 605006 India
| | - A K Das
- Department of Medicine, JIPMER, Puducherry, 605006 India
| |
Collapse
|
5
|
Abstract
Castleman and Towne described a disease presenting as a mediastinal mass resembling thymoma. It is also known as "giant lymph node hyperplasia", "lymph node hamartoma", "angiofollicular mediastinal lymph node hyperplasia", and "angiomatous lymphoid hyperplasia". The pathogenesis is unknown, but the bulk of evidence points toward faulty immune regulation, resulting in excessive B-lymphocyte and plasma-cell proliferation in lymphatic tissue. In addition to the mediastinal presentation, extrathoracic involvement in the neck, axilla, mesentery, pelvis, pancreas, adrenal gland, and retroperitoneum also have been described. There are 2 major pathologic variations of Castleman disease: (1) hyaline-vascular variant, the most frequent, characterized by small hyaline-vascular follicles and capillary proliferation; and (2) the plasma-cell variant, in which large lymphoid follicles are separated by sheets of plasma cells. The hyaline-vascular cases usually are largely asymptomatic, whereas the less common plasma-cell variant may present with fever, anemia, weight loss, and night sweats, along with polyclonal hypergamma-globulinemia. Castleman disease is a rare lymphoproliferative disorders. Few cases have been described world widely. In this article we reviewed the classification, pathogenesis, pathology, radiological features and up to date treatment with special emphasis on the role of viral stimulation, recent therapeutic modalities and the HIV-associated disease.
Collapse
Affiliation(s)
- Ibrahiem Saeed-Abdul-Rahman
- Division of Nephrology, Department of Internal Medicine, King Fahd University Hospital, Dammam University, Al-Khobar, Saudi Arabia
| | | |
Collapse
|