Interleukin-6-producing thymic squamous cell carcinoma associated with Castleman's disease and nephrotic syndrome

From the archives of MD Anderson Cancer Center Castleman disease involving the thymus gland: Case report and literature review

Castleman disease is a nodal based disease and very rarely involves the thymus gland. We report a 52-year-old man who was found incidentally to have a single thymic mass by computerized tomography scan. Thymectomy was performed, and the gross specimen showed a well-circumscribed, multi-loculated cystic mass. Histologic examination showed thymus involved by Castleman disease, hyaline-vascular variant. The lesion was characterized by lymphoid follicles with wide mantle zones, variably lymphocyte-depleted germinal centers with sclerotic radial blood vessels, and prominent interfollicular/stromal changes including numerous endothelial venules with sclerotic walls and hyaline sclerosis, scattered and frequent dysplastic follicular dendritic cells and foci of dystrophic calcification. Immunohistochemical analysis showed that the follicle mantle zones were composed of numerous B-cells positive for CD20, PAX5, and IgD. Antibodies specific for CD21 and CD23 highlighted prominent follicular dendritic cell networks within follicles. There was no evidence of human herpes virus 8. We searched the literature and could identify only 10 additional cases of thymic CD. Previously reported cases included 8 unicentric and 2 multicentric, classified pathologically as plasma cell variant (n = 4), hyaline vascular variant (n = 3), and mixed (n = 3). Thymectomy, as was done in the currently reported case, most often leads to the diagnosis of Castleman disease and was a mainstay of treatment in other reported cases.

Interleukin-6-producing Intravascular Large B-cell Lymphoma with Lymphadenopathy Mimicking the Histology of Multicentric Castleman Disease

An inguinal lymph node biopsy of a woman with a one-month history of a progressive fever, fatigue, dyspnea, skin rash, and lymphadenopathy revealed a well-preserved basic structure, hyperplastic germinal centers, and an interfollicular region containing polyclonal plasma cell sheets, suggesting plasma cell-type multicentric Castleman disease (MCD). We initiated prednisolone and anti-interleukin (IL)-6 antibody (tocilizumab), without success. A biopsy specimen re-evaluation detected CD20-positive atypical large B cells infiltrating the small vessels within and around the lymph node and its capsule. We diagnosed her with intravascular large B-cell lymphoma (IVLBCL). Lymphoma cells were weakly positive for IL-6 by immunohistochemical staining. IL-6 from lymphoma cells may have caused the MCD-like presentation as a paraneoplastic etiology. Malignant lymphoma should be excluded before diagnosing MCD.

Synchronous retroperitoneal Castleman's disease with clear cell renal cell carcinoma

Castleman's disease is a rare non-clonal lymphoproliferative disorder and known to be associated with a number of disorders such as polyneuropathy, organomegaly, endocrinopathy, monoclonal protein and skin changes syndrome, Kaposi sarcoma, paraneoplastic pemphigus and plasma cell dyscrasias. The association of Castleman's disease with epithelial malignancy is not clear and limited to few case reports. We describe a case of synchronous Castleman's disease with renal cell carcinoma in a 53-year-old woman. She presented with right abdominal lump with feeling of heaviness. She also presented with vague discomfort in left hypochondrium for 15 years. The CT imaging of abdomen revealed two masses-one in right kidney and another in left anterior pararenal space of retroperitoneum. The patient underwent right radical nephrectomy with excision of left retroperitoneal mass. Histological examination revealed clear cell renal cell carcinoma and Castleman's disease, respectively. Role of interleukin-6 has been postulated as an important factor in association of Castleman's disease and epithelial malignancy.

Cervical Castleman’s disease mimicking lymph node metastasis of esophageal carcinoma

Castleman’s disease (CD) is an uncommon benign lymphoproliferative disorder of unknown etiology. A rare case of cervical CD diagnosed at lymph node dissection for esophageal carcinoma is reported. An esophageal tumor was identified in a 67-year-old man during a follow-up examination after surgery for oral carcinoma. Esophagoscopy revealed a type 1 tumor in the cervical esophagus. Histology of esophagoscopic biopsies indicated squamous cell carcinoma. Contrast-enhanced computed tomography revealed swollen lymph nodes of the right cervical region. No distant metastasis was detected. Esophageal carcinoma, T2N2M0, Stage IIIA was diagnosed. Neoadjuvant chemotherapy was recommended, but the patient rejected the chemotherapy. The patient underwent laparoscopic-assisted transhiatal esophagectomy. The histopathological diagnosis was moderately differentiated squamous cell carcinoma with pT1bN0M0, Stage IA. On histology, the swollen lymph nodes of the right cervical region revealed CD. The patient’s postoperative course was relatively good.

Synchronous squamous cell carcinoma of tongue and unicentric cervical Castleman's disease clinically mimicking a stage IV disease: a rare association or coincidence?

Malignancy in a setting of hyaline vascular type of Castleman's disease (HVCD) is an exceptional occurrence. Herein, we report an extremely rare case of synchronous unicentric cervical HVCD and squamous cell carcinoma (SCC) of tongue mimicking stage IV disease. A 32-year-old gentleman presented with an ulcerated mass on the right tongue border and ipsilateral cervical nodal mass. As the clinical stage was IVB (T(1)N(3)M(0)), an anterior two-third glossectomy with bilateral modified neck dissection was performed. On gross examination, an ulcerated mass on the right lateral border was identified. In addition, an 8 cm large nodal mass at right level III-V was seen. Microscopy from the ulcerated growth in the tongue revealed an invasive well differentiated squamous cell carcinoma. However, the right cervical nodal mass yielded surprise histology of Castleman's disease, hyaline-vascular type. Final tumor pathological staging was revised to pT1N0M0 . This case reveals that HVCD can rarely be associated with an epithelial malignancy wherein it can clinically mimic nodal metastasis. Whether such a phenomenon occurs due to underlying immune aberrations or is a rare co-incidence remains unclear.

Thymic squamous cell carcinoma producing granulocyte colony-stimulating factor associated with a high serum level of interleukin 6

Granulocyte colony-stimulating factor (G-CSF)-producing thymic carcinoma is extremely rare. A-66-year-old man presented with an anterior mediastinal mass, and underwent surgical biopsy. He had marked leukocytosis, and his serum levels of G-CSF and interleukin-6 were elevated. Histologically, the tumor consisted of squamous cell carcinoma, which showed positive immunoreactivity for G-CSF. He was treated with thoracic radiotherapy, and chest imaging revealed a marked reduction of tumor size. He was doing well at 8 months after tumor diagnosis.

Interleukin-6-producing undifferentiated thymic carcinoma with neuroendocrine features

Undifferentiated thymic carcinoma is a rare tumor of the thymus. Due to the extreme rarity of undifferentiated thymic carcinoma, very limited information about its characteristics is available. We encountered an autopsy case of a 33-year-old woman diagnosed as having an undifferentiated thymic carcinoma with a high inflammatory response. The patient's serum interleukin-6 (IL-6) was elevated to 1930 pg/ml, and immunohistochemical staining of the carcinoma cells was positive for neuroendocrine markers and IL-6. To the best of our knowledge, this is the first report of an IL-6-producing undifferentiated thymic carcinoma with neuroendocrine features that shows a novel potential to produce IL-6.