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Zinzani PL, Paulli M, Arcaini L, Della Torre E, Ferrero S, Figuera A, Frigeri F, Martelli M, Sabattini E, Scarpa R, Barosi G. Unmet Clinical Needs in the Management of Idiopathic Multicentric Castleman Disease: A Consensus-based Position Paper From an ad hoc Expert Panel. Hemasphere 2023; 7:e891. [PMID: 37234822 PMCID: PMC10208718 DOI: 10.1097/hs9.0000000000000891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/11/2023] [Indexed: 05/28/2023] Open
Abstract
Castleman disease describes a group of heterogeneous clinicopathological disorders now included in the tumor-like lesions with B-cell predominance of the World Health Organization classification. Managing idiopathic multicentric Castleman disease (iMCD) is challenging, because few systematic studies or comparative randomized clinical trials have been conducted. International, consensus evidence-based guidelines for iMCD were published in 2018, but gaps in the therapeutic options for difficult-to-treat patients, who do not respond to siltuximab and other conventional therapies, still exist. This article presents the results of group discussion among an ad hoc constituted Panel of Italian experts to identify and address unmet clinical needs (UCNs) in managing iMCD. Recommendations on the appropriateness of clinical decisions and proposals for new research concerning the identified UCNs were issued through formalized multiple-step procedures after a comprehensive analysis of the scientific literature. The following key UCNs were addressed: strengthening the diagnostic certainty in iMCD patients before planning first-line therapy; management of siltuximab therapy; choice and management of immune-modulating, or chemotherapy agents in patients resistant/intolerant to siltuximab therapy. While most of the conclusions reached by the Panel are consistent with the existing guidelines, some alternative therapeutic options were stressed, and the discussion contributed to bringing forth the issues that need further investigation. Hopefully, this comprehensive overview will improve the practice of iMCD and inform the design and implementation of new studies in the field.
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Affiliation(s)
- Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli,” Bologna, Italy
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, Italy
| | - Marco Paulli
- Unit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luca Arcaini
- Department of Molecular Medicine, University of Pavia, Italy
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Emanuel Della Torre
- Università Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simone Ferrero
- Department of Molecular Biotechnologies and Health Sciences, Hematology Division, University of Torino, Italy
- Hematology Division, AOU “Città della Salute e della Scienza di Torino,” Torino, Italy
| | - Amalia Figuera
- Division of Hematology, AOU Policlinico “G. Rodolico-S. Marco,” Catania, Italy
| | - Ferdinando Frigeri
- UOC Ematologia a Indirizzo Oncologico, AORN “Sant’Anna e San Sebastiano,” Caserta, Italy
| | - Maurizio Martelli
- Hematology Unit, Department of Translational and Precision Medicine, “Sapienza” University, Rome, Italy
| | - Elena Sabattini
- Hemathopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policinico di S. Orsola, Bologna, Italy
| | - Riccardo Scarpa
- Department of Medicine-DIMED, University of Padova, Padua, Italy
- Internal Medicine I, Ca’ Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Giovanni Barosi
- Center for the Study of Myelofibrosis, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
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2
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Kinugawa Y, Uehara T, Iwaya M, Asaka S, Kobayashi S, Nakajima T, Komatsu M, Yasuo M, Yamamoto H, Ota H. IL-6 expression helps distinguish Castleman's disease from IgG4-related disease in the lung. BMC Pulm Med 2021; 21:219. [PMID: 34246246 PMCID: PMC8272341 DOI: 10.1186/s12890-021-01603-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/31/2021] [Indexed: 11/26/2022] Open
Abstract
Background It is difficult to distinguish between multicentric Castleman’s disease (MCD) and IgG4-related lung disease (IgG4-LD), an IgG4-related disease (IgG4-RD) in the lung. Methods We focused on IL-6, which is elevated in MCD, to distinguish between MCD and IgG4-LD by RNAscope, a highly sensitive RNA in situ method. Six cases of MCD and four cases of IgG4-LD were selected. Results In all cases of MCD and IgG4-LD, 10 or more IgG4-positive cells were found in one high-power field. All MCD cases were inconsistent with the pathological IgG4-related comprehensive diagnostic criteria, but 2 of 6 cases had an IgG4/IgG ratio greater than 40%. In all IgG4-LD cases, histological features were consistent with the pathological IgG4-RD comprehensive diagnostic criteria. IL-6 expression was observed in all MCD and IgG4-LD cases except for one IgG4-LD biopsy. IL-6-expressing cells were mainly identified in the stroma. Sites of IL-6 expression were not characteristic and were sparse. IL-6 expression tended to be higher in MCD compared with IgG4-LD. A positive correlation was found between the IL-6 H-score and serum IL-6 level. Conclusion Differences in IL-6 expression may help distinguish between MCD and IgG4-LD. In addition, the presence of high IL-6 levels may help elucidate the pathological mechanisms of IgG4-LD.
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Affiliation(s)
- Yasuhiro Kinugawa
- Department of Laboratory Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Takeshi Uehara
- Department of Laboratory Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
| | - Mai Iwaya
- Department of Laboratory Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Shiho Asaka
- Department of Laboratory Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Shota Kobayashi
- Department of Laboratory Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Tomoyuki Nakajima
- Department of Laboratory Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Masamichi Komatsu
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masanori Yasuo
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroshi Yamamoto
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiroyoshi Ota
- Department of Laboratory Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.,Department of Biomedical Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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3
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Koa B, Borja AJ, Aly M, Padmanabhan S, Tran J, Zhang V, Rojulpote C, Pierson SK, Tamakloe MA, Khor JS, Werner TJ, Fajgenbaum DC, Alavi A, Revheim ME. Emerging role of 18F-FDG PET/CT in Castleman disease: a review. Insights Imaging 2021; 12:35. [PMID: 33709329 PMCID: PMC7952491 DOI: 10.1186/s13244-021-00963-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/01/2020] [Accepted: 01/04/2021] [Indexed: 12/11/2022] Open
Abstract
Castleman disease (CD) describes a group of rare hematologic conditions involving lymphadenopathy with characteristic histopathology and a spectrum of clinical abnormalities. CD is divided into localized or unicentric CD (UCD) and multicentric CD (MCD) by imaging. MCD is further divided based on etiological driver into human herpesvirus-8-associated MCD, POEMS-associated MCD, and idiopathic MCD. There is notable heterogeneity across MCD, but increased level of pro-inflammatory cytokines, particularly interleukin-6, is an established disease driver in a portion of patients. FDG-PET/CT can help determine UCD versus MCD, evaluate for neoplastic conditions that can mimic MCD clinico-pathologically, and monitor therapy responses. CD requires more robust characterization, earlier diagnosis, and an accurate tool for both monitoring and treatment response evaluation; FDG-PET/CT is particularly suited for this. Moving forward, future prospective studies should further characterize the use of FDG-PET/CT in CD and specifically explore the utility of global disease assessment and dual time point imaging. Trial registration ClinicalTrials.gov, NCT02817997, Registered 29 June 2016, https://clinicaltrials.gov/ct2/show/NCT02817997
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Affiliation(s)
- Benjamin Koa
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.,Drexel University College of Medicine, Philadelphia, PA, USA
| | - Austin J Borja
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mahmoud Aly
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Sayuri Padmanabhan
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph Tran
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Vincent Zhang
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Sheila K Pierson
- Department of Medicine, Division of Translational Medicine and Human Genetics, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark-Avery Tamakloe
- Department of Medicine, Division of Translational Medicine and Human Genetics, University of Pennsylvania, Philadelphia, PA, USA
| | - Johnson S Khor
- Department of Medicine, Division of Translational Medicine and Human Genetics, University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas J Werner
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - David C Fajgenbaum
- Department of Medicine, Division of Translational Medicine and Human Genetics, University of Pennsylvania, Philadelphia, PA, USA
| | - Abass Alavi
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Mona-Elisabeth Revheim
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA. .,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway. .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Problemveien 7, 0316, Oslo, Norway.
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Freeman SC, Baskaran J, Gbadamosi-Akindele M. Human Herpesvirus-8 Negative Multicentric Castleman Disease in a Patient with Human Immunodeficiency Virus Treated with Highly Active Antiretroviral Therapy and Chemotherapy. Cureus 2019; 11:e5530. [PMID: 31523587 PMCID: PMC6721916 DOI: 10.7759/cureus.5530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Multicentric Castleman disease (MCD) is a rare lymphoproliferative disorder with a high mortality rate in undiagnosed patients. Traditionally, human immunodeficiency virus (HIV) positive MCD occurs due to infection with human herpes virus-8 (HHV), which is thought to play a role in the pathogenesis of MCD. We present the case of a 49-year-old woman who was referred to our oncology clinic for generalized lymphadenopathy in a waxing and waning pattern for the last four years. She was found to be HIV positive. Here we report a rare case of HIV-positive, HHV-negative MCD that responded to prompt treatment with highly active antiretroviral therapy (HAART) followed by chemotherapy as evidenced by improved CD4+ T cell numbers and reduction in lymphadenopathy. The findings in this HHV seronegative patient may indicate an alteration in the virulence and tropism between HHV and HIV, and further demonstrate the need for continued investigation into the pathogenesis of Castleman disease.
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Affiliation(s)
- S Caleb Freeman
- Dermatology, Creighton University School of Medicine, Omaha, USA
| | - Janani Baskaran
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
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5
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Walsh NM, Kutzner H, Requena L, Cerroni L. Plasmacytic cutaneous pathology: A review. J Cutan Pathol 2019; 46:698-708. [DOI: 10.1111/cup.13499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/02/2019] [Accepted: 05/13/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Noreen M. Walsh
- Department of Pathology, Queen Elizabeth II Health Sciences CenterNova Scotia Health Authority (Central Zone) Halifax Canada
- Department of PathologyDalhousie University Halifax Canada
- Department of MedicineDalhousie University Halifax Canada
| | - Heinz Kutzner
- Dermatopathologie Friedrichshafen Friedrichshafen Germany
| | - Luis Requena
- Dermatology DepartmentFundacion Jimenez Diaz Madrid Spain
| | - Lorenzo Cerroni
- Research Unit of Dermatopathology, Department of DermatologyMedical University of Graz Graz Austria
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6
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Owattanapanich W, Pholmoo W, Pongpruttipan T, Siritanaratkul N. High proportion of TAFRO syndrome in Thai adult Castleman's disease patients: a 10-year experience. Ann Hematol 2018; 97:1019-1026. [PMID: 29464312 PMCID: PMC5910486 DOI: 10.1007/s00277-018-3269-x] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 01/31/2018] [Indexed: 01/03/2023]
Abstract
Castleman’s disease (CD) is a rare lymphoproliferative disorder, and its prevalence in Thailand is not known. This 10-year period study investigated the prevalence of CD in Thailand, and the clinical characteristics and outcomes of Thai CD patients, with special focus on the existence and prevalence of TAFRO syndrome. TAFRO syndrome is defined as CD with thrombocytopenia, anasarca, fever, reticulin fibrosis, and organomegaly. Thirty-three CD patients diagnosed and treated at Siriraj Hospital during January 2007 to December 2016 were included. The prevalence of CD was 1.4 per 1,000,000 patients/10 years. Median age was 46 years, with slight female predominance. Six patients were assigned to the TAFRO group. A high proportion of TAFRO syndrome (18.2%) was found among Thai adult CD patients. In addition to routine TAFRO diagnostic criteria, significantly lower hemoglobin and albumin levels were observed in the TAFRO group than in the non-TAFRO group. Treatment outcomes of CD patients were complete remission (52%), stable disease (30%), and death (13%). Three-year overall survival in the non-TAFRO group and TAFRO group was 88 and 50%, respectively. While most CD patients had a good prognosis, severe cases with TAFRO syndrome had poor outcome.
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Affiliation(s)
- Weerapat Owattanapanich
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Wikanda Pholmoo
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tawatchai Pongpruttipan
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Noppadol Siritanaratkul
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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7
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Jiang JP, Shen XF, Du JF, Guan WX. A retrospective study of 34 patients with unicentric and multicentric Castleman's disease: Experience from a single institution. Oncol Lett 2017; 15:2407-2412. [PMID: 29434951 DOI: 10.3892/ol.2017.7625] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 10/27/2015] [Accepted: 04/13/2017] [Indexed: 12/24/2022] Open
Abstract
The aim of the present study was to share the experience of a single institute in the diagnosis, use of accessory examinations and treatment strategies of Castleman's disease (CD). The present study analyzed 34 patients (13 males and 21 females) with CD who were hospitalized between January 2006 and September 2014. The patients were divided into two groups based on the anatomical distribution of the disease: Unicentric CD (UCD) and multicentric CD (MCD). Histological data was obtained from lymph node biopsies. All clinical data were acquired by reviewing patients' medical records and contacting patients by telephone. A total of 27 patients had UCD and 7 patients had MCD. All 27 patients with UCD with benign symptoms underwent complete diagnostic surgical resection and survived, with the exception of 1 patient who succumbed to pancreatic head carcinoma 13 months after surgery. A total of 7 patients with MCD presented with systemic symptoms and 2 of these patients declined treatment following the definite diagnosis of CD. The remaining 5 patients were treated with various strategies, including surgical resection and further glucocorticoid treatment, intravenous siltuximab, rituximab in combination with cyclophosphamide, doxorubicin, vincristine and prednisone chemotherapy or hematopoietic stem cell transplantation. A total of 3 patients with MCD survived, with a median follow-up period of 69 months. The present study indicates that complete surgical resection is currently the standard treatment for UCD. Perioperative use of multidetector computed tomography and the laparoscopic approach have certain advantages in UCD. Molecular target therapy is effective in patients with stable MCD, and hematopoietic stem cell transplantation may be beneficial in certain patients with MCD and disease progression.
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Affiliation(s)
- Jin-Peng Jiang
- Department of Rehabilitation Medicine, General Hospital of Beijing Military Command, Beijing 100700, P.R. China.,Department of General Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
| | - Xiao-Fei Shen
- Department of General Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
| | - Jun-Feng Du
- Department of General Surgery, General Hospital of Beijing Military Command, Beijing 100700, P.R. China
| | - Wen-Xian Guan
- Department of General Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
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8
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Abstract
Siltuximab (Sylvant™), an interleukin (IL)-6 chimeric immunoglobulin Gк monoclonal antibody, is a currently the only agent approved to treat human idiopathic (herpesvirus-8 negative) multicentric Castleman disease (iMCD), which is a rare lymphoproliferative disorder. iMCD is caused by dysregulated production of IL-6 in the lymph nodes, and is associated with high morbidity, and potentially fatal consequences. Siltuximab binds to human IL-6 with high affinity and specificity, thereby preventing it from binding to IL-6 receptors, and neutralizing IL-6 bioactivity. In clinical trials in patients with iMCD, siltuximab reduced levels of C-reactive protein (a biomarker for IL-6), and provided clinical responses. Relative to placebo, the addition of siltuximab to best supportive care improved tumor- and symptom-related outcomes, with patients also reporting improvements in MCD symptoms, functional status, and well-being. Siltuximab has an acceptable tolerability profile, with the majority of treatment-emergent adverse events being manageable and/or of mild severity. In the absence of a cure, siltuximab represents a significant achievement in the management of this difficult-to-treat orphan disease.
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10
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Avilés-Robles M, Roberts-Vega S, Romero-Baizabal BL, Dorantes-Acosta E, Mena-Cedillos C, Perezpeña-Diazconti M. [Multicentric Castleman's disease characterized by polyclonal hyperimmunoglobulinemia and paraneoplastic pemphigus]. Bol Med Hosp Infant Mex 2015; 72:129-139. [PMID: 29425993 DOI: 10.1016/j.bmhimx.2015.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 05/06/2015] [Indexed: 06/08/2023] Open
Affiliation(s)
- Martha Avilés-Robles
- Departamento de Infectología, Hospital Infantil de México Federico Gómez, México D.F., México.
| | - Samuel Roberts-Vega
- Departamento de Urgencias, Hospital Infantil de México Federico Gómez, México D.F., México
| | | | - Elisa Dorantes-Acosta
- Departamento de Hemato-Oncología, Hospital Infantil de México Federico Gómez, México D.F., México
| | - Carlos Mena-Cedillos
- Departamento de Dermatología, Hospital Infantil de México Federico Gómez, México D.F., México
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11
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Son HW, Huh IY, Lee SH, Kim AS, Park SH, Kim DY. General anesthesia in a patient with multicentric Castleman's disease: a case report. Korean J Anesthesiol 2015; 68:304-8. [PMID: 26045937 PMCID: PMC4452678 DOI: 10.4097/kjae.2015.68.3.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 07/23/2014] [Accepted: 07/28/2014] [Indexed: 11/10/2022] Open
Affiliation(s)
- Hee Won Son
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - In Young Huh
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sang Hyun Lee
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - An Suk Kim
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Se Hun Park
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Dae-Young Kim
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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12
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Affiliation(s)
- Jonathan
E. Gable
- Department
of Pharmaceutical Chemistry, University
of California, San Francisco, 600 16th Street, San Francisco, California 94158-2280, United States
- Graduate
Group in Biophysics, University of California,
San Francisco, 600 16th
Street, San Francisco, California 94158-2280, United States
| | - Timothy M. Acker
- Department
of Pharmaceutical Chemistry, University
of California, San Francisco, 600 16th Street, San Francisco, California 94158-2280, United States
| | - Charles S. Craik
- Department
of Pharmaceutical Chemistry, University
of California, San Francisco, 600 16th Street, San Francisco, California 94158-2280, United States
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13
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Ortega L, Cooper CJ, Otoukesh S, Mojtahedzadeh M, Didia CS, Torabi A, Nahleh Z. Multicentric Castleman's Disease and Kaposi's Sarcoma in a HIV-Positive Patient on Highly Active Antiretroviral Therapy. Rare Tumors 2014; 6:5480. [PMID: 25276327 PMCID: PMC4178280 DOI: 10.4081/rt.2014.5480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 05/14/2014] [Revised: 06/11/2014] [Accepted: 06/13/2014] [Indexed: 11/23/2022] Open
Abstract
Castleman’s disease is a group of rare lymphoproliferative disorders. The plasmablastic multicentric Castleman’s disease is frequently discovered in HIV-infected individuals in association with Kaposi sarcoma (HHV-8). Thirty-five year old male presented to our care with the main compliant of severe back pain for one week. His past medical problems include acquired immune deficiency syndrome diagnosed 12 years prior and Kaposi sarcoma, currently on highly active antiretroviral therapy (HAART). Radiographic imaging revealed hepatomegaly and diffuse lymphadenopathy. The HIV viral load was <20 polymerase chain reaction copies/mL, absolute CD4 count was 453 cells/mcL (490-1740 cells/mcL) and CD8 count was 4142 cells/mcL (180-1170 cells/ mcL). Excisional biopsy of the left supraclavicular lymph node was performed with pathological findings of HHV8+ Kaposi sarcoma in the background of multicentric Castleman’s disease (plasmacytic variant). No evidence of transformation into large B-cell or plasmablastic lymphoma was noted. He was discharged on HAART and follow up to receive chemotherapy with cyclophosphamide, adriamycin, vincristine plus prednisone was started and rituximab plus prophylaxis for pneumocystis carinii. Multicentric Castleman’s disease has become more relevant in recent years due to its association with HIV and HHV-8 (Kaposi sarcoma) and its potential to progress into plasmablastic B-cell lymphoma. The progression of MCD to B-cell lymphoma is a concern, especially in patients with HIV infection because it precludes the worst outcome and a high mortality, despite treatment. The most intriguing part of this case is that MCD occurred in a HIV-positive on HAART. This case signals a warning that a high suspicion for MCD can be justified even in those HIV-positive patients on HAART because the possibly of progression to plasmablastic B-cell lymphoma.
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Affiliation(s)
- Lauro Ortega
- Department of Internal Medicine, Texas Tech University Health Sciences Center , El Paso, TX, USA
| | - Chad J Cooper
- Department of Internal Medicine, Texas Tech University Health Sciences Center , El Paso, TX, USA
| | - Salman Otoukesh
- Department of Internal Medicine, Texas Tech University Health Sciences Center , El Paso, TX, USA
| | - Mona Mojtahedzadeh
- Department of Neuroscience Research Center, Paul L. Foster School of Medicine, Texas Tech University , El Paso, TX, USA
| | - Claudia S Didia
- Department of Neuroscience Research Center, Paul L. Foster School of Medicine, Texas Tech University , El Paso, TX, USA
| | - Alireza Torabi
- Department of Pathology, Texas Tech University Health Sciences Center , El Paso, TX, USA
| | - Zeina Nahleh
- Department of Internal Medicine, Texas Tech University Health Sciences Center , El Paso, TX, USA
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Cheung YS, Chan AWH, Lee KF, Wong J, Chong CCN, Lai PBS. Case of hepatocellular carcinoma with multicentric Castleman's disease. Surgical Practice 2014. [DOI: 10.1111/1744-1633.12081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Yue-Sun Cheung
- Department of Surgery; Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong
| | - Anthony Wing-Hung Chan
- Department of Anatomical and Cellular Pathology; Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong
| | - Kit-Fai Lee
- Department of Surgery; Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong
| | - John Wong
- Department of Surgery; Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong
| | | | - Paul Bo-San Lai
- Department of Surgery; Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong
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Oyaert M, Boone E, De Ceuninck L, Moreau E, Van Dorpe J, Vanpoucke H, Deeren D. Clonal multicentric Castleman's disease with increased free Κ light chains in a patient with systemic lupus erythematosus. Ann Hematol 2013; 93:1255-7. [PMID: 24248673 DOI: 10.1007/s00277-013-1962-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 11/08/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Matthijs Oyaert
- Clinical Laboratory, AZ Delta Roeselare Menen, Roeselare, Belgium
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