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Ulas ST, Dasdelen S. [Multicentric Castleman's disease combined with polyserositis and POEMS syndrome: case report and review article]. Internist (Berl) 2021; 62:777-785. [PMID: 34137908 DOI: 10.1007/s00108-021-01063-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
Castleman disease (CD) is a very rare disorder characterised by hyperplasia of the lymphoid tissue. The aetiology varies considerably and includes autoimmunological, infectious, autoinflammatory and paraneoplastic diseases (e.g. MGUS with POEMS syndrome). What they all have in common is usually a dysregulation/overproduction of certain cytokines and growth factors (including interleukin 6 and VEGF). The sum of these changes sometimes causes very heterogeneous symptoms and thus often makes early diagnosis difficult. The prognosis of unrecognised and untreated disease is very serious and has an average 5‑year survival rate of 55-77%. The present paper describes the case of a 79-year-old patient with refractory polyserositis who was correctly diagnosed after > 8 years.
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Affiliation(s)
- Sevtap Tugce Ulas
- Klinik für Radiologie, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Süha Dasdelen
- Klinik für Nephrologie, Vivantes Humboldt-Klinikum, Am Nordgraben 2, 13509, Berlin, Deutschland. .,Private Universitätsklinik Witten/Herdecke, Witten/Herdecke, Deutschland.
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Castleman disease: A single-center case series. Int J Surg Case Rep 2021; 80:105650. [PMID: 33631648 PMCID: PMC7907481 DOI: 10.1016/j.ijscr.2021.105650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 01/11/2023] Open
Abstract
Castleman disease is an overgrowth of lymphatic cells, usually in the chest or abdomen. Multicentric Castleman disease affects lymphatic cells throughout the body. HHV-8 and HIV have been associated with multicentric Castleman disease. Unicentric Castleman disease affects a single group of lymph nodes. Centricity is considered the most important indicator of patient outcomes.
Background Castleman disease (CD) is a rare lymphocytic disorder. Unicentric CD (UCD) has an excellent long-term prognosis after surgical excision; however, multicentric CD (MCD) has a severe clinical course with poor outcomes. Study design We analyzed the clinical presentation of 28 patients treated at a single institution from 1995 to 2017. Demographics, clinical variables, anatomical site, centricity, histopathology, immunochemistry, and surgical approach were reviewed. We evaluated the 5-year recurrence and survival for patients with UCD and MCD. Results Of the 28 patients, 57 % (n = 16) were female, with a mean age of 41.6 ± 15.6 years. CD was asymptomatic in 57 % (n = 16) of patients, 21 % (n = 6) presented with local symptoms such as pain, and 21 % (n = 6) of patients also had systemic symptoms, including weight loss and fever. CD was unicentric in 64 % (n = 18) and multicentric in 36 % (n = 10). The hyaline vascular variant was noted in 57 % (n = 16) of the tumors, plasmacytoid variant in 36 % (n = 10), and mixed variants in 7% (n = 2) of tumors. Anatomical distributions included: head and neck (20 %), thorax and axilla (24 %), retroperitoneal (13 %), abdominopelvic (30 %) regions, and other (13 %). Complete surgical resection was performed in 95 % of patients with UCD. Surgical biopsy and medical therapy were provided to all patients with MCD. The recurrence rate for UCD and MCD was 6 % (n = 1) and 14 % (n = 1), respectively. The five-year disease-free survival rate for UCD was 95 % (n = 19) and MCD was 33 % (n = 2). We found 100 % survival in patients with UCD and histology demonstrating the HV variant. Conclusion CD is rare and often misdiagnosed due to the absence of specific clinical symptoms. Surgeons should include CD in their differential diagnoses when evaluating patients with lymph node hyperplasia. Surgery can be curative in nearly all patients with UCD. Patients with MCD require a combination of surgical therapy, chemotherapy, and immunotherapy; however, cytoreductive surgery benefits for patients with MCD have not been established.
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Abstract
OBJECTIVE. The purpose of this article is to review important imaging and clinical features to help elucidate causes of lymphadenopathy in patients with HIV infection. CONCLUSION. HIV lymphadenopathy has various causes generally categorized as inflammatory or reactive, such as immune reconstitution syndrome; infectious, such as tuberculous and nontuberculous mycobacterial infections and HIV infection itself; and neoplastic, such as lymphoma, Kaposi sarcoma, and Castleman disease. It is important to consider patients' demographic characteristics, clinical presentations, CD4 lymphocyte counts, and radiologic features to identify likely causes of lymphadenopathy.
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Haap M, Wiefels J, Horger M, Hoyer A, Müssig K. Clinical, laboratory and imaging findings in Castleman's disease - The subtype decides. Blood Rev 2018; 32:225-234. [PMID: 29223447 DOI: 10.1016/j.blre.2017.11.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 11/21/2017] [Accepted: 11/28/2017] [Indexed: 01/09/2023]
Abstract
Castleman's disease (CD) is a rare lymphoproliferative disorder with its distinct unicentric (uCD) and multicentric (mCD) entities. The present work aimed at characterizing CD in more detail. From the 775 articles found by a PubMed search, 1133 cases were extracted. Two own cases were included. UCD was identified in 719 (42% males) and mCD in 416 (63% males) cases. Age in uCD was 34±17 and in mCD 48±18years. The hyaline-vascular type predominated in uCD and the plasma cell type in mCD. Clinical symptoms were more common in mCD. The head and neck region was most frequently affected in uCD and the axillary region in mCD. Prevalence of human immunodeficiency virus (HIV) and human herpesvirus-8 (HHV-8) positivity was higher in mCD. In CT scans, high contrast enhancement and calcifications were more frequent in uCD (all p<0.0001). The two forms of CD not only differ markedly in their clinical, laboratory and imaging findings, but also in treatment response and prognosis.
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Affiliation(s)
- Michael Haap
- Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Tübingen, Germany; Department of Internal Medicine, Endocrinology und Diabetology, Angiology, Nephrology and Clinical Chemistry, University of Tübingen, Tübingen, Germany
| | - Julia Wiefels
- Department of Internal Medicine, Endocrinology und Diabetology, Angiology, Nephrology and Clinical Chemistry, University of Tübingen, Tübingen, Germany
| | - Marius Horger
- Department of Radiology, University of Tübingen, Tübingen, Germany
| | - Annika Hoyer
- Institute for Biometry and Epidemiology, German Diabetes Center, Leibniz Center of Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD), München, Neuherberg, Germany
| | - Karsten Müssig
- German Center for Diabetes Research (DZD), München, Neuherberg, Germany; Divison of Endocrinology und Diabetology, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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Kligerman SJ, Auerbach A, Franks TJ, Galvin JR. Castleman Disease of the Thorax: Clinical, Radiologic, and Pathologic Correlation: From the Radiologic Pathology Archives. Radiographics 2017; 36:1309-32. [PMID: 27618318 DOI: 10.1148/rg.2016160076] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Castleman disease is a complex lymphoproliferative disease pathologically divided into two subtypes, the hyaline vascular variant (HVV) and the plasma cell variant (PCV). The HVV is the most common, is thought to represent a benign neoplasm of lymph node stromal cells, and is treated with surgical resection. It is most commonly found in the mediastinum, where it classically appears as a unicentric, avidly enhancing mass at computed tomography (CT) and magnetic resonance imaging. This appearance can mimic other avidly enhancing mediastinal masses, and location, clinical history, laboratory data, and nuclear medicine single photon emission CT (SPECT) and positron emission tomography (PET) studies can help narrow the differential diagnosis. Multicentric Castleman disease (MCD), which in the majority of cases is composed of the PCV, is an aggressive lymphoproliferative disorder associated with human herpesvirus infection, interleukin 6 dysregulation, and other systemic disorders. While it can be difficult to differentiate MCD from lymphoma, the presence of avidly enhancing lymph nodes can suggest the diagnosis. The purpose of this article is to review the clinical, immunologic, and pathologic findings associated with both unicentric Castleman disease and MCD and discuss how the imaging findings correlate with the pathophysiology of the disease.
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Affiliation(s)
- Seth J Kligerman
- From the Department of Diagnostic Radiology and Nuclear Medicine, Division of Chest Imaging (S.J.K., J.R.G.), and Department of Internal Medicine, Division of Pulmonary/Critical Care (J.R.G.), University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; Department of Hematopathology (A.A.) and Department of Pulmonary and Mediastinal Pathology (T.J.F.), the Joint Pathology Center, Department of Defense, Defense Health Agency, Silver Spring, Md; and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
| | - Aaron Auerbach
- From the Department of Diagnostic Radiology and Nuclear Medicine, Division of Chest Imaging (S.J.K., J.R.G.), and Department of Internal Medicine, Division of Pulmonary/Critical Care (J.R.G.), University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; Department of Hematopathology (A.A.) and Department of Pulmonary and Mediastinal Pathology (T.J.F.), the Joint Pathology Center, Department of Defense, Defense Health Agency, Silver Spring, Md; and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
| | - Teri J Franks
- From the Department of Diagnostic Radiology and Nuclear Medicine, Division of Chest Imaging (S.J.K., J.R.G.), and Department of Internal Medicine, Division of Pulmonary/Critical Care (J.R.G.), University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; Department of Hematopathology (A.A.) and Department of Pulmonary and Mediastinal Pathology (T.J.F.), the Joint Pathology Center, Department of Defense, Defense Health Agency, Silver Spring, Md; and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
| | - Jeffrey R Galvin
- From the Department of Diagnostic Radiology and Nuclear Medicine, Division of Chest Imaging (S.J.K., J.R.G.), and Department of Internal Medicine, Division of Pulmonary/Critical Care (J.R.G.), University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201; Department of Hematopathology (A.A.) and Department of Pulmonary and Mediastinal Pathology (T.J.F.), the Joint Pathology Center, Department of Defense, Defense Health Agency, Silver Spring, Md; and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (J.R.G.)
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Huang H, Feng R, Li J, Song X, Li S, Xu K, Cao J, Zhang L, Bi Y, Xu Z. Castleman disease-associated diffuse parenchymal lung disease: A STROBE-compliant retrospective observational analysis of 22 cases in a tertiary Chinese hospital. Medicine (Baltimore) 2017; 96:e8173. [PMID: 28953671 PMCID: PMC5626314 DOI: 10.1097/md.0000000000008173] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Intrathoracic involvement is common in Castleman disease (CD), but CD-associated diffuse parenchymal lung disease (DPLD) is rare and not well-reported.We conducted a retrospective analysis of 262 CD patients with a definite pathological diagnosis who were hospitalized between 1999 and 2015.Twenty-two CD patients had DPLD based on chest computed tomography (CT) scans. Among them, 9 were male and 13 were female, with a mean age of 45.3 years. Coughing (72.7%), fever (68.2%), and dyspnea (59.1%) were the common clinical manifestations. In high-resolution CT, obvious lymphadenopathy (81.8%) was the most frequent, followed by multiple nodules of different sizes (72.7%), cysts (59.1%), and patches of ground-glass opacity (54.5%). Six patients had lymphocytic interstitial pneumonia (LIP)-like CT images. Superficial lymph node biopsies (63.6%), video-assisted thoracic surgery lung biopsies (27.3%), CT-guided percutaneous lung biopsies (9.1%), and endoscopic lymph node biopsies (9.1%) were performed to make final diagnoses. The hyaline vascular variant (27.3%), the plasma cell variant (63.6%), and the mixed variant (9.1%) were the pathological subtypes. All but 2 were prescribed chemotherapy, and none was administered anti-interleukin-6 therapy. Among them, 14 patients improved, 3 died, 2 were stable, 2 were refractory, and 1 was lost to follow-up.Chinese CD-associated DPLD might be more prevalent in middle-aged female patients, with most cases being the plasma cell variant. Although a LIP-like pattern was reported, only one-quarter of the patients showed LIP-like CT images. Multiple nodules (especially solid nodules), cysts, and patchy areas were the common pulmonary radiological findings. More than half of the patients improved after chemotherapy. A well-designed prospective study should be performed to confirm these results.
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Affiliation(s)
| | | | | | | | - Shan Li
- Department of Respiratory Medicine
| | - Kai Xu
- Radiological Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jian Cao
- Radiological Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Nin CS, de Souza VVS, do Amaral RH, Schuhmacher Neto R, Alves GRT, Marchiori E, Irion KL, Balbinot F, Meirelles GDSP, Santana P, Gomes ACP, Hochhegger B. Thoracic lymphadenopathy in benign diseases: A state of the art review. Respir Med 2016; 112:10-7. [PMID: 26860219 DOI: 10.1016/j.rmed.2016.01.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 11/14/2015] [Accepted: 01/28/2016] [Indexed: 12/27/2022]
Abstract
Lymphadenopathy is a common radiological finding in many thoracic diseases and may be caused by a variety of infectious, inflammatory, and neoplastic conditions. This review aims to describe the patterns of mediastinal and hilar lymphadenopathy found in benign diseases in immunocompetent patients. Computed tomography is the method of choice for the evaluation of lymphadenopathy, as it is able to demonstrate increased size of individual nodes, abnormalities of the interface between the mediastinum and lung, invasion of surrounding fat, coalescence of adjacent nodes, obliteration of the mediastinal fat, and hypo- and hyperdensity in lymph nodes. Intravenous contrast enhancement may be needed to help distinguish nodes from vessels. The most frequent infections resulting in this finding are tuberculosis and fungal disease (particularly histoplasmosis and coccidioidomycosis). Sarcoidosis is a relatively frequent cause of lymphadenopathy in young adults, and can be distinguished from other diseases - especially when enlarged lymph nodes are found to be multiple and symmetrical. Other conditions discussed in this review are silicosis, drug reactions, amyloidosis, heart failure, Castleman's disease, viral infections, and chronic obstructive pulmonary disease.
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Affiliation(s)
- Carlos Schüler Nin
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.
| | | | | | | | | | - Edson Marchiori
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | | | - Fernanda Balbinot
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.
| | | | - Pablo Santana
- Hospital São Joaquim Beneficência Portuguesa, São Paulo-SP, Brazil
| | | | - Bruno Hochhegger
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.
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Chou SHS, Prabhu SJ, Crothers K, Stern EJ, Godwin JD, Pipavath SN. Thoracic diseases associated with HIV infection in the era of antiretroviral therapy: clinical and imaging findings. Radiographics 2015; 34:895-911. [PMID: 25019430 DOI: 10.1148/rg.344130115] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) pandemic has entered its 4th decade. Since the introduction of combination antiretroviral therapy (ART) in 1996, the number of AIDS-related deaths has plateaued worldwide. Today, owing to the effectiveness of ART, the HIV-infected population is aging and HIV infection has become a chronic illness. Non-AIDS comorbidities are increasing, and the spectrum of HIV-related thoracic diseases is evolving. In developed countries, bacterial pneumonia has become more common than Pneumocystis pneumonia. Its imaging appearance depends on the responsible organism, most commonly Streptococcus pneumoniae. Mycobacterium tuberculosis continues to be a major threat. Its imaging patterns vary depending on CD4 count. Primary lung cancer and Hodgkin lymphoma are two important non-AIDS-defining malignancies that are increasingly encountered at chest imaging. Human herpesvirus 8, also known as Kaposi sarcoma-associated herpesvirus (KSHV), is strongly linked to HIV-related diseases, including Kaposi sarcoma, multicentric Castleman disease, KSHV inflammatory cytokine syndrome, and primary effusion lymphoma. Immune reconstitution inflammatory syndrome is a direct complication of ART whose manifestations vary with the underlying disease. Given the high rate of smoking among HIV-infected patients, chronic obstructive pulmonary disease is another important cause of morbidity and mortality. A high degree of suspicion is required for the early diagnosis of pulmonary arterial hypertension and lymphocytic interstitial pneumonia, given their nonspecific manifestations. Finally, multilocular thymic cyst manifests as a cystic anterior mediastinal mass. Recognition of the clinical and radiologic manifestations of these less traditional HIV-related diseases can expedite diagnosis and treatment in the ART era.
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Affiliation(s)
- Shinn-Huey S Chou
- From the Department of Radiology (S.H.S.C., S.J.P., E.J.S., J.D.G., S.N.P.) and Division of Pulmonary and Critical Care Medicine (K.C.), University of Washington, 1959 NE Pacific St, UW Mailbox 357115, Seattle, WA 98195-7115
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Law A, Shmukler A, Burns J, Haramati LB. Viruses, Immunity and Unusual Lymphoproliferative Disorders of the Chest: Integrating Imaging With Pathogenesis and Clinical Presentations. J Comput Assist Tomogr 2015; 40:71-9. [PMID: 26484956 DOI: 10.1097/rct.0000000000000333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Unusual lymphoproliferative diseases result from the stimulation of intrathoracic lymphoid tissue by viruses and immune dysfunction, ranging from benign hyperplasia to malignant transformation. We review the clinical, radiological, and histopathological findings of unusual lymphoproliferative disorders, which have been linked to viruses or immune dysfunction, focusing on thoracic manifestations. Understanding these advances in science enhances the radiologist's skills in integrating the imaging findings to the clinical scenario to suggest the correct diagnosis.
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Affiliation(s)
- Amy Law
- From the *Department of Radiology, and †Departments of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
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Luo JM, Li S, Huang H, Cao J, Xu K, Bi YL, Feng RE, Huang C, Qin YZ, Xu ZJ, Xiao Y. Clinical spectrum of intrathoracic Castleman disease: a retrospective analysis of 48 cases in a single Chinese hospital. BMC Pulm Med 2015; 15:34. [PMID: 25886851 PMCID: PMC4404013 DOI: 10.1186/s12890-015-0019-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 03/06/2015] [Indexed: 12/11/2022] Open
Abstract
Background Thorax is the common place to develop Castleman disease (CD), but there is no systemic clinical analysis for intrathoracic CD. Methods We conducted a retrospective analysis of 48 intrathoracic CD patients with definite pathological diagnosis who were hospitalized between 1992 and 2012 in a Chinese tertiary referral hospital. Results The study included 16 cases with unicentric CD (UCD) and 32 cases with multicentric CD (MCD). UCD were younger than MCD (30.5y vs 41.6ys, P < 0.05). MCD were more symptomatic (50% vs 96.9%, P < 0.001) and sicker than UCD, including more fever, hepatomegaly and/or splenomegaly and hypoalbuminemia. All of UCD showed solitary mass in various sites and two of them were complicated by small pleural effusion. In the MCD group, their chest CT showed obvious lymphadenopathy in the hilum and/or mediastinum (100%), diffuse parenchymal lung shadows (43.75%), pleural effusion (40.6%), mass in the mediastinum (6.25%) or hilum (3.12%) and bronchiolitis obliterans (BO) (3.12%). Besides LIP-like images, multiple nodules of different size and sites, patchy, ground-glass opacities and consolidation were showed in their chest CT. Surgery were arranged for all UCD for diagnosis and treatment and all were alive. In MCD group, superficial lymph nodes biopsies (21 cases), surgery biopsy (9 cases) and CT-guided percutaneous lung biopsy (2 cases) were performed. Hyaline vascular (HV) variant were more common in the UCD group (75% vs 37.5%, P < 0.05). In MCD group, 28 cases were prescribed with chemotherapy, one refused to receive therapy and the rest three were arranged for regular follow-up. Among MCD, 18 cases was improved, 7 cases was stable, 4 cases lost follow-up and 3 cases died. Conclusions Intrathoracic MCD was more common than UCD in our hospital. MCD was older, more symptomic and sicker than UCD. HV variant were more common in UCD. All of UCD showed mass in various intrathoracic locations and surgery resection was performed for all and all were alive. Mass, pleural effusion, BO and diffuse pulmonary shadows, including LIP-like images, multiple nodules of different size and sites, patchy, GGO and consolidations were showed in our MCD. Most of MCD cases were arranged with chemotherapy and their prognosis were worse than UCD’s.
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Affiliation(s)
- Jin Mei Luo
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China.
| | - Shan Li
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China.
| | - Hui Huang
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China.
| | - Jian Cao
- Radiological Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China.
| | - Kai Xu
- Radiological Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China.
| | - Ya Lan Bi
- Pathological Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China.
| | - Rui E Feng
- Pathological Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China.
| | - Cheng Huang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China.
| | - Ying Zhi Qin
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China.
| | - Zuo Jun Xu
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China.
| | - Yi Xiao
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, #1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China.
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Abstract
AIM The objective of this study was to evaluate the clinicoradiological findings of thoracic Castleman disease. METHODS The study included 34 patients (22 male and 12 female patients; mean age, 32 [SD, 18.1] years) with thoracic Castleman disease. Clinicoradiological findings of the 34 patients were analyzed. Regarding computed tomography findings, lesion number, location, degree of enhancement (moderate, >20 Hounsfield units than back muscle enhancement; high, >40 Hounsfield units), and associated findings were recorded. RESULTS Of 34 patients, hyaline-vascular type (HVT) was found in 27 patients (79%), plasma cell type (PCT) in 5 patients (15%), and mixed type (6%) in 2 patients. In HVTs (n = 27), lesions were found, in decreasing order, in the lower neck (n = 9, 33%), pulmonary hilum (n = 6, 22%), and the upper paratracheal area (n = 4, 15%). Ten (37%) of 27 HVT patients had symptoms, whereas all (100%) with PCT had generalized symptoms. In 26 (96%) of 27 HVT patients, disease was unicentric, whereas it was multicentric in all PCT patients. Moderate to high degree of lesion enhancement was seen in 22 (92%) of 24 HVT patients and 4 (80%) of 5 PCT patients. Feeding vessels or draining veins were identified in 12 (44%) of 27 HVT patients and 2 (40%) of 5 PCT patients. The diseases were cured with surgical removal in HVT, whereas they showed variable prognosis in PCT. CONCLUSIONS Irrespective of subtypes, Castleman disease is characterized radiologically by unicentric or multicentric enhancing lymph node enlargement; in HVT, they show good prognosis after surgical treatment, but in PCT, they show variable prognosis.
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What a differential a virus makes: a practical approach to thoracic imaging findings in the context of HIV infection--part 2, extrapulmonary findings, chronic lung disease, and immune reconstitution syndrome. AJR Am J Roentgenol 2012; 198:1305-12. [PMID: 22623542 DOI: 10.2214/ajr.11.8004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The Centers for Disease Control and Prevention reported more than one million people with HIV infection in the United States in 2006, an increase of 11% over 3 years. Worldwide, nearly 34 million people are infected with HIV. Pulmonary disease accounts for 30-40% of acute hospitalizations of HIV-seropositive patients, underscoring the importance of understanding the range of cardiothoracic imaging findings associated with HIV infection. This article will cover extrapulmonary thoracic diseases, chronic lung diseases, and immune reconstitution inflammatory syndrome in HIV-infected patients. Our approach is focused on the radiologist's perspective by recognizing and categorizing key imaging findings to generate a differential diagnosis. The differential diagnosis can be further refined by incorporating clinical data, such as patient demographics, CD4 count, and presenting symptoms. In addition, with prolonged survival of HIV-infected patients in the era of highly active antiretroviral therapy, radiologists can also benefit from awareness of imaging features of a myriad of chronic cardiopulmonary diseases in this patient population. Finally, the change of imaging findings and clinical status in response to treatment provides important diagnostic information, such as in immune reconstitution syndrome. CONCLUSION Developing a practical approach to key cardiothoracic imaging findings in HIV-infected patients will aid the radiologist in generating a clinically relevant differential diagnosis and interpretation, thereby improving patient care.
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Borie R, Cadranel J, Galicier L, Couderc LJ. [Pulmonary involvement due to HHV-8 virus during the course of HIV infection]. Rev Mal Respir 2012; 29:1209-23. [PMID: 23228679 DOI: 10.1016/j.rmr.2012.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 02/08/2012] [Indexed: 12/01/2022]
Abstract
HHV-8 is a herpes virus discovered in 1994 in Kaposi sarcoma cells. Its involvement was later demonstrated in multicentric Castleman disease and in primary lymphoma effusion lymphoma. These diseases arise almost exclusively in immunocompromised patients, mostly in association with HIV infection. Apart from Kaposi's sarcoma, combined antiretroviral therapy does not seem to have reduced the incidence of these diseases, which remain rare. In these three diseases, pulmonary involvement is common and may be the presenting feature. Kaposi's sarcoma of the lung is usually asymptomatic but may require specific therapy. Pulmonary involvement is mostly associated with cutaneous disease. Patients with Castleman disease typically present with fever and lymphadenopathy, associated with interstitial lung disease without opportunistic infection. Patients with primary lymphoma effusion presents with fever and an exudative lymphocytic pleural effusion, without a pleural mass on the CT-scan. Rapid diagnosis of these conditions avoids unnecessary invasive examinations and leads to prompt specific treatment.
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Affiliation(s)
- R Borie
- Service de Pneumologie A, Centre de Compétence Maladies Rares Pulmonaires, Hôpital Bichat, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75877 Paris Cedex 18, France.
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Abstract
OBJECTIVES We undertook a systematic review of 404 published cases of Castleman's disease to identify the role of the surgeon beyond assistance in tissue-based diagnosis. BACKGROUND Castleman's disease is a rare primary disease of the lymph node caused by infection with herpesviridae. Little is known about the role of surgery in this condition. DATA SOURCES Medline, Embase, Cochrane Database of Systematic Reviews, ISI Thompson Web of Knowledge, and hand search of articles' bibliography. STUDY SELECTION Of the 1791 citations identified through the initial electronic search and screened for possible inclusion, 488 articles were retained after title and abstract reviews. Of these, 239 were accepted for this review. DATA EXTRACTION A complete dataset containing age, gender, centricity (unicentric vs multicentric), histopathologic type (hyaline vascular [HV] vs plasma cell [PC]), anatomical location of the only focus in unicentric Castleman's disease (UCD) or the dominant focus in multicentric Castleman's disease (MCD), nature of the surgical approach (resective vs diagnostic), and outcome (disease-free survival [DFS] vs death due to disease) was extracted. RESULTS A resective or debulking surgical approach was described in 77.0% of all patients, but was far more common in unicentric (262/278; 94.2%) than multicentric (49/126; 38.9%) disease (χ² 146.8; P < 0.0001). Unicentric disease had a significantly higher overall survival (95.3% vs 61.1%; χ² 55.7; P < 0.0001), 3 year DFS (89.7% vs 55.6%; χ² 27.8; P < 0.0001), and 5 year DFS (81.2% vs 34.4%; χ² 28.6; P < 0.0001) than multicentric disease. Failure to treat unicentric disease by resective surgery resulted in a significant mortality (17.6% vs 3.8% χ²; P < 0.05). In multicentric disease, outcomes are comparable between debulking surgery alone, immunochemotherapy alone, or a combination of both (28.0% vs 28.9% vs 50.0%; P = nonsignificant). CONCLUSIONS Surgery is the gold standard for treatment of unicentric Castelman's disease. The role of debulking surgery in human immunodeficiency virus (-) MCD needs to be evaluated in prospective studies.
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What a Differential a Virus Makes: A Practical Approach to Thoracic Imaging Findings in the Context of HIV Infection??? Part 1, Pulmonary Findings. AJR Am J Roentgenol 2012; 198:1295-304. [DOI: 10.2214/ajr.11.8003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Abstract
Castleman's disease is a primary infectious disease of the lymph node that causes local symptoms or a systemic inflammatory syndrome. Histopathology reveals a destroyed lymph node architecture that can range from hyaline-vascular disease to plasma-cell disease. Viral interleukin 6 (vIL-6) produced during the replication of human herpesvirus type 8 (HHV8) is the key driver of systemic inflammation and cellular proliferation. Stage progression of Castleman's disease results from switches between viral latency and lytic replication, and lymphatic and hematogenous spread. Multicentric plasma-cell disease in HIV-1 patients is associated with HHV8 infection. Polyclonal plasmablast proliferation escapes control in the germinal center with eventual malignant transformation into non-Hodgkin lymphoma. Surgery produces excellent results in unicentric disease, while multicentric disease responds to anti-CD20 therapy or IL-6 and chemotherapy. Lymphovascular endothelium and naive B cells are infectious reservoir-opening options for antiangiogenic and anti-CD19 strategies to enhance outcomes in patients with systemic disease.
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Sun X, Han B. Multicentric Castleman's disease presenting with multiple nodes in lungs: a case report and literature review. Int J Hematol 2008; 88:278-282. [PMID: 18815726 DOI: 10.1007/s12185-008-0146-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 06/06/2008] [Accepted: 06/20/2008] [Indexed: 12/01/2022]
Abstract
We report a rare multicentric Castleman's disease case whose lung manifestation is severe than any known report. This is a 64-year-old woman, she had repeated cough, fever and breathlessness for more than 1 year. CT imaging showed multiple small nodules in both the lungs at the first onset. Large nodes and masses in both the lungs evolved 1 year later. After three times of lung biopsies (one video-assisted thoracoscopic surgery and two CT-guided percutaneous transthoracic), she was finally diagnosed as multicentric Castleman's disease. She got surprising relief after combination chemotherapy in spite of her severe lung changes.
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Affiliation(s)
- Xuefeng Sun
- Department of Hematology, Peking Union Medical College Hospital, 1 ShuaiFuYuan, WangFuJing, Beijing, China
| | - Bing Han
- Department of Hematology, Peking Union Medical College Hospital, 1 ShuaiFuYuan, WangFuJing, Beijing, China.
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