1
|
Harada T, Kikushige Y, Miyamoto T, Uno K, Niiro H, Kawakami A, Koga T, Akashi K, Yoshizaki K. Peripheral helper-T-cell-derived CXCL13 is a crucial pathogenic factor in idiopathic multicentric Castleman disease. Nat Commun 2023; 14:6959. [PMID: 37907518 PMCID: PMC10618253 DOI: 10.1038/s41467-023-42718-0] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/19/2023] [Indexed: 11/02/2023] Open
Abstract
Castleman disease (CD) is a rare lymphoproliferative disorder. Among subtypes of CD, idiopathic multicentric CD-not otherwise specified (iMCD-NOS) has a poor prognosis and its pathogenesis is largely unknown. Here we present a xenotransplantation model of iMCD-NOS pathogenesis. Immunodeficient mice, transplanted with lymph node (LN) cells from iMCD-NOS patients, develop iMCD-like lethal inflammation, while mice transplanted with LN cells from non-iMCD patients without inflammation serve as negative control. Grafts depleted of human CD3+ T cells fail to induce inflammation in vivo. Upon engraftment, peripheral helper T (Tph) cells expand and levels of human CXCL13 substantially increase in the sera of mice. A neutralizing antibody against human CXCL13 blocks development of inflammation and improves survival in the recipient mice. Our study thus indicates that Tph cells, producing CXCL13 play a critical role in the pathogenesis of iMCD-NOS, and establishes iMCD-NOS as an immunoregulatory disorder.
Collapse
Affiliation(s)
- Takuya Harada
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medicine, Fukuoka, Japan
| | - Yoshikane Kikushige
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medicine, Fukuoka, Japan
- Center for Cellular and Molecular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Toshihiro Miyamoto
- Department of Hematology, Faculty of Medicine, Institute of Medical Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Kazuko Uno
- Luis Pasteur Center for Medical Research, Kyoto, Japan
| | - Hiroaki Niiro
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medicine, Fukuoka, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Koichi Akashi
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medicine, Fukuoka, Japan.
- Center for Cellular and Molecular Medicine, Kyushu University Hospital, Fukuoka, Japan.
| | - Kazuyuki Yoshizaki
- The Institute of Scientific and Industrial Research, SANKEN, Osaka University, Osaka, Japan.
- Medical corporation of Tokushukai, Osaka, Japan.
| |
Collapse
|
2
|
Lin Q, Wei J, Qian J, You L, Qian W. Somatic Mutations Confer Severe Peripheral Neuropathy in POEMS Syndrome-Associated Multicentric Castleman Disease. Neurosci Bull 2020; 36:664-666. [PMID: 32166648 DOI: 10.1007/s12264-020-00481-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 12/10/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Qingqing Lin
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
- Malignant Lymphoma Diagnosis and Therapy Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Juying Wei
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
- Institute of Hematology, Zhejiang University, Hangzhou, 310003, China
- Malignant Lymphoma Diagnosis and Therapy Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Jiejing Qian
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
- Malignant Lymphoma Diagnosis and Therapy Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Liangshun You
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
- Institute of Hematology, Zhejiang University, Hangzhou, 310003, China.
- Malignant Lymphoma Diagnosis and Therapy Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
| | - Wenbin Qian
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
- Institute of Hematology, Zhejiang University, Hangzhou, 310003, China.
- Malignant Lymphoma Diagnosis and Therapy Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
| |
Collapse
|
3
|
Nabel CS, Sameroff S, Shilling D, Alapat D, Ruth JR, Kawano M, Sato Y, Stone K, Spetalen S, Valdivieso F, Feldman MD, Chadburn A, Fosså A, van Rhee F, Lipkin WI, Fajgenbaum DC. Virome capture sequencing does not identify active viral infection in unicentric and idiopathic multicentric Castleman disease. PLoS One 2019; 14:e0218660. [PMID: 31242229 PMCID: PMC6594611 DOI: 10.1371/journal.pone.0218660] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 06/06/2019] [Indexed: 01/09/2023] Open
Abstract
Castleman disease (CD) describes a spectrum of heterogeneous disorders defined by characteristic lymph node histopathology. Enlarged lymph nodes demonstrating CD histopathology can occur in isolation (unicentric CD; UCD) sometimes accompanied by mild symptoms, or at multiple sites (multicentric CD, MCD) with systemic inflammation and cytokine-driven multi-organ dysfunction. The discovery that Kaposi sarcoma herpesvirus/human herpesvirus (HHV)-8 drives MCD in a subset of patients has led to the hypotheses that UCD and MCD patients with negative HHV-8 testing by conventional methods may represent false negatives, or that these cases are driven by another virus, known or unknown. To investigate these hypotheses, the virome capture sequencing for vertebrate viruses (VirCapSeq-VERT) platform was employed to detect RNA transcripts from known and novel viruses in fresh frozen lymph node tissue from CD patients (12 UCD, 11 HHV-8-negative MCD [idiopathic MCD; iMCD], and two HHV-8-positive MCD) and related diseases (three T cell lymphoma and three Hodgkin lymphoma). This assay detected HHV-8 in both HHV-8-positive cases; however, HHV-8 was not found in clinically HHV-8-negative iMCD or UCD cases. Additionally, no novel viruses were discovered, and no single known virus was detected with apparent association to HHV-8-negative CD cases. Herpesviridae family members, notably including Epstein-Barr virus (EBV), were detected in 7 out of 12 UCD and 5 of 11 iMCD cases with apparent correlations with markers of disease severity in iMCD. Analysis of a separate cohort of archival formalin-fixed, paraffin-embedded lymph node tissue by In situ hybridization revealed significantly fewer EBV-positive cells in UCD and iMCD compared to tissue from HHV-8-positive MCD and EBV-associated lymphoproliferative disorder. In an additional cohort, quantitative testing for EBV by PCR in peripheral blood during disease flare did not detect systemic EBV viremia, suggesting detection lymph node tissue is due to occult, local reactivation in UCD and iMCD. This study confirms that HHV-8 is not present in UCD and iMCD patients. Further, it fails to establish a clear association between any single virus, novel or known, and CD in HHV-8-negative cases. Given that distinct forms of CD exist with viral and non-viral etiological drivers, CD should be considered a group of distinct and separate diseases with heterogeneous causes worthy of further study.
Collapse
Affiliation(s)
- Christopher S. Nabel
- Dana-Farber Cancer Institute, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, United States of America
| | - Stephen Sameroff
- Columbia University, New York, New York, United States of America
| | - Dustin Shilling
- Castleman Disease Collaborative Network, Philadelphia, Pennsylvania, United States of America
| | - Daisy Alapat
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Jason R. Ruth
- Castleman Disease Collaborative Network, Philadelphia, Pennsylvania, United States of America
| | | | - Yasuharu Sato
- Division of Pathophysiology, Okayama University Graduate School of Health Sciences, Okayama, Japan
| | - Katie Stone
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | | | - Federico Valdivieso
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Michael D. Feldman
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Amy Chadburn
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | | | - Frits van Rhee
- Myeloma Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - W. Ian Lipkin
- Columbia University, New York, New York, United States of America
| | - David C. Fajgenbaum
- Castleman Disease Collaborative Network, Philadelphia, Pennsylvania, United States of America
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| |
Collapse
|
4
|
Abstract
Castleman disease (CD) describes a heterogeneous group of hematologic disorders that share characteristic lymph node histopathology. Patients of all ages present with either a solitary enlarged lymph node (unicentric CD) or multicentric lymphadenopathy (MCD) with systemic inflammation, cytopenias, and life-threatening multiple organ dysfunction resulting from a cytokine storm often driven by interleukin 6 (IL-6). Uncontrolled human herpesvirus-8 (HHV-8) infection causes approximately 50% of MCD cases, whereas the etiology is unknown in the remaining HHV-8-negative/idiopathic MCD cases (iMCD). The limited understanding of etiology, cell types, and signaling pathways involved in iMCD has slowed development of treatments and contributed to historically poor patient outcomes. Here, recent progress for diagnosing iMCD, characterizing etio-pathogenesis, and advancing treatments are reviewed. Several clinicopathological analyses provided the evidence base for the first-ever diagnostic criteria and revealed distinct clinical subtypes: thrombocytopenia, anasarca, fever, reticulin fibrosis/renal dysfunction, organomegaly (iMCD-TAFRO) or iMCD-not otherwise specified (iMCD-NOS), which are both observed all over the world. In 2014, the anti-IL-6 therapy siltuximab became the first iMCD treatment approved by the US Food and Drug Administration, on the basis of a 34% durable response rate; consensus guidelines recommend it as front-line therapy. Recent cytokine and proteomic profiling has revealed normal IL-6 levels in many patients with iMCD and potential alternative driver cytokines. Candidate novel genomic alterations, dysregulated cell types, and signaling pathways have also been identified as candidate therapeutic targets. RNA sequencing for viral transcripts did not reveal novel viruses, HHV-8, or other viruses pathologically associated with iMCD. Despite progress, iMCD remains poorly understood. Further efforts to elucidate etiology, pathogenesis, and treatment approaches, particularly for siltuximab-refractory patients, are needed.
Collapse
Affiliation(s)
- David C Fajgenbaum
- Division of Translational Medicine & Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
5
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
6
|
Oksenhendler E, Boutboul D, Fajgenbaum D, Mirouse A, Fieschi C, Malphettes M, Vercellino L, Meignin V, Gérard L, Galicier L. The full spectrum of Castleman disease: 273 patients studied over 20 years. Br J Haematol 2018; 180:206-216. [PMID: 29143319 DOI: 10.1111/bjh.15019] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/19/2017] [Indexed: 12/16/2022]
Abstract
The spectrum of Castleman disease (CD) has considerably extended since its first description in 1956. Recently, an international collaborative working group has reached consensus on the diagnostic criteria and classification of CD. We herein report 273 patients with lymph node histopathology consistent with CD and investigate the newly established diagnostic criteria. Twenty of these patients with Castleman-like histopathology were removed from analyses, because they were diagnosed with an exclusionary disorder (18 with haematological malignancy). Among the 253 remaining patients, 57 were considered unicentric CD (UCD), 169 were multicentric CD associated with Human Herpesvirus 8 (HHV-8+MCD), including 140 patients with human immunodeficiency virus (HIV) infection and 29 patients without HIV infection, and 27 were HHV-8 negative/idiopathic multicentric CD (iMCD). 2-(18 F)fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography was useful in 62 patients for staging/classification of the disease and for excluding associated lymphoma. UCD was mainly associated with hyaline-vascular histopathological features, and most patients were asymptomatic. Of the 27 patients that we had originally diagnosed with iMCD, 26 met the newly established diagnostic criteria. Patients with iMCD and HHV-8+ MCD demonstrated similar characteristics, including fever, splenomegaly, cytopenia and inflammatory symptoms. However, the disease was more aggressive in HHV-8+ MCD, particularly in HIV-infected patients.
Collapse
Affiliation(s)
- Eric Oksenhendler
- Department of Clinical Immunology, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
- EA3518, Université Paris Diderot Paris 7, Paris, France
- National Reference Centre for Castleman Disease (CRMdC), Paris, France
| | - David Boutboul
- Department of Clinical Immunology, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
- National Reference Centre for Castleman Disease (CRMdC), Paris, France
| | - David Fajgenbaum
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Adrien Mirouse
- Department of Clinical Immunology, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - Claire Fieschi
- Department of Clinical Immunology, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
- National Reference Centre for Castleman Disease (CRMdC), Paris, France
- Inserm U1126, Centre Hayem, Hôpital Saint-Louis, Paris, France
- Université Paris Diderot Paris 7, Paris, France
| | - Marion Malphettes
- Department of Clinical Immunology, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
- National Reference Centre for Castleman Disease (CRMdC), Paris, France
- Inserm U1126, Centre Hayem, Hôpital Saint-Louis, Paris, France
| | - Laetitia Vercellino
- Department of Nuclear Medicine, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - Véronique Meignin
- National Reference Centre for Castleman Disease (CRMdC), Paris, France
- Department of Pathology, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - Laurence Gérard
- Department of Clinical Immunology, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
- EA3518, Université Paris Diderot Paris 7, Paris, France
- National Reference Centre for Castleman Disease (CRMdC), Paris, France
| | - Lionel Galicier
- Department of Clinical Immunology, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
- EA3518, Université Paris Diderot Paris 7, Paris, France
- National Reference Centre for Castleman Disease (CRMdC), Paris, France
| |
Collapse
|
7
|
Abstract
A 66-year-old man with a several year history of thrombocytopenia, pleural effusion and ascites, anasarca, and organomegaly presented with general fatigue, appetite loss, dyspnea with type II respiratory failure. The precise history of the patient and the re-evaluation of lymph node and bone marrow biopsies conducted by the previous physician indicated TAFRO syndrome. The patient's laboratory data improved for a year with tocilizumab, but then worsened to the point that the patient required artificial ventilation due to the deterioration of type II respiratory failure. The replacement of tocilizumab with rituximab yielded a steady improvement, but it was necessary to address the patient's persistent respiratory failure. Peripheral nerve disorder might have been involved with the patient's respiratory failure.
Collapse
Affiliation(s)
- Tatsuya Aoki
- General Internal Medicine, Fukuchiyama City Hospital, Japan
| | - Mikio Wada
- General Internal Medicine, Fukuchiyama City Hospital, Japan
| | | | | | - Akihiro Nagata
- Department of Pathology, Fukuchiyama City Hospital, Japan
| | - Keizo Kagawa
- General Internal Medicine, Fukuchiyama City Hospital, Japan
| |
Collapse
|
8
|
Khan MK, Talukder RH, Kamruzzaman M. The Castleman's Disease and Related Disorders--A Case Report. Mymensingh Med J 2016; 25:168-175. [PMID: 26931270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Castleman's disease is a rare primary disease of the lymph nodes. Little is known about the management of the disease. Surgical treatment gives a very good result. What other modalities of treatment could be done is not yet established. The role of surgery gives good result and follow up evaluation is satisfactory. We found a solitary intra-abdominal mass of lymphoid hyperplasia with a histological diagnosis of Castlemans disease identified in the pathological data base. Unicentric disease was defined as it was a solitary mass. Clinical, Radiological and Laboratory data were analysed to evaluate treatment response. The patient also has related disorders as Acanthosis nigricans, Myoneuronal disorder as-MG and bronchiolitis. The patient diagnosed as angiofollicular hyperplasia (Castleman's disease). After evaluation patient under went surgical treatment, partial excision of tumor mass due to morbid adhesion with inferior vena cava. The patient becomes symptom free and lump disappears within 60 days of treatment. There was no recurrence of the disease after further evaluation. The author recommends that in Unicentric variant of Castlemans disease surgical resection of the tumor is curative. The unicentric tumour may be hyaline-vascular or hyaline-vascular/ plasma cell type. Partial resection, Radiotherapy or observation alone may avoid excessive aggressive therapy.
Collapse
Affiliation(s)
- M K Khan
- Dr Md Kamruzzaman Khan, Professor of Surgery & Head of Department, Dhaka Community Medical College, Dhaka, Bangladesh
| | | | | |
Collapse
|
9
|
Gracia-Cazaña T, Delgado-Beltrán C, Concellón MA, Fuertes MA. Mixed Connective Tissue Disease in a Patient With Castleman Disease and Hodgkin Lymphoma: Excellent Clinical Response to Rituximab. Actas Dermosifiliogr 2015; 106:843-6. [PMID: 26232308 DOI: 10.1016/j.ad.2015.03.017] [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: 01/20/2015] [Revised: 03/25/2015] [Accepted: 03/29/2015] [Indexed: 11/19/2022] Open
Affiliation(s)
- T Gracia-Cazaña
- Servicio de Dermatología, Hospital de Barbastro, Huesca, España.
| | - C Delgado-Beltrán
- Servicio de Reumatología, Hospital Clínico Lozano Blesa, Zaragoza, España
| | - M A Concellón
- Servicio de Dermatología, Hospital Clínico Lozano Blesa, Zaragoza, España
| | - M A Fuertes
- Servicio de Hematología, Hospital Clínico Lozano Blesa, Zaragoza, España
| |
Collapse
|
10
|
Sakakibara S, Tosato G. Contribution of viral mimics of cellular genes to KSHV infection and disease. Viruses 2014; 6:3472-86. [PMID: 25243371 PMCID: PMC4189034 DOI: 10.3390/v6093472] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 09/05/2014] [Accepted: 09/11/2014] [Indexed: 12/29/2022] Open
Abstract
Kaposi’s sarcoma-associated herpesvirus (KSHV, also named Human herpesvirus 8 HHV-8) is the cause of Kaposi sarcoma (KS), the most common malignancy in HIV-infected individuals worldwide, primary effusion lymphoma (PEL) and multicentric Castleman disease (MCD). KSHV is a double-stranded DNA virus that encodes several homologues of cellular proteins. The structural similarity between viral and host proteins explains why some viral homologues function as their host counterparts, but sometimes at unusual anatomical sites and inappropriate times. In other cases, structural modification in the viral proteins can suppress or override the function of the host homologue, contributing to KSHV-related diseases. For example, viral IL-6 (vIL-6) is sufficiently different from human IL-6 to activate gp130 signaling independent of the α subunit. As a consequence, vIL-6 can activate many cell types that are unresponsive to cellular IL-6, contributing to MCD disease manifestations. Here, we discuss the molecular biology of KSHV homologues of cellular products as conduits of virus/host interaction with a focus on identifying new strategies for therapy of KS and other KSHV-related diseases.
Collapse
Affiliation(s)
- Shuhei Sakakibara
- Department of Molecular Immunology, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka 565-0871, Japan.
| | - Giovanna Tosato
- Laboratory of Cellular Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20982, USA.
| |
Collapse
|
11
|
Williams DS. Castleman's disease. J Insur Med 2013; 43:256-258. [PMID: 24069787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- David S Williams
- Banner Life, Legal and General America, 9184 Sunderland Way, West Chester, OH 45069, USA.
| |
Collapse
|
12
|
Reuland AK, Engelhardt M, Meyer PT, Stroh AL, Lübbert M, Finke J, Schmitt-Gräff A, Zirlik A, Wäsch R. Aggressive plasmablastic lymphoproliferation complicated by hemophagocytic syndrome 12 years after heart transplant. Leuk Lymphoma 2012; 53:1845-8. [PMID: 22335533 DOI: 10.3109/10428194.2012.666664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
13
|
Xu W, Yu Y, Zhi YQ. [Occurrence of Castleman disease secondary to the treatment of solitary plasmacytoma of bone: a case report]. Zhonghua Xue Ye Xue Za Zhi 2011; 32:873. [PMID: 22339967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
14
|
Al-Maghrabi JA. Castleman's disease. Update on pathogenesis. Saudi Med J 2011; 32:451-458. [PMID: 21556463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Castleman's disease (CD) is an unusual lymphoproliferative disorder that may mimic lymphoma clinically and pathologically. It is classified clinically as localized and multicentric types, and pathologically as hyaline vascular and plasma cell types. It is associated with increased risk of lymphoma and follicular dendritic cell tumors. The pathogenesis of CD is still controversial and complex. Active research is ongoing to highlight more on the etiopathogenesis of this entity. The aim of this article is to review the literature on pathogenesis of CD and to focus on the possible role of viruses in the development of this disease.
Collapse
Affiliation(s)
- Jaudah A Al-Maghrabi
- Department of Pathology, Faculty of Medicine, King Abdulaziz University Hospital, PO Box 80205, Jeddah 21589, Kingdom of Saudi Arabia.
| |
Collapse
|
15
|
Alkaied H, Harris K, Elsayegh D, Khachaturova I, Awasum M, Varma S. Does Kaposi's sarcoma predict multicentric Castleman disease in the presence of generalized lymphadenopathy? Med Oncol 2011; 29:1109-13. [PMID: 21472488 DOI: 10.1007/s12032-011-9886-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Accepted: 02/25/2011] [Indexed: 10/18/2022]
Abstract
Multisystemic Castleman disease (MCD) can be associated with HHV8 infection, which involves the mantle zone of follicles. This condition results in an increase number of HHV8-positive (HHV8+) plasmablasts that multiply and amalgamate to form plasmablastic B-cell lymphoma. All previously reported cases of HIV-positive patients with MCD were coinfected with HHV8. Twelve cases of HIV- MCD that are HHV8+ were encountered in the literature, three of them developed lymphoma, and none of those cases were reported to have Kaposi's sarcoma (KS). We report a unique case of HIV-negative elderly woman with preexisting KS that presented to the hospital with recurring nausea, vomiting, and fever, assessment revealed diffuse lymphadenopathy. Axillary lymph node biopsy showed HHV8+ MCD with foci of microlymphoma. Despite the treatment with high-dose steroids, she developed multisystem failure that lead to her death.
Collapse
Affiliation(s)
- Homam Alkaied
- Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY 10305, USA.
| | | | | | | | | | | |
Collapse
|
16
|
Yousif MEA, El Hassan AM, Abdulrahim AS. Castleman's disease in a kidney failure patient diagnosed incidentally during transplantation. Arab J Nephrol Transplant 2011; 4:31-33. [PMID: 21469593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Castleman's disease is a rare lymphoid disorder. It comprises two pathological entities. These are the hyaline-vascular type which is usually localized (uni-centeric) and the plasma-cell type which is usually multicenteric and rather aggressive. CASE REPORT Here we present a 53 years old Sudanese male who underwent kidney transplantation in August 2009 from a related live-donor. During transplantation, he was accidently found to have an abnormal looking lymph node at the site of the graft bed. The lymph node was totally excised and sent for histopathology. Based on the histopathological examination, the diagnosis of Castleman's disease of the hyaline vascular type was made. The patient gained normal graft function and was maintained on tacrolimus, azathioprine and prednisolone. He maintained normal graft function for more than twelve months post transplantation with a serum creatinine level of 0.9 mg/dl. He remained free from recurrence of Castleman's disease during the follow up period. CONCLUSION Unicenteric Castleman's disease may be completely asymptomatic. Surgical excision of the lesion was curative for our patient despite maintenance on immunosuppression.
Collapse
|
17
|
Lee SM, Edwards SG, Chilton DN, Ramsay A, Miller RF. Highly active antiretroviral therapy alone may be an effective treatment for HIV-associated multi-centric Castleman's disease. Haematologica 2010; 95:1979-81. [PMID: 20801900 DOI: 10.3324/haematol.2010.027441] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
18
|
Han X, Zhou DB. [Advances in etiology and management of Castleman's disease]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2009; 31:639-643. [PMID: 19968087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Castleman's disease (CD) is a rare lymphoproliferative disorder. The etiology of CD may involve viral infection, abnormal modulation of cytokines, and angiogenesis. Human herpes virus (HHV) -8 infection and interleukin-6 (IL-6) overexpression may play key roles in the development of CD. Treatment options include surgical excision, radiation therapy, chemotherapy, antiviral therapy, and targeted therapy. No standardized treatment has been established for multicentric CD and the treatment efficacy usually is poor. Among newly available agents, the effectiveness of antiviral therapy against HHV-8 is unclear; anti-CD20 and anti-IL-6 receptor monoclonal antibodies have shown promising efficacy; thalidomide and bortezomib have shown their initial efficacy.
Collapse
Affiliation(s)
- Xiao Han
- Department of Hematology, PUMC Hospital, CAMS and PUMC, Beijing 100730, China
| | | |
Collapse
|
19
|
Abstract
Castleman disease (CD) is an uncommon lymphoproliferative disorder with a unique histopathology. Generally diagnosis is not difficult for an experienced pathologist. However, not usually, some histopathological entities or tissue reactions may mimic CD. Here CD-like reaction due to toxic substance ingestion has been presented.
Collapse
Affiliation(s)
- Semra Paydas
- Cukurova University, Faculty of Medicine, Department of Medical Oncology, Turkey
| | | | | | | | | |
Collapse
|
20
|
Modak D, Ganguly RR, Haldar SN, Samanta PS, Pramanik N, Guha SK. Castlemans disease in HIV infected patient from eastern India. J Assoc Physicians India 2008; 56:547-548. [PMID: 18846911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Castlemans disease is a rare lymphoproliferative disorder. We report a patient of Castlemans disease with advanced HIV infection who responded well to conventional HAART. This case is interesting because of the rarity of the disease in the eastern part of India and its good out come with antiretroviral therapy.
Collapse
Affiliation(s)
- D Modak
- Department of Tropical Medicine, School of Tropical Medicine, Kolkata
| | | | | | | | | | | |
Collapse
|
21
|
Chen XF, Han H, Li YH, Zhang Y, Qin ZK, Liu ZW, Yu SL, Hou GL, Zhou FJ. [Local Castleman's disease: a report of 17 cases with literature review]. Ai Zheng 2008; 27:315-318. [PMID: 18334125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND & OBJECTIVE Castleman's disease (CD), also named angiofollicular lymph node hyperplasia or giant lymph node hyperplasia, is an uncommon reactive lymphadenopathy with unknown causes. This study was to report clinical features and therapeutic outcomes of 17 cases of local Castleman's disease (LCD), review literatures to improve the diagnosis and management of CD. METHODS Clinical data of 17 LCD patients, treated in Cancer Center of Sun Yat-sen University from Aug. 1995 to Jul. 2006, were reviewed. RESULTS There were 3 cases with and 14 cases without clinical symptoms. A single lymph node or aggregation of multiple lymph nodes was observed in a single location. The longest diameters of involved lymph nodes ranged from 1.2 to 10.4 cm. The lesions were located in the neck (11 cases), mediastinum (3 cases), lung (1 case), mesentery (1 case), adrenal region (1 case). Fifteen cases were hyaline vascular type, 1 case was plasma cell type and 1 case was mixed type; all were confirmed pathologically. One hyaline vascular type LCD patient had splenomegaly, hypoalbumin (25.6 g/L), hyperglobulin (80.0 g/L) and positive fecal occult blood. One plasma cell type LCD patient had anemia (95.0 g/L), positive urine protein and positive fecal occult blood. The other 15 patients had normal laboratory results. All patients underwent complete surgical resection. The duration of follow-up ranged from 1 to 129 months with a median of 25 months. Fifteen followed-up patients were all alive without recurrence. CONCLUSIONS LCD patients mainly have lymphadenectasis in a single location, no clinical symptoms and normal laboratory results, with a majority of hyaline vascular type. Although CT is helpful for the diagnosis of LCD, the final diagnosis depends on pathologic examination. LCD patients can live long without recurrence after complete surgical resection of the tumor.
Collapse
Affiliation(s)
- Xiao-Feng Chen
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, 510060, P. R. China
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Bazeos A, Powles T, Stebbing J. HIV-associated Castleman's disease: from case reports to evidence. J HIV Ther 2007; 12:61-62. [PMID: 17962792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
|
23
|
Abstract
PURPOSE OF REVIEW Castleman disease was initially described over 50 years ago as a benign localized mass of lymph nodes found primarily in the mediastinum of asymptomatic patients. Subsequently, additional types were recognized that extend the spectrum of this heterogeneous group of diseases. Optimal standard therapies have not been established. Currently, most patients receive treatments derived from past experience with non-Hodgkin lymphoma that are not altogether satisfactory. RECENT FINDINGS Advances in understanding the biological basis of Castleman disease have provided new targets for therapeutic exploitation. Recognition of the role of interleukin-6 in disease perpetuation has led to the use of an antihuman interleukin-6 receptor monoclonal antibody, tocilizumab. Rituximab, an anti-CD20 monoclonal antibody, targets CD20-positive B lymphocytes, a prominent component of this disorder. Human herpes virus-8 and angiogenesis, both involved in the pathogenesis of Castleman disease, may provide additional unique therapeutic opportunities. SUMMARY Rational approaches to the treatment of Castleman disease have begun to have an impact on disease management; however, the role of these new agents remains to be established. As the complexity of Castleman disease is more fully understood, additional targets for new innovative therapies undoubtedly will be identified.
Collapse
Affiliation(s)
- Anu Dham
- Division of Hematology-Oncology, University of Minnesota, Minneapolis, Minneapolis, USA
| | | |
Collapse
|
24
|
Affiliation(s)
- M S Parker
- Medical College of Virginia Hospitals-VCU Health Systems, Richmond, Virginia, USA.
| |
Collapse
|
25
|
Kojima M, Motoori T, Asano S, Nakamura S. Histological diversity of reactive and atypical proliferative lymph node lesions in systemic lupus erythematosus patients. Pathol Res Pract 2007; 203:423-31. [PMID: 17540509 DOI: 10.1016/j.prp.2007.03.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Accepted: 03/12/2007] [Indexed: 11/19/2022]
Abstract
Localized or generalized lymphadenopathy, which may be associated with systemic symptoms such as fever, is frequently found in patients with systemic lupus erythematosus (SLE). Histologically, the lymph node lesion is characterized by varying degrees of coagulative necrosis with hematoxylin bodies or reactive follicular hyperplasia. The former histology is unique to SLE, but is rarely seen in biopsied specimens. In this review, we describe a histologic variation of SLE lymphadenopathy based on the findings of our own cases, and discuss several problems related to the differential diagnosis of various benign and malignant lymphoproliferative disorders (LPDs). Among 33 cases we encountered, 17 (51%) cases exhibited atypical LPDs: (i) reactive follicular hyperplasia with giant follicles (RFHGFs), 3 cases; (ii) histologic findings of Castleman's disease (CD), 5 cases ; (iii) atypical paracortical hyperplasia with lymphoid follicles (APHLFs), 7 cases; and (iv) atypical lymphoplasmacytic and immunoblastic proliferation (ALPIBP), 2 cases. This finding indicates that atypical LPDs frequently appear in SLE. Moreover, the majority of patients with atypical LPDs exhibited follicular hyperplasia (RFHGF, 3 cases; histologic findings of CD, 5 cases; and APHLF, 7 cases). Previously, follicular hyperplasia was usually considered a non-specific change and therefore has received little attention in the literature. However, the present review indicates that reactive follicular hyperplasia in lymph nodes from SLE occasionally poses serious problems in the differential diagnosis of various benign and malignant LPDs. The presence of numerous copies of Epstein-Barr virus was determined by in situ hybridization studies in only two (8%) of the 26 cases examined. As previously suggested, the absence of EBV, as determined by ISH studies, in the majority of LPDs associated with SLE indicates that EBV is not related to the lymphoproliferative process, and suggests that the underlying cause of the patient's lymphadenopathy may reside in the immune deficit of SLE in the majority of reactive and atypical LPDs associated with SLE.
Collapse
Affiliation(s)
- Masaru Kojima
- Department of Pathology and Clinical Laboratories, Gunma Cancer Center Hospital, Ohta, Japan.
| | | | | | | |
Collapse
|
26
|
Kawamura N, Hayashi T, Abe T, Nakayama J, Mori N, Sekii K, Yoshioka T, Itatani H. [Castleman's disease in the pelvic cavity]. Hinyokika Kiyo 2007; 53:141-4. [PMID: 17352168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Although Castleman's disease may occur in any lymph node of the body, it is the most commonly found in the thoracic cavity. Castleman's disease rarely occurs in the pelvic cavity and only 18 such cases have been reported. We report a case of pelvic Castleman's disease. A 57-year-old man was referred for evaluation of a pelvic tumor. The tumor was surgically resected and the histopathological diagnosis of the resected tissue was hyaline vascular type of Castleman's disease. No evidence of disease was detected five months post-operatively.
Collapse
|
27
|
Scadden DT, Muse VV, Hasserjian RP. Case records of the Massachusetts General Hospital. Case 30-2006. A 41-year-old man with dyspnea, fever, and lymphadenopathy. N Engl J Med 2006; 355:1358-68. [PMID: 17005954 DOI: 10.1056/nejmcpc069021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- David T Scadden
- Department of Hematology-Oncology, Massachusetts General Hospital, USA
| | | | | |
Collapse
|
28
|
Nishimoto N. [IL-6 targetting therapy for inflammatory immune diseases]. Nihon Naika Gakkai Zasshi 2006; 95:1795-800. [PMID: 17037317 DOI: 10.2169/naika.95.1795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
|
29
|
Ohsugi Y, Tsuchimoto N. [Pharmacological and clinical profile of anti-human IL-6 receptor antibody (tocilizumab, ACTEMRA), a novel therapeutic drug for Castleman's disease]. Nihon Yakurigaku Zasshi 2006; 126:419-25. [PMID: 16462093 DOI: 10.1254/fpj.126.419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
30
|
Abstract
A 48-year-old man infected with an HIV-1 experienced intermittent bouts of fever, lymphadenopathy, elevated CRP level, and thrombocytopenia, each lasting about 2 weeks, and recurring at 2-3 month intervals. His CD4 count was about 500/microL, and he had never received antiretroviral therapy (ART). In March 2005, he experienced the same symptoms, accompanied by liver damage, splenomegaly, pleural fluid, and a high serum soluble IL-2 receptor level. Examination of a cervical lymph node specimen resulted in a diagnosis of Castleman disease, plasma cell type. Immunohistochemical studies confirmed the presence of HHV-8 and Ebstein-Barr virus (EBV). Since the plasma HHV-8 DNA and serum IL-6 were elevated during the flare-up, were negative between episodes, he was treated with ART to control the Castleman disease. He remained asymptomatic for 3 months, but, similar symptoms recurred with a high level of HHV-8 DNA in his PBMCs. Oral valganciclovir was them started at 1,800 mg twice daily, and his symptoms immediately improved. The HHV-8 DNA level in the PBMCs decreased markedly over the course of 4 weeks, and valganciclovir was discontinued. One week later, he experienced another flare-up, and was successfully treated with 10 days of valganciclovir 1,800 mg, followed by maintenance with valganciclovir 900 mg. ART was discontinued, because the valganciclovir plus ART caused severe fatigue. No subsequent flare-ups have been observed, and, no HHV-8 DNA has been detected in his PBMCs. Castleman disease is an unusual complication in patients with HIV-1 and HHV-8 infection, but it should be included in the differential diagnosis of patients who exhibit a relapsing systemic inflammatory syndrome and lymphoadenopathy. Further study is needed to determine the appropriate usage and timing of the anti-HHV-8 and HIV-1 medication.
Collapse
Affiliation(s)
- Rumi Minami
- National Hospital Organization, Kyushu Medical Center, Division of Immunology and infectious disease, Clinical Research Institute
| | | |
Collapse
|
31
|
Abstract
Fifty years ago, Dr Benjamin Castleman first described the unusual lymphoproliferative disorder that now bears his name. Over the subsequent decades, astute clinical and pathologic observations coupled with clever molecular biologic research have increased our understanding of the aetiology of Castleman disease (CD). This article proposes three broad CD variants based on both distinctive histopathology and clinical behaviour. The pivotal roles of infection with human herpesvirus 8 and interleukin-6 production in the development of CD are emphasized. Finally, the natural history of CD and the myriad of therapeutic options are reviewed in the context of a unified model of CD pathophysiology, and continued areas of uncertainty are discussed.
Collapse
Affiliation(s)
- Corey Casper
- Department of Medicine, Division of Infectious Disease, University of Washington School of Medicine, and The Program in Infectious Disease, Fred Hutchinson Cancer Research Center, Seattle, WA 98122, USA.
| |
Collapse
|
32
|
Nishimoto N. [Anti-IL-6 receptor antibody]. Nihon Rinsho 2005; 63 Suppl 5:723-7. [PMID: 15954436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
MESH Headings
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal/physiology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Arthritis, Juvenile/drug therapy
- Arthritis, Juvenile/etiology
- Arthritis, Rheumatoid/drug therapy
- Arthritis, Rheumatoid/etiology
- Castleman Disease/drug therapy
- Castleman Disease/etiology
- Crohn Disease/drug therapy
- Crohn Disease/etiology
- Humans
- Interleukin-6/physiology
- Randomized Controlled Trials as Topic
- Receptors, Interleukin-6/immunology
- Receptors, Interleukin-6/physiology
- Still's Disease, Adult-Onset/drug therapy
- Still's Disease, Adult-Onset/etiology
Collapse
Affiliation(s)
- Norihiro Nishimoto
- Laboratory of Immune Regulation, Graduate School of Frontier Biosciences, Osaka University
| |
Collapse
|
33
|
Arima T, Natsume A, Hatano H, Nakahara N, Fujita M, Ishii D, Wakabayashi T, Doyu M, Nagasaka T, Yoshida J. Intraventricular chordoid meningioma presenting with Castleman disease due to overproduction of interleukin-6. J Neurosurg 2005; 102:733-7. [PMID: 15871519 DOI: 10.3171/jns.2005.102.4.0733] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ A rare case of chordoid meningioma in the lateral ventricle observed in an adult is reported. The first clinical manifestation of the disease was a prolonged fever of unknown origin. Abnormalities in the patient's blood chemistry, principally polyclonal hypergammaglobulinemia (immunoglobulin [Ig]G, IgA, and markedly IgE) and an elevated serum level of C-reactive protein, were associated with the disease. The tumor was histologically confirmed to be a chordoid meningioma, and its surgical removal resulted in complete resolution of the patient's symptoms. By combining reverse transcription—polymerase chain reaction and immunohistochemical analysis, it may be shown that cytokine production, including that of interleukin (IL)-6, IL-1β, and vascular endothelial growth factor, plays a role in the pathogenesis of chordoid meningioma associated with Castleman syndrome.
Collapse
Affiliation(s)
- Toru Arima
- Department of Neurosurgery, Division of Pathology, Clinical Laboratory, Center for Genetic and Regenerative Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Horster S, Jung C, Zietz C, Cohen CD, Siebeck M, Goebel FD. AIDS, multicentric Castleman's disease, and plasmablastic leukemia: report of a long-term survival. Infection 2005; 32:296-8. [PMID: 15624895 DOI: 10.1007/s15010-004-3148-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Plasmablastic leukemia (PL) as a complication of human herpes virus 8 (HHV8)-associated Castleman's disease is marked by a rapid and fatal outcome. In patients with AIDS, survival of 7 to 14 days after diagnosis has been reported. Prompt splenectomy and chemotherapy might lead to a significant survival benefit. Here we report a case of long-term survival in a patient with AIDS and multicentric Castleman's disease (MCD) complicated by PL.
Collapse
Affiliation(s)
- S Horster
- Medical Policlinic, Pettenkoferstr. 8a, D-80336 Munich, Germany.
| | | | | | | | | | | |
Collapse
|
35
|
Wang J, Zhu XJ. [The new development on pathogenesis of autoimmune paraneoplastic pemphigus]. Beijing Da Xue Xue Bao Yi Xue Ban 2004; 36:540-3. [PMID: 15489940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Paraneoplastic pemphigus (PNP) is an autoimmune mucocutaneous disease first named by Anhalt, et al in 1990. The disease is characterized by such distinctive clinical symptoms and signs as severe, painful mucosal erosions, polymorphous skin lesions, histopathology hallmarks, and immunological findings. The situation typically presents in patients with lymphoproliferative diseases and primarily malignancies. A main challenge of the study is the relationship between the existence of associated tumors and the autoimmune reaction to the skin. Some researchers suspected that the possible expression of foreign antigens on the tumor can cross react with epidermal antigens inducing the auto-reactive clones of T-lymphocytes. Some speculated that the type of tumors associated with PNP may produce plakin proteins that result in initiation of the immune response. Other reports believed the autoimmune reaction is related to the epitope spreading or to the changing of cytokines. We analyzed 12 PNP patients diagnosed in our department in the past few years. An intensive study to the B cells in the PNP associated with tumors demonstrated that the tumors have structural basis to produce antibody. The similar immunoglobulin heavy chain genes of tumor B cells in 7 patients strongly suggested that the B cell clones were functional and recognized the same antigen epitope. The autoantibodies secreted by the tumor can react against specific plakin proteins in epidermis, lead to the impairment of cell-cell adhesion, and cause the mucocutaneous lesions. The clinical significance of the RESULTS indicates the importances of early finding and total resection of the associated tumors, and the usage of IVIG pre or during operation to prevent Bronchitis Obliterans. The new finding is also important for the study of other antibody mediated autoimmune diseases.
Collapse
Affiliation(s)
- Jing Wang
- Department of Dermatology, Peking University First Hospital, Beijing 100034, China
| | | |
Collapse
|
36
|
Sprinz E, Jeffman M, Liedke P, Putten A, Schwartsmann G. Successful treatment of AIDS-related Castleman's disease following the administration of highly active antiretroviral therapy (HAART). Ann Oncol 2004; 15:356-8. [PMID: 14760135 DOI: 10.1093/annonc/mdh066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
37
|
Pontenagel U, Ulrich B. Diagnose and therapy of the Castleman’s disease. Dtsch Med Wochenschr 2004; 129:953-6. [PMID: 15083398 DOI: 10.1055/s-2004-823164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- U Pontenagel
- Abteilung Chirurgie, FACS, FRCS, Kliniken der Landeshauptstadt Düsseldorf, Krankenhaus Gerresheim
| | | |
Collapse
|
38
|
De Marchi G, De Vita S, Fabris M, Scott CA, Ferraccioli G. Systemic connective tissue disease complicated by Castleman's disease: report of a case and review of the literature. Haematologica 2004; 89:ECR03. [PMID: 15075095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Castleman's disease is an atypical lymphoproliferative disorder characterized by the prevalence of B CD5-positive cells in the marginal zone. Autoimmune manifestations have often been reported, but the association of Castleman's disease with systemic autoimmune syndromes has been rarely described. However, many authors stress the difficulties in distinguishing between connective tissue disease and Castleman's disease in most cases. To clarify this issue, we describe a patient and review the literature reports of all cases of Castleman's disease associated with a connective tissue disease. A 19-year old woman presented with autoimmune thyroiditis and polymyositis. Seven years after the onset she developed a systemic inflammatory flare and a burst of autoimmunity, followed by generalized lymphoadenopathy. A mediastinal lymph node biopsy led to the diagnosis of Castleman disease of mixed type. Chemotherapy was given, with rapid response of the lymphoproliferative disorder but persistence of the underlying autoimmune disorder. The plasma concentration of B-lymphocyte stimulator (BLyS) was high (13.3 ng/mL) at the diagnosis of Castleman's disease. It fell dramatically after chemotherapy (4.97 ng/mL), even though it remained just above the mean BLyS value found in healthy blood donors (3.37+/-0.78 ng/mL).Castleman's disease can present autoimmune traits. In our patient, Castleman's disease complicated the course of a connective tissue disorder several years after the onset. We hypothesize that chronic stimulation of B-cell clones, particularly CD5+, by BLyS could favor the development of both autoimmune diseases and a broad range of lymphoproliferative disorders (such as Castleman's disease). This is the first report of increased BLyS levels in a patient with Castleman's disease, supporting a possible pathogenetic role of BLyS in the development of an autoimmune disorder and of a B lymphoproliferative disorder years later.
Collapse
Affiliation(s)
- Ginevra De Marchi
- Division of Rheumatology, DPMSC, School of Medicine, University of Udine, Pzza S. Maria della Misericordia 1, 33100, Udine, Italy
| | | | | | | | | |
Collapse
|
39
|
Chou SP, Chen LK, Lo SS, Li AFY, Chang FC, Hwang SJ. Hyaline-vascular variant of Castleman's disease mimicking a gastric submucosal tumor. J Chin Med Assoc 2004; 67:152-5. [PMID: 15181970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Castleman's disease is a rare lymphoproliferative disorder with unknown underlying cause. Three histologic variants (hyaline-vascular, plasma cell and mixed) as well as 2 clinical groups (localized and multicentic) have been described. Most patients with the hyaline-vascular variant are asymptomatic other than localized pressure from the mass. Hyaline-vascular Castleman's disease was commonly found as intrathoracic presentation. Extrathoracic lesions have been reported in the retroperitoneum, mesentery, central nervous system, orbit, pelvis, neck, axilla, and skeletal muscles. Herein, we report a case of hyaline-vascular Castleman's disease mimicking a gastric submucosal leiomyoma that has rarely been reported in English literature review. The lesion was not actually developing from the stomach, however, the clinical presentation was mimicking a submucosal gastric tumor. Furthermore, the patient in this case had both chronic hepatitis C and splenosis. The relationship between the underlying diseases and the development of the CD deserves further investigations.
Collapse
Affiliation(s)
- Shih-Pin Chou
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwvan, ROC
| | | | | | | | | | | |
Collapse
|
40
|
Ma YT, Weatherby SJ, Rao DG, Winer JB, Craddock C, Williams AC. Facial flushing and localized Castleman's disease: an extension of the POEMS syndrome phenotype. J Intern Med 2003; 253:247-8; author reply 249. [PMID: 12542568 DOI: 10.1046/j.1365-2796.2003.01090.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
41
|
Bryant-Greenwood P, Sorbara L, Filie AC, Little R, Yarchoan R, Wilson W, Raffeld M, Abati A. Infection of mesothelial cells with human herpes virus 8 in human immunodeficiency virus-infected patients with Kaposi's sarcoma, Castleman's disease, and recurrent pleural effusions. Mod Pathol 2003; 16:145-53. [PMID: 12591967 DOI: 10.1097/01.mp.0000052374.61768.79] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Recurrent pleural effusions are common complications of hospitalized patients with human immunodeficiency virus (HIV) infection and may pose difficult diagnostic dilemmas. A common cause of recurrent pleural effusions in up to 30% of HIV-seropositive patients is pulmonary involvement by Kaposi's sarcoma, a human herpesvirus 8 (HHV 8)-related neoplasm. The pathogenesis of these effusions is unclear. These recurrent effusions, although benign, have shown significant mesothelial atypia/reactive changes of uncertain etiology. We attempted to evaluate these effusions morphologically and molecularly for the presence of HHV 8, with particular attention to mesothelial cells. All recurrent pleural effusions, as defined by any effusion tapped for cytological examination on more than two occasions, in HIV-positive patients at the National Institutes of Health were examined from 1998 to the present. Cases were stratified according to patients with and without histologically confirmed HHV 8 disease manifestations. Five patients with HHV 8 diseases (four with disseminated Kaposi's sarcoma and one with Castleman's disease) were identified. As a control group, five effusions from HIV-seropositive patients without known HHV 8-related diseases were identified. Cytological examination of effusions in patients with HHV 8-related diseases demonstrated atypical/markedly reactive mesothelial cells accompanied by a polymorphous background of lymphocytes. Molecular studies for B- and T-cell clonality in microdissected whole samples showed no definitive clones in these cases. Conversely, polymerase chain reaction (PCR) studies for the HHV 8 virus was positive in these samples. PCR studies on pure populations of microdissected mesothelial cells from the HHV 8-related effusions were positive for HHV 8 sequences, whereas those from HIV patients with non-HHV 8 related diseases were negative. Immunohistochemistry for HHV 8 (monoclonal antibody to latent nuclear antigen (LNA-1; ORF-73) on cellblock material demonstrated scattered positive mesothelial cells in three of the five cases of HHV 8-associated effusions. HHV 8 has been recently implicated in the pathogenesis of Kaposi's sarcoma and primary effusion lymphoma. Mesothelial cells in recurrent pleural effusions from patients with Kaposi's sarcoma and Castleman's disease appear to be infected with HHV 8. Additional studies need to be done to define the role of mesothelial cell infection in the pathogenesis of these HHV 8-associated effusions and define the prognostic significance.
Collapse
Affiliation(s)
- Peter Bryant-Greenwood
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Building 10, Room 2A19, Bethesda, MD, USA
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
Abstract
The advent of potent antiretroviral therapy has altered the expected natural history of human immunodeficiency virus (HIV) infection and of many previously associated opportunistic complications, including malignancies. At the same time, HIV suppression hasn’t affected all of these complications equally and the longer expected survival of infected patients may allow the development of newer complications. Additionally, the use of potent antiretroviral combination therapy may itself lead to hematological toxicities. Together these changes affect the consultation role of the hematology-oncology specialist in comprehensive HIV care and demand ongoing education.
In Section I, Dr. Paul Volberding reviews the biology of antiretroviral drug development and the progression in discovering new agents as the viral life cycle is further elucidated. He briefly summarizes the process of combining agents to achieve the degree of viral suppression required for long-term clinical benefit.
In Section II, Dr. Kelty Baker reviews the effects of HIV and its therapy on hematologic dyscrasia and clotting disorders. She summarizes how therapy may decrease certain previously common manifestations of HIV disease while adding new problems likely to result in referral to the hematologist. In addition, she addresses the role of secondary infections, such as parvovirus, in this spectrum of disorders.
In Section III, Dr. Alexandra Levine discusses the still challenging aspects of HIV associated non-Hodgkin’s lymphoma and the association between HIV infection and Hodgkin’s disease. She addresses current controversies in the pathogenesis of HIV related lymphomas and summarizes a number of recent trials of combination chemotherapy, with or without monoclonal antibodies, in their management. Additionally, she reviews the complex relationship of HIV disease with multicentric Castleman’s disease and recent attempts to manage this disorder.
Collapse
Affiliation(s)
- Paul A Volberding
- University of California at San Francisco, San Francisco, CA 94121, USA
| | | | | |
Collapse
|
43
|
Aaron L, Lidove O, Yousry C, Roudiere L, Dupont B, Viard JP. Human herpesvirus 8-positive Castleman disease in human immunodeficiency virus-infected patients: the impact of highly active antiretroviral therapy. Clin Infect Dis 2002; 35:880-2. [PMID: 12228826 DOI: 10.1086/342696] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2002] [Revised: 04/17/2002] [Indexed: 11/03/2022] Open
Abstract
We report the case histories of 7 human immunodeficiency virus (HIV)-infected patients receiving highly active antiretroviral therapy (HAART) who had a diagnosis of Castleman disease. All 6 patients who were treated responded to chemotherapy; immune reconstitution was observed in 5 patients, but it did not prevent relapse of Castleman disease. However, the mean duration of survival observed in this series (48 months) was most probably due to immune reconstitution resulting from receipt of HAART, which reduced the mortality associated with HIV disease.
Collapse
Affiliation(s)
- Laurent Aaron
- Service des Maladies Infectieuses et Tropicales, Hôpital Necker Enfants-Malades, 75743 Paris Cedex 15, France.
| | | | | | | | | | | |
Collapse
|
44
|
Mongil Ruiz I, Canduela Martínez V. [Periodic fever]. An Esp Pediatr 2002; 57:334-44. [PMID: 12392668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Periodic fever can be defined as recurrent episodes of fever lasting from a few days to several weeks separated by symptom-free intervals of variable duration, recurring throughout several months. Although these clinical pictures are unusual in clinical practice, in some instances the differential diagnosis with recurrent infections, malignancies and connective tissue diseases is difficult. The aim of this review is to group together these different clinical pictures, which are dispersed in the literature, to obtain an overall and detailed perspective.We classified these processes in two categories: hereditary (familial Mediterranean fever, hyper-IgD syndrome, tumor necrosis factor-receptor-associated periodic syndrome, Muckle-Wells syndrome and familial cold urticaria) and non-hereditary (periodic fever, aphthous stomatitis, pharyngitis, and adenopathy syndrome [PFAPA syndrome], cyclic neutropenia, chronic infantile neurological cutaneous and articular syndrome [CINCA syndrome], Castleman's disease, early onset sarcoidosis and Blau syndrome). Although diagnosis is essentially clinical, in recent years many advances have been made in the knowledge of the molecular and genetic bases of hereditary diseases, which may be of considerable help in establishing the diagnosis and improving treatment.
Collapse
|
45
|
Hengge UR, Ruzicka T, Tyring SK, Stuschke M, Roggendorf M, Schwartz RA, Seeber S. Update on Kaposi's sarcoma and other HHV8 associated diseases. Part 2: pathogenesis, Castleman's disease, and pleural effusion lymphoma. Lancet Infect Dis 2002; 2:344-52. [PMID: 12144897 DOI: 10.1016/s1473-3099(02)00288-8] [Citation(s) in RCA: 161] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The pathogenesis of Kaposi's sarcoma (KS) is better understood since the identification of the novel human herpesvirus 8 (HHV8), which can be found in all forms of KS. Viral oncogenesis and cytokine-induced growth, as well as some states of immunocompromise, contribute to its development. Several virally encoded genes--eg, bcl-2, interleukin 6, cyclin D, G-protein-coupled receptor, and interferon regulatory factor--provide key functions on cellular proliferation and survival. Growth promotion of KS is further stimulated by various proinflammatory cytokines and growth factors such as tumour necrosis factor a, interleukin 6, basic fibroblast growth factor, and vascular endothelial growth factor, resulting in a hyperplastic polyclonal lesion with predominant spindle cells derived from lymphoid endothelia. HHV8 has recently been discovered to escape HLA-class-I-restricted antigen presentation to cytotoxic T lymphocytes by increasing endocytosis of MHC class I chains from the cell surface, thus enabling latent infection and immune escape in primary and chronic infection. Multicentric Castleman's disease is a rare lymphoproliferative disorder of the plasma cell type, which has been reported in both HIV-seropositive and HIV-seronegative patients, and which frequently contains HHV8 DNA. Pleural effusion lymphoma, or body-cavity-based lymphoma, belongs to the group of non-Hodgkin B-cell lymphomas characterised by pleural, pericardial, or peritoneal lymphomatous effusions in the absence of a solid tumour mass. Pleural effusion lymphoma has an intermediate immunophenotype lacking B or T lymphocyte antigens and also belongs to the diseases associated with HHV8.
Collapse
Affiliation(s)
- Ulrich R Hengge
- Department of Dermatology, Venerology, and Allergology, University of Essen, Germany.
| | | | | | | | | | | | | |
Collapse
|
46
|
Kokkonen J, Tikkanen S, Karttunen TJ, Savilahti E. A similar high level of immunoglobulin A and immunoglobulin G class milk antibodies and increment of local lymphoid tissue on the duodenal mucosa in subjects with cow's milk allergy and recurrent abdominal pains. Pediatr Allergy Immunol 2002; 13:129-36. [PMID: 12000486 DOI: 10.1034/j.1399-3038.2002.00090.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In previous studies, we have reported endoscopic and histological alterations locally on the gastrointestinal (GI) tract associated with a gastrointestinal type of cow's milk allergy. In this study, we sought to further characterize endoscopic, and immunological findings in these children. We also hypothesized that the same type of immune responses might also be found in children with unexplained and recurrent abdominal pains. We did a gastroduodenoscopy for persistent GI symptoms, examined the mucosal histology of the small intestine and measured the antibodies to whole cow's milk and its fractions with an enzyme-linked immunosorbent assay (ELISA) in a consecutive series of 22 subjects with untreated and 14 with treated cow's milk allergy (CMA) and 44 with recurrent abdominal pains (RAP). The immunological findings of the study subjects were compared with 54 controls. Lymphonodular hyperplasia (LNH) of the duodenum was the main endoscopic finding in 11 subjects (50%) with untreated and 5 (36%) with treated CMA. It was also found in 6 of 44 subjects with RAP. Compared with the controls, the patients with CMA showed significantly higher levels of IgA class antibodies to whole milk (p = 0.003) and betaLG (p < 0.0001). Of the IgG class antibodies to betaLG (p = 0.032), BSA (p < 0.0001) and alphaCAS (p < 0.0001) were significantly higher. The patients with LNH of the duodenal bulb as the main endoscopic finding showed significantly higher values of IgG class antibodies to betaLG (p = 0.01) and alphaCAS (p = 0.005). Interestingly, the patients examined for RAP showed a similar increment in the pattern of whole milk and specific milk protein antibodies as the CMA children. In conclusion this study showed that gastrointestinal CMA beyond infancy is significantly associated with high levels of IgG and IgA class antibodies to milk and its fractions. As high levels of these antibodies and LNH of the duodenal bulb were also found in subjects with RAP, the study further suggests that gastrointestinal CMA might be one major reason for RAP.
Collapse
Affiliation(s)
- Jorma Kokkonen
- Department of Paediatrics, University Hospital of Oulu, Finland.
| | | | | | | |
Collapse
|
47
|
Abstract
BACKGROUND Castleman's disease (angiofollicular lymph node hyperplasia) is a group of rare lymphoproliferative disorders sharing characteristic clinical and histological features, and usually accompanied by a marked systemic inflammatory response. All types may be complicated by acquired systemic amyloidosis, usually of AA type, but occasionally of AL type associated with monoclonal gammopathy. DESIGN Descriptive study of five patients with unicentric Castleman's disease complicated by systemic AA amyloidosis. METHODS A diagnosis of amyloidosis was confirmed by microscopy and immunohistochemical staining. Serum concentrations of C-reactive protein (CRP) and serum amyloid A protein (SAA) were measured by immunoassays. Radiolabelled serum amyloid P component scintigraphy was used to monitor the progress of amyloid deposition. RESULTS In four patients the primary diagnosis was made only after years of investigation of systemic symptoms. The tumours were resected in all cases, leading to remission of the systemic inflammatory state. Long-term follow-up in four patients, including scintigraphy, showed regression of amyloid deposits. DISCUSSION This rare but usually fatal condition can be cured surgically even in advanced cases. Awareness of the diagnosis and its correct management are important in investigation of patients with unexplained systemic symptoms, especially associated with systemic amyloidosis.
Collapse
Affiliation(s)
- H J Lachmann
- NHS National Amyloidosis Centre and the Centre for Amyloidosis and Acute Phase Proteins, Department of Medicine, Royal Free and University College Medical School, Royal Free Campus, London, UK.
| | | | | | | | | |
Collapse
|
48
|
Abstract
PURPOSE Castleman's disease is a polyclonal lymphoplasmacytic and vascular proliferation prominant in lymphoid tissues. It is associated with lymph node enlargement, hepatosplenomegaly and fever. This manifestations could be secondary to hyperproduction of interleukin 6. The prognosis is poor. The opportunistic infections which are characteristic of severe HIV infection worsen the prognosis. Prolonged monochemotherapy with vinblastine or etoposide can control Castleman's disease. CURRENT KNOWLEDGE AND KEY POINTS Recent advances in human herpesvirus 8 (HHV8) knowledge and its predominance in the forms which are linked to the HIV seropositivity have partly explained the clinical manifestations of Castleman's disease. Indeed, HHV8 produce an homologous interleukin 6, the vIL-6, responsible for lymphoplasmacytic proliferation. The presence of other homologues of human cytokines produced by HHV8 could contribute to lymphoplasmacytosis and to endothelial proliferation. FUTURE AND PROSPECTS Taking into account this viral origin, alpha interferon could be an alternative in forms which are less progressive. However, antiviral therapy against HHV8 or HIV and the immunitary restoration do not have any influence on the evolution of Castleman's disease, contrary to opportunistic infections.
Collapse
Affiliation(s)
- L Aaron
- Service de maladies infectieuses et tropicales, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris, France
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Lebbé C. [HHV-8 infection in renal transplantation]. Nephrologie 2002; 22:313-5. [PMID: 11715609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
MESH Headings
- Antigens, Viral/analysis
- Castleman Disease/etiology
- Castleman Disease/virology
- DNA, Viral/analysis
- Europe/epidemiology
- Herpesviridae Infections/epidemiology
- Herpesviridae Infections/etiology
- Herpesviridae Infections/transmission
- Herpesviridae Infections/virology
- Herpesvirus 8, Human/immunology
- Herpesvirus 8, Human/isolation & purification
- Herpesvirus 8, Human/physiology
- Humans
- Kidney/virology
- Kidney Transplantation/adverse effects
- Lymphoma, Large B-Cell, Diffuse/etiology
- Lymphoma, Large B-Cell, Diffuse/virology
- Postoperative Complications/epidemiology
- Postoperative Complications/etiology
- Postoperative Complications/virology
- Sarcoma, Kaposi/epidemiology
- Sarcoma, Kaposi/etiology
- Sarcoma, Kaposi/virology
- Seroepidemiologic Studies
- Skin Neoplasms/epidemiology
- Skin Neoplasms/etiology
- Skin Neoplasms/virology
- Transplants/virology
- United States/epidemiology
Collapse
Affiliation(s)
- C Lebbé
- Service de dermatologie, Hôpital Saint-Louis, Paris.
| |
Collapse
|
50
|
Terai C. [Castleman's disease]. Ryoikibetsu Shokogun Shirizu 2001:511-3. [PMID: 11212788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- C Terai
- Institute of Rheumatology, Tokyo Women's Medical University
| |
Collapse
|