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Miura K, Nishimaki-Watanabe H, Takahashi H, Nakagawa M, Otake S, Hamada T, Koike T, Iizuka K, Takeuchi Y, Kurihara K, Endo T, Ito S, Nukariya H, Namiki T, Hayashi Y, Nakamura H. TAFRO Syndrome: Guidance for Managing Patients Presenting Thrombocytopenia, Anasarca, Fever, Reticulin Fibrosis, Renal Insufficiency, and Organomegaly. Biomedicines 2024; 12:1277. [PMID: 38927484 PMCID: PMC11200895 DOI: 10.3390/biomedicines12061277] [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: 05/04/2024] [Revised: 06/01/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
TAFRO syndrome is an inflammatory disorder of unknown etiology characterized by thrombocytopenia, anasarca, fever, reticulin fibrosis, renal insufficiency, and organomegaly. Despite great advancements in research on the TAFRO syndrome in the last decade, its diagnosis and treatment are still challenging for most clinicians because of its rarity and severity. Since the initial proposal of the TAFRO syndrome as a distinct disease entity in 2010, two independent diagnostic criteria have been developed. Although these are different in the concept of whether TAFRO syndrome is a subtype of idiopathic multicentric Castleman disease or not, they are similar except for the magnitude of lymph node histopathology. Because there have been no specific biomarkers, numerous diseases must be ruled out before the diagnosis of TAFRO syndrome is made. The standard of care has not been fully established, but interleukin-6 blockade therapy with siltuximab or tocilizumab and anti-inflammatory therapy with high-dose corticosteroids are the most commonly applied for the treatment of TAFRO syndrome. The other immune suppressive agents or combination cytotoxic chemotherapies are considered for patients who do not respond to the initial treatment. Whereas glowing awareness of this disease improves the clinical outcomes of patients with TAFRO syndrome, further worldwide collaborations are warranted.
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Affiliation(s)
- Katsuhiro Miura
- Department of Medicine, Division of Hematology and Rheumatology, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi City, Tokyo 173-8610, Japan; (H.T.); (M.N.); (S.O.); (T.H.); (T.K.); (K.I.); (Y.T.); (K.K.); (T.E.); (S.I.); (H.N.); (T.N.); (Y.H.); (H.N.)
| | - Haruna Nishimaki-Watanabe
- Department of Pathology and Microbiology, Division of Oncologic Pathology, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi City, Tokyo 173-8610, Japan;
| | - Hiromichi Takahashi
- Department of Medicine, Division of Hematology and Rheumatology, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi City, Tokyo 173-8610, Japan; (H.T.); (M.N.); (S.O.); (T.H.); (T.K.); (K.I.); (Y.T.); (K.K.); (T.E.); (S.I.); (H.N.); (T.N.); (Y.H.); (H.N.)
| | - Masaru Nakagawa
- Department of Medicine, Division of Hematology and Rheumatology, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi City, Tokyo 173-8610, Japan; (H.T.); (M.N.); (S.O.); (T.H.); (T.K.); (K.I.); (Y.T.); (K.K.); (T.E.); (S.I.); (H.N.); (T.N.); (Y.H.); (H.N.)
| | - Shimon Otake
- Department of Medicine, Division of Hematology and Rheumatology, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi City, Tokyo 173-8610, Japan; (H.T.); (M.N.); (S.O.); (T.H.); (T.K.); (K.I.); (Y.T.); (K.K.); (T.E.); (S.I.); (H.N.); (T.N.); (Y.H.); (H.N.)
| | - Takashi Hamada
- Department of Medicine, Division of Hematology and Rheumatology, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi City, Tokyo 173-8610, Japan; (H.T.); (M.N.); (S.O.); (T.H.); (T.K.); (K.I.); (Y.T.); (K.K.); (T.E.); (S.I.); (H.N.); (T.N.); (Y.H.); (H.N.)
| | - Takashi Koike
- Department of Medicine, Division of Hematology and Rheumatology, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi City, Tokyo 173-8610, Japan; (H.T.); (M.N.); (S.O.); (T.H.); (T.K.); (K.I.); (Y.T.); (K.K.); (T.E.); (S.I.); (H.N.); (T.N.); (Y.H.); (H.N.)
| | - Kazuhide Iizuka
- Department of Medicine, Division of Hematology and Rheumatology, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi City, Tokyo 173-8610, Japan; (H.T.); (M.N.); (S.O.); (T.H.); (T.K.); (K.I.); (Y.T.); (K.K.); (T.E.); (S.I.); (H.N.); (T.N.); (Y.H.); (H.N.)
- Department of Pathology and Microbiology, Division of Laboratory Medicine, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi City, Tokyo 173-8610, Japan
| | - Yuuichi Takeuchi
- Department of Medicine, Division of Hematology and Rheumatology, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi City, Tokyo 173-8610, Japan; (H.T.); (M.N.); (S.O.); (T.H.); (T.K.); (K.I.); (Y.T.); (K.K.); (T.E.); (S.I.); (H.N.); (T.N.); (Y.H.); (H.N.)
| | - Kazuya Kurihara
- Department of Medicine, Division of Hematology and Rheumatology, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi City, Tokyo 173-8610, Japan; (H.T.); (M.N.); (S.O.); (T.H.); (T.K.); (K.I.); (Y.T.); (K.K.); (T.E.); (S.I.); (H.N.); (T.N.); (Y.H.); (H.N.)
| | - Toshihide Endo
- Department of Medicine, Division of Hematology and Rheumatology, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi City, Tokyo 173-8610, Japan; (H.T.); (M.N.); (S.O.); (T.H.); (T.K.); (K.I.); (Y.T.); (K.K.); (T.E.); (S.I.); (H.N.); (T.N.); (Y.H.); (H.N.)
| | - Shun Ito
- Department of Medicine, Division of Hematology and Rheumatology, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi City, Tokyo 173-8610, Japan; (H.T.); (M.N.); (S.O.); (T.H.); (T.K.); (K.I.); (Y.T.); (K.K.); (T.E.); (S.I.); (H.N.); (T.N.); (Y.H.); (H.N.)
| | - Hironao Nukariya
- Department of Medicine, Division of Hematology and Rheumatology, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi City, Tokyo 173-8610, Japan; (H.T.); (M.N.); (S.O.); (T.H.); (T.K.); (K.I.); (Y.T.); (K.K.); (T.E.); (S.I.); (H.N.); (T.N.); (Y.H.); (H.N.)
| | - Takahiro Namiki
- Department of Medicine, Division of Hematology and Rheumatology, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi City, Tokyo 173-8610, Japan; (H.T.); (M.N.); (S.O.); (T.H.); (T.K.); (K.I.); (Y.T.); (K.K.); (T.E.); (S.I.); (H.N.); (T.N.); (Y.H.); (H.N.)
| | - Yoshiyuki Hayashi
- Department of Medicine, Division of Hematology and Rheumatology, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi City, Tokyo 173-8610, Japan; (H.T.); (M.N.); (S.O.); (T.H.); (T.K.); (K.I.); (Y.T.); (K.K.); (T.E.); (S.I.); (H.N.); (T.N.); (Y.H.); (H.N.)
| | - Hideki Nakamura
- Department of Medicine, Division of Hematology and Rheumatology, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi City, Tokyo 173-8610, Japan; (H.T.); (M.N.); (S.O.); (T.H.); (T.K.); (K.I.); (Y.T.); (K.K.); (T.E.); (S.I.); (H.N.); (T.N.); (Y.H.); (H.N.)
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Shirai T, Ichikawa S, Saegusa J. Tacrolimus Treatment for TAFRO Syndrome. Biomedicines 2024; 12:1070. [PMID: 38791031 PMCID: PMC11118940 DOI: 10.3390/biomedicines12051070] [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: 04/11/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
TAFRO syndrome is an acute systemic inflammatory disorder characterized by thrombocytopenia, anasarca, fever, reticulin myelofibrosis, renal dysfunction, and organomegaly. While its lymph node pathology is similar to that of idiopathic multicentric Castleman disease (iMCD), the clinical features of TAFRO syndrome differ from those of typical iMCD, as they include a more aggressive clinical course and high mortality. However, an optimal treatment strategy for TAFRO syndrome has not yet been established, owing to a poor understanding of its pathogenesis. The limited cases we encountered suggest that tacrolimus treatment in combination with glucocorticoids may potentially be effective and well tolerated as an initial treatment, and hold promise as a glucocorticoid-sparing agent. Herein, we report an additional case and review the sparse literature available regarding TAFRO syndrome treated via tacrolimus.
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Affiliation(s)
- Taiichiro Shirai
- Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
- Laboratory of Immune Response Dynamics, WPI Immunology Frontier Research Center, Osaka University, Osaka 565-0871, Japan
- Department of Immune Response Dynamics, Research Institute for Microbial Diseases, Osaka University, Osaka 565-0871, Japan
| | - Shinya Ichikawa
- Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Jun Saegusa
- Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
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Epstein-Barr Virus-Positive Cutaneous and Systemic Plasmacytosis with TAFRO Syndrome-like Symptoms Successfully Treated with Rituximab. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020216. [PMID: 36837418 PMCID: PMC9962959 DOI: 10.3390/medicina59020216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023]
Abstract
Histopathologic findings in the lymph nodes of patients with thrombocytopenia, anasarca, fever, reticulin fibrosis, renal dysfunction, and organomegaly (TAFRO) syndrome are similar to those of idiopathic multicentric Castleman's disease (iMCD), but TAFRO syndrome is different from iMCD in how it can progress rapidly and be fatal. These patients present scarce lymphadenopathy and low immunoglobulin levels. We present a case of cutaneous and systemic plasmacytosis (C/SP) that caused TAFRO syndrome-like symptoms which were successfully treated with rituximab. A 67-year-old woman presented with fever and a pruritic skin rash. Numerous plasma cells were observed in the peripheral blood and imaging revealed organomegaly, anasarca, and generalized lymphadenopathy. Subsequently, she rapidly developed thrombocytopenia as well as renal and heart failure. She tested positive for the Epstein-Barr virus (EBV), elevated immunoglobulins, and C/SP, which are also atypical for TAFRO syndrome, thereby complicating the diagnosis. However, after using the Japanese TAFRO Syndrome Research Group diagnostic criteria, we promptly administered rituximab to treat the C/SP with TAFRO-like symptoms and saved her life. Finally, histopathological observations of the lymph node biopsy helped confirm EBV-positive hypervascular-type iMCD. Therefore, diagnosing TAFRO-like syndromes based on the Japanese diagnostic criteria and following the associated treatment even without a confirmed diagnosis is crucial to improving the patient outcomes.
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Masaki Y, Ueda Y, Yanagisawa H, Arita K, Sakai T, Yamada K, Mizuta S, Fukushima T, Takai K, Aoki S, Kawabata H. TAFRO Syndrome: A Disease Requiring Immediate Medical Attention. Intern Med 2023; 62:27-32. [PMID: 35598998 PMCID: PMC9876714 DOI: 10.2169/internalmedicine.9622-22] [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: 02/04/2023] Open
Abstract
TAFRO syndrome was first described in 2010, standing for thrombocytopenia, anasarca, fever, reticulin fibrosis and organomegaly. Because the lymph node histopathology of TAFRO syndrome mimics idiopathic multicentric Castleman disease (iMCD), some researchers consider TAFRO syndrome to be a subtype of iMCD. However, the clinical features of TAFRO syndrome considerably differ from those of iMCD without TAFRO. The clinical features of patients with TAFRO syndrome with or without iMCD-histopathology are similar, and these patients require an accurate diagnosis and urgent treatment. Although a histological diagnosis, including a differential diagnosis, is important, lymph node involvement in patients with TAFRO syndrome is usually modest or sometimes absent. Furthermore, a bleeding tendency due to thrombocytopenia and severe anasarca hampers performing a biopsy. Nonetheless, patients with various other disorders may manifest TAFRO syndrome-like symptoms, making the differential diagnosis in borderline cases difficult. Therefore, the establishment of precise and specific biomarkers is important.
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Affiliation(s)
- Yasufumi Masaki
- Department of Hematology and Immunology, Medicine, Kanazawa Medical University, Japan
| | - Yusuke Ueda
- Department of Hematology and Immunology, Medicine, Kanazawa Medical University, Japan
| | - Hiroto Yanagisawa
- Department of Hematology and Immunology, Medicine, Kanazawa Medical University, Japan
| | - Kotaro Arita
- Department of Hematology and Immunology, Medicine, Kanazawa Medical University, Japan
| | - Tomoyuki Sakai
- Department of Hematology and Immunology, Medicine, Kanazawa Medical University, Japan
| | - Kazunori Yamada
- Department of Hematology and Immunology, Medicine, Kanazawa Medical University, Japan
| | - Shuichi Mizuta
- Department of Hematology and Immunology, Medicine, Kanazawa Medical University, Japan
| | - Toshihiro Fukushima
- Department of Hematology and Immunology, Medicine, Kanazawa Medical University, Japan
| | - Kazue Takai
- Department of Hematology, Niigata City General Hospital, Japan
| | - Sadao Aoki
- Department of Pathophysiology, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences, Japan
| | - Hiroshi Kawabata
- Department of Hematology, National Hospital Organization Kyoto Medical Center, Japan
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Fujimi A, Nagamachi Y, Yamauchi N, Onoyama N, Matsuno T, Miyajima N, Koike K, Goto Y, Ihara K, Nishisato T, Kobune M. Acute Abdomen and Adrenal Swelling as the First Manifestations of TAFRO Syndrome. Intern Med 2022. [PMID: 36070944 DOI: 10.2169/internalmedicine.0267-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
TAFRO syndrome, a rare systemic inflammatory disorder, commonly develops in an acute or subacute manner, with an aggressive clinical behavior. A substantial number of cases of TAFRO syndrome presenting with abdominal pain, and adrenal abnormalities on imaging have also been reported. A 54-year-old man developed severe acute abdominal pain. Bilateral adrenal swelling was detected on computed tomography. Although the abdominal pain resolved spontaneously, a fever and anasarca were observed. The patient was eventually diagnosed with TAFRO syndrome, and corticosteroid administration resulted in remission. TAFRO syndrome should be included in the differential diagnosis of acute abdomen and adrenal abnormalities.
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Affiliation(s)
- Akihito Fujimi
- Department of Hematology, Sapporo Kiyota Hospital, Japan
| | | | | | - Naoki Onoyama
- Department of Internal Medicine, Sapporo Kiyota Hospital, Japan
| | - Teppei Matsuno
- Department of Internal Medicine, Sapporo Kiyota Hospital, Japan
| | - Naoya Miyajima
- Department of Internal Medicine, Sapporo Kiyota Hospital, Japan
| | - Kazuhiko Koike
- Department of Internal Medicine, Sapporo Kiyota Hospital, Japan
| | - Yoshiro Goto
- Department of Internal Medicine, Sapporo Kiyota Hospital, Japan
| | - Kohji Ihara
- Department of Internal Medicine, Sapporo Kiyota Hospital, Japan
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Abstract
Although Castleman disease was first described in 1956, this disease includes various conditions, including unicentric Castleman disease with hyaline vascular histology, human herpesvirus-8 (HHV-8) related multicentric Castleman disease, idiopathic multicentric Castleman disease, and mimics of Castleman disease associated with other conditions. To date, Castleman disease remains incompletely understood due to its rareness and difficulties in clinical and pathological diagnosis. TAFRO syndrome was reported in Japan in 2010. Because lymph node histology is similar in patients with TAFRO syndrome and Castleman disease, TAFRO syndrome is described as a related disorder of Castleman disease. Clinically, however, these conditions differ markedly. Although elevated interleukin-6 (IL-6) expression is characteristic of Castleman disease, increased expression of IL-6 may occur in patients with other diseases, making elevated IL-6 unsuitable for differential diagnosis. Further understanding of these disorders requires the identification of novel disease-specific biomarkers. This review article therefore outlines the characteristics of Castleman disease and TAFRO syndrome.
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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.
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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
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Masaki Y, Kawabata H, Fujimoto S, Kawano M, Iwaki N, Kotani T, Nakashima A, Kurose N, Takai K, Suzuki R, Aoki S. Epidemiological analysis of multicentric and unicentric Castleman disease and TAFRO syndrome in Japan. J Clin Exp Hematop 2019; 59:175-178. [PMID: 31708515 PMCID: PMC6954167 DOI: 10.3960/jslrt.19021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Castleman disease is a polyclonal lymphoproliferative disease which is clinically classified into unicentric (UCD) and multicentric (MCD). TAFRO syndrome is a relatively new concept that partly overlaps with MCD. Due to their rarity, their incidence remains unknown. This study investigated the incidence and prevalence of UCD, MCD, and TAFRO syndrome in Japan using a fixed-point observation method based on their incidence in Ishikawa prefecture. The annual incidences of MCD, UCD, and TAFRO syndrome in Japan were 309-731, 71-542, and 110-502, respectively, yielding annual incidence rates per million individuals of 2.4-5.8, 0.6-4.3, and 0.9-4.9, respectively, and nationwide prevalence of 4,180-14,900, 1,350-10,300, and 860-7,240, respectively. In conclusion, MCD, UCD and TAFRO syndrome may not be as rare as previously estimated in Japan.
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Fujimoto S, Sakai T, Kawabata H, Kurose N, Yamada S, Takai K, Aoki S, Kuroda J, Ide M, Setoguchi K, Tsukamoto N, Iwao‐Kawanami H, Kawanami T, Mizuta S, Fukushima T, Masaki Y. Is TAFRO syndrome a subtype of idiopathic multicentric Castleman disease? Am J Hematol 2019; 94:975-983. [PMID: 31222819 DOI: 10.1002/ajh.25554] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 12/22/2022]
Abstract
Castleman disease (CD) is a rare lymphoproliferative disorder that can be unicentric or multicentric. Multicentric CD (MCD) is further subdivided into human herpesvirus type-8-associated, POEMS syndrome-associated, and idiopathic (iMCD). TAFRO syndrome is a newly identified disorder of unknown etiology characterized by thrombocytopenia, anasarca, fever, reticulin myelofibrosis, renal dysfunction, and organomegaly. The TAFRO syndrome is sometimes regarded as a subtype of iMCD (TAFRO-iMCD), whereas iMCD without TAFRO syndrome is considered "not otherwise specified" (iMCD-NOS). However, a proportion of patients with TAFRO syndrome have been diagnosed without lymph node biopsies (TAFRO syndrome without proven iMCD; TAFRO-w/op-iMCD). To clarify the clinical features of iMCD-NOS, TAFRO-iMCD, and TAFRO-w/op-iMCD, we retrospectively analyzed 220 patients extracted from the database of the Multicenter Collaborative Retrospective Study for Establishing the Concept of TAFRO Syndrome. The patients included 87 with iMCD-NOS, 63 with TAFRO-iMCD, and 19 with TAFRO-w/op-iMCD. Patients in all three groups exhibited anemia, hypoalbuminemia, and elevated serum C-reactive protein and interleukin-6 levels. No significant differences in clinical, laboratory, and prognostic features were noted between the TAFRO-iMCD, and TAFRO-w/op-iMCD groups. However, the iMCD-NOS group exhibited polyclonal hyper-γ-globulinemia. The five-year survival rates of patients in the iMCD-NOS and TAFRO-involved groups were 100% and 66.5%, respectively (dropping markedly during the first few months in the latter). The iMCD-NOS and the TAFRO-iMCD samples typically showed plasma cell and mixed-type histologies, respectively. Thus, iMCD can be classified into two distinct subtypes, iMCD-NOS and TAFRO-iMCD. As such, TAFRO-iMCD and TAFRO-w/op-iMCD may be considered the same entity, requiring prompt diagnosis and intensive care.
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Affiliation(s)
- Shino Fujimoto
- Department of Hematology and ImmunologyKanazawa Medical University Uchinada Japan
| | - Tomoyuki Sakai
- Department of Hematology and ImmunologyKanazawa Medical University Uchinada Japan
| | - Hiroshi Kawabata
- Department of Hematology and ImmunologyKanazawa Medical University Uchinada Japan
- Department of Hematology and Oncology, Graduate School of MedicineKyoto University Kyoto Japan
| | - Nozomu Kurose
- Department of Pathology and Laboratory MedicineKanazawa Medical University Uchinada Japan
| | - Sohsuke Yamada
- Department of Pathology and Laboratory MedicineKanazawa Medical University Uchinada Japan
| | - Kazue Takai
- Department of HematologyNiigata City General Hospital Niigata Japan
| | - Sadao Aoki
- Department of Pathophysiology, Faculty of Pharmaceutical SciencesNiigata University of Pharmacy and Applied Life Sciences Niigata Japan
| | - Junya Kuroda
- Division of Hematology and Oncology, Department of MedicineKyoto Prefectural University of Medicine Kyoto Japan
| | - Makoto Ide
- Department of HematologyTakamatsu Red Cross Hospital Takamatsu Japan
| | - Keigo Setoguchi
- Department of Systemic Immunological DiseasesTokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Tokyo Japan
| | | | - Haruka Iwao‐Kawanami
- Department of Hematology and ImmunologyKanazawa Medical University Uchinada Japan
| | - Takafumi Kawanami
- Department of Hematology and ImmunologyKanazawa Medical University Uchinada Japan
| | - Shuichi Mizuta
- Department of Hematology and ImmunologyKanazawa Medical University Uchinada Japan
| | - Toshihiro Fukushima
- Department of Hematology and ImmunologyKanazawa Medical University Uchinada Japan
| | - Yasufumi Masaki
- Department of Hematology and ImmunologyKanazawa Medical University Uchinada Japan
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Kurose N, Guo X, Shioya A, Mizutani KI, Kumagai M, Fujimoto S, Kawabata H, Masaki Y, Takai K, Aoki S, Nakamura S, Yamada S. The potential role of follicular helper T cells in idiopathic multicentric Castleman disease with and without TAFRO syndrome. Pathol Res Pract 2019; 215:152563. [PMID: 31358479 DOI: 10.1016/j.prp.2019.152563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/22/2019] [Accepted: 07/24/2019] [Indexed: 01/09/2023]
Abstract
Idiopathic multicentric Castleman disease (iMCD) is a systemic inflammatory disease of unknown etiology caused by hypercytokinemia. Recently, TAFRO (thrombocytopenia, anasarca, fever, renal failure or reticulin fibrosis, and organomegaly) syndrome has been reported, which shows similar histopathological findings to iMCD and factors associated with a poor prognosis. iMCD shows no plasma cell infiltration in the germinal center (GC), but CD38-positive (CD38+)-plasma cells are observed in the interfollicular area. Our previous report revealed that atrophic change of GC, glomeruloid vascular proliferation, and abnormal proliferation of follicular dendritic cells are more prominent in iMCD with TAFRO (TAFRO+) in comparison to iMCD without TAFRO (TAFRO-). In addition, the numbers of CD38+ and immunoglobulin G4-positive (IgG4+) plasma cells were decreased in the interfollicular area. The roles of T follicular helper cells (Tfh) are well-known to assist B-cell proliferation, maturation, and differentiation.It maintains the formation of GC and is also related in the class switching of IgG isotypes, including IgG4. Thus, we immunohistochemically examined the number of Tfh in GCs in both TAFRO- and TAFRO+ iMCD. The number of Tfh was significantly decreased in TAFRO- iMCD (n = 9) and was further decreased in TAFRO+ iMCD (n = 18) in comparison to non-specific lymphadenopathy (n = 6) and IgG4-related disease (n = 4). These results suggest that decreased Tfh may be one etiology of iMCD.
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Affiliation(s)
- Nozomu Kurose
- Department of Pathology and Laboratory Medicine, Ishikawa, Japan.
| | - Xin Guo
- Department of Pathology and Laboratory Medicine, Ishikawa, Japan
| | - Akihiro Shioya
- Department of Pathology and Laboratory Medicine, Ishikawa, Japan
| | | | - Motona Kumagai
- Department of Pathology and Laboratory Medicine, Ishikawa, Japan
| | - Shino Fujimoto
- Department of Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan
| | - Hiroshi Kawabata
- Department of Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan
| | - Yasufumi Masaki
- Department of Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan
| | - Kazue Takai
- Division of Hematology, Niigata City General Hospital, Niigata, Japan
| | - Sadao Aoki
- Department of Pathophysiology, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences, Niigata, Japan
| | - Shigeo Nakamura
- Department of Pathology and Biological Response, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Sohsuke Yamada
- Department of Pathology and Laboratory Medicine, Ishikawa, Japan
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11
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Kurose N, Mizutani KI, Kumagai M, Shioya A, Guo X, Nakada S, Fujimoto S, Kawabata H, Masaki Y, Takai K, Aoki S, Kojima M, Nakamura S, Kida M, Yamada S. An extranodal histopathological analysis of idiopathic multicentric Castleman disease with and without TAFRO syndrome. Pathol Res Pract 2018; 215:410-413. [PMID: 30642741 DOI: 10.1016/j.prp.2018.12.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/30/2018] [Accepted: 12/24/2018] [Indexed: 12/31/2022]
Abstract
Thrombocytopenia, anasarca, fever, renal failure or reticulin fibrosis, and organomegaly (TAFRO) syndrome, a poor prognostic clinical condition showing similar histopathological findings to idiopathic multicentric Castleman disease (iMCD), has been reported in Japan. In our previous report, a clinicopathological analysis was performed on 70 nodal cases of iMCD with/without TAFRO. iMCD is classified into three types based on histopathology: (i) plasmacytic (PC), (ii) mixed, and (iii) hypervascular (hyperV). In this report, extranodal histopathological changes of iMCD with/without TAFRO were analyzed. Regarding the kidney pathology, we observed the proliferation of mesangial cells with positive staining of interleukin-6 (IL-6), consistent with membranoproliferative glomerulonephritis, in two cases of iMCD with TAFRO. The number of megakaryocytes per high-powered fields was not significantly different between iMCD cases with and without TAFRO. In conclusion, extranodal lesions of iMCD with/without TAFRO showed various interesting histopathological findings. These lesions may therefore be related to the clinical condition of TAFRO. Obtaining further knowledge about TAFRO will require the observation of nodal as well as extranodal lesions.
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Affiliation(s)
- Nozomu Kurose
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Ishikawa, Japan.
| | - Ken-Ichi Mizutani
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Motona Kumagai
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Akihiro Shioya
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Xin Guo
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Satoko Nakada
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Shino Fujimoto
- Department of Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan
| | - Hiroshi Kawabata
- Department of Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan
| | - Yasufumi Masaki
- Department of Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan
| | - Kazue Takai
- Division of Hematology, Niigata City General Hospital, Niigata, Japan
| | - Sadao Aoki
- Department of Pathophysiology, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences, Niigata, Japan
| | - Masaru Kojima
- Department of Anatomic and Diagnostic Pathology, Dokkyo University School of Medicine, Tochigi, Japan
| | - Shigeo Nakamura
- Department of Pathology and Biological Response, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Masatoshi Kida
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, USA
| | - Sohsuke Yamada
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Ishikawa, Japan
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