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Tu KH, Fan PY, Chen TD, Chuang WY, Wu CY, Ku CL, Tian YC, Yang CW, Fang JT, Yang HY. TAFRO Syndrome with Renal Thrombotic Microangiopathy: Insights into the Molecular Mechanism and Treatment Opportunities. Int J Mol Sci 2021; 22:ijms22126286. [PMID: 34208103 PMCID: PMC8230834 DOI: 10.3390/ijms22126286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 01/02/2023] Open
Abstract
TAFRO syndrome is an extremely rare form of idiopathic MCD, characterized by thrombocytopenia, anasarca, fever, reticulin fibrosis on bone marrow biopsy, and organomegaly. Like idiopathic MCD, renal involvement is also a common presentation in patients with TAFRO syndrome. Furthermore, membranoproliferative glomerulonephritis (MPGN)-like injury and thrombotic microangiopathy (TMA) are the most reported histopathologic findings of renal biopsy. Several molecular mechanisms have been previously postulated in order to explain the TAFRO syndrome symptoms, including abnormal production of interleukin-6 (IL-6), vascular endothelial growth factor (VEGF), etc. The role of these cytokines in renal injury, however, is not well understood. The aim of this review article is to summarize the latest knowledge of molecular mechanisms behind the TAFRO syndrome and their potential role in renal damage.
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Affiliation(s)
- Kun-Hua Tu
- Kidney Research Center, Department of Nephrology, Chang-Gung Memorial Hospital, Taoyuan 333, Taiwan; (K.-H.T.); (P.-Y.F.); (Y.-C.T.); (C.-W.Y.); (J.-T.F.)
- Transplantation Immunology Lab, Chang-Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Pei-Yi Fan
- Kidney Research Center, Department of Nephrology, Chang-Gung Memorial Hospital, Taoyuan 333, Taiwan; (K.-H.T.); (P.-Y.F.); (Y.-C.T.); (C.-W.Y.); (J.-T.F.)
| | - Tai-Di Chen
- Department of Pathology, Chang-Gung Memorial Hospital, Taoyuan 333, Taiwan; (T.-D.C.); (W.-Y.C.)
| | - Wen-Yu Chuang
- Department of Pathology, Chang-Gung Memorial Hospital, Taoyuan 333, Taiwan; (T.-D.C.); (W.-Y.C.)
- College of Medicine, Chang-Gang University, Taoyuan 333, Taiwan;
| | - Chao-Yi Wu
- Division of Allergy, Asthma and Rheumatology, Department of Pediatrics, Chang-Gung Memorial Hospital, Taoyuan 333, Taiwan;
| | - Cheng-Lung Ku
- College of Medicine, Chang-Gang University, Taoyuan 333, Taiwan;
| | - Ya-Chung Tian
- Kidney Research Center, Department of Nephrology, Chang-Gung Memorial Hospital, Taoyuan 333, Taiwan; (K.-H.T.); (P.-Y.F.); (Y.-C.T.); (C.-W.Y.); (J.-T.F.)
- Transplantation Immunology Lab, Chang-Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Chih-Wei Yang
- Kidney Research Center, Department of Nephrology, Chang-Gung Memorial Hospital, Taoyuan 333, Taiwan; (K.-H.T.); (P.-Y.F.); (Y.-C.T.); (C.-W.Y.); (J.-T.F.)
- College of Medicine, Chang-Gang University, Taoyuan 333, Taiwan;
| | - Ji-Tseng Fang
- Kidney Research Center, Department of Nephrology, Chang-Gung Memorial Hospital, Taoyuan 333, Taiwan; (K.-H.T.); (P.-Y.F.); (Y.-C.T.); (C.-W.Y.); (J.-T.F.)
- College of Medicine, Chang-Gang University, Taoyuan 333, Taiwan;
| | - Huang-Yu Yang
- Kidney Research Center, Department of Nephrology, Chang-Gung Memorial Hospital, Taoyuan 333, Taiwan; (K.-H.T.); (P.-Y.F.); (Y.-C.T.); (C.-W.Y.); (J.-T.F.)
- Transplantation Immunology Lab, Chang-Gung Memorial Hospital, Taoyuan 333, Taiwan
- Advanced Immunology Lab, Chang-Gung Memorial Hospital, Taoyuan 333, Taiwan
- Correspondence: ; Tel.: +886-3328-1200-8181
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Simeni Njonnou SR, Deuson J, Royer-Chardon C, Vandergheynst FA, Wilde VD. Unexplained cause of thrombocytopenia, fever, anasarca and hypothyroidism: TAFRO syndrome with thrombotic microangiopathy renal histology. BMJ Case Rep 2020; 13:13/6/e234155. [PMID: 32606113 DOI: 10.1136/bcr-2019-234155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Indexed: 02/06/2023] Open
Abstract
TAFRO (thrombocytopenia, anasarca, fever, reticulin myelofibrosis or renal dysfunction and organomegaly) syndrome is a systemic inflammatory disease characterised by thrombocytopenia, anasarca, fever or inflammatory syndrome, reticulin myelofibrosis or renal dysfunction and organomegaly. It was first described as a subtype of idiopathic multicentric Castleman disease. Here, we report the case of a 42-year-old woman presenting with thrombocytopenia, anasarca, inflammatory syndrome, renal insufficiency, reticulin myelofibrosis at bone marrow biopsy and cervical and axillary lymph nodes. Kidney biopsy showed double contours of the glomerular basement membrane, mesangiolysis and endothelial swelling compatible with thrombotic microangiopathy (TMA) as well as with TAFRO syndrome. She was successfully treated by corticosteroids, tocilizumab and rituximab. This new case description of TAFRO syndrome underlines three features of this disease rarely described in the literature and never simultaneously in the same patient: the association to severe hypothyroidism, the presence of TMA-like lesions on kidney biopsy and the treatment by the association of steroids, tocilizumab and rituximab.
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Affiliation(s)
- Sylvain Raoul Simeni Njonnou
- Internal Medicine, Hopital Erasme, Brussels, Belgium
- Internal Medicine and Specialties, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
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Yanagiya R, Suzuki T, Nakamura S, Fujita K, Oyama M, Okuyama A, Sugasawa K, Nakayama T, Suzuki Y, Ishizawa K, Saito S. TAFRO Syndrome Presenting with Retroperitoneal Panniculitis-like Computed Tomography Findings at Disease Onset. Intern Med 2020; 59:997-1000. [PMID: 31839656 PMCID: PMC7184093 DOI: 10.2169/internalmedicine.3740-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
TAFRO syndrome is rare, and its pathophysiology remains unclear. We herein report the case of a 66-year-old man who presented at our emergency department with epigastric pain. Contrast-enhanced computed tomography (CT) showed high-density retroperitoneal panniculus with contrast enhancement. He was treated initially with a protease inhibitor and hydration, to little effect. Anasarca, thrombocytopenia, and renal dysfunction developed gradually, and TAFRO syndrome was diagnosed. He was treated successfully with prednisolone and cyclophosphamide, and subsequent CT findings showed improvement. Abnormal CT findings of the retroperitoneum may indicate the early stages of TAFRO syndrome before the presentation of typical ascites.
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Affiliation(s)
- Ryo Yanagiya
- Department of Internal Medicine, Nihonkai General Hospital, Japan
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology (3rd internal medicine), Yamagata University Faculty of Medicine, Japan
| | - Takuma Suzuki
- Department of Internal Medicine, Okitama Public General Hospital, Japan
| | - Shuhei Nakamura
- Department of Gastroenterology, Nihonkai General Hospital, Japan
| | - Kotaro Fujita
- Department of Internal Medicine, Nihonkai General Hospital, Japan
| | - Midori Oyama
- Department of Internal Medicine, Nihonkai General Hospital, Japan
| | - Ayumi Okuyama
- Department of Internal Medicine, Nihonkai General Hospital, Japan
| | - Kunie Sugasawa
- Department of Internal Medicine, Nihonkai General Hospital, Japan
| | | | - Yoshihiro Suzuki
- Department of Gastroenterology, Nihonkai General Hospital, Japan
| | - Kenichi Ishizawa
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology (3rd internal medicine), Yamagata University Faculty of Medicine, Japan
| | - Soichi Saito
- Department of Internal Medicine, Nihonkai General Hospital, Japan
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Abstract
RATIONALE Castleman disease (CD) is a nonclonal lymphoproliferative disorder sometimes manifested systemic inflammatory symptoms. Systemic lupus erythematosus (SLE) is an autoimmune disease characterized with multi-system involvement as well as broad spectrum of serum autoantibodies. When these two conditions happened to have similar clinical spectrum features, the confusion with each other occurred. PATIENT CONCERNS A 46-year-old man suffered from chronic fever, nephrotic syndrome, acute kidney injury, anemia, thrombocytopenia and serositis, as well as hypocomplementemia and negative anti-nuclear antibody. DIAGNOSES Meeting the classification criteria for SLE, the patient was diagnosed as SLE at first. The renal biopsy showed that he had endocapillary proliferative glomerulonephritis with negative immunofluorescence. Finally, he was diagnosed with CD after lymph nodes biopsy. INTERVENTIONS The patient was treated with oral prednisone (50 mg daily) but got poor response. After being proved to have CD, he was treated with CHOP chemotherapy. OUTCOMES His condition was controlled by CHOP chemotherapy. After six course of chemotherapy, the proteinuria disappeared. LESSONS If patients, even qualified by classification criteria of SLE, had negative autoantibody or unsatisfied response to the standard treatment, the original diagnosis should be suspected. The biopsy may be help to identify the final criminals, such as CD.
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Affiliation(s)
- Li Wang
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology and Clinical Immunology
- Li Wang and Hua Chen contributed equally to this article
| | - Hua Chen
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology and Clinical Immunology
- Li Wang and Hua Chen contributed equally to this article
| | - Jing Shi
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology and Clinical Immunology
| | | | - Hang Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wenjie Zheng
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology and Clinical Immunology
| | - Fengchun Zhang
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology and Clinical Immunology
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Failing JJ, Higgins JV, Kautz JM. 35-Year-Old Man With Thrombocytopenia and Generalized Lymphadenopathy. Mayo Clin Proc 2015; 90:1569-73. [PMID: 26541250 DOI: 10.1016/j.mayocp.2015.04.029] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/01/2015] [Accepted: 04/08/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Jarrett J Failing
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN
| | - John V Higgins
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN
| | - Jordan M Kautz
- Advisor to residents and Consultant in General Internal Medicine, Mayo Clinic, Rochester, MN.
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Benjamin B, Zaltzman R, Shpitz B, Gordon CR, Avital S. Presacral Mass Discovered during Pregnancy followed by Myasthenia Gravis. Isr Med Assoc J 2015; 17:318-320. [PMID: 26137661] [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: 06/04/2023]
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Barbarov I, Koren-Michowitz M, Schiby G, Portnoy O, Livingstone D, Segal G. Fulminant HHV-8 associated Castleman's disease in a non-HIV, Kaposi sarcoma patient with borderline hemophagocytic syndrome. Isr Med Assoc J 2015; 17:253-255. [PMID: 26040056] [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: 06/04/2023]
MESH Headings
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antiviral Agents/administration & dosage
- Castleman Disease/complications
- Castleman Disease/diagnosis
- Castleman Disease/drug therapy
- Castleman Disease/physiopathology
- Disease Progression
- Fatal Outcome
- Ganciclovir/administration & dosage
- Glucocorticoids/administration & dosage
- Herpesvirus 8, Human/isolation & purification
- Humans
- Immunologic Factors/administration & dosage
- Liver Failure/etiology
- Lymph Nodes/pathology
- Lymphohistiocytosis, Hemophagocytic/complications
- Lymphohistiocytosis, Hemophagocytic/diagnosis
- Lymphohistiocytosis, Hemophagocytic/drug therapy
- Lymphohistiocytosis, Hemophagocytic/physiopathology
- Male
- Middle Aged
- Renal Insufficiency/etiology
- Rituximab
- Sarcoma, Kaposi/complications
- Sarcoma, Kaposi/drug therapy
- Sarcoma, Kaposi/physiopathology
- Sarcoma, Kaposi/virology
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Műzes G, Sipos F, Csomor J, Sréter L. Successful tocilizumab treatment in a patient with human herpesvirus 8-positive and human immunodeficiency virus-negative multicentric Castleman's disease of plasma cell type nonresponsive to rituximab-CVP therapy. APMIS 2013; 121:668-74. [PMID: 23163599 DOI: 10.1111/apm.12029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 08/10/2012] [Accepted: 10/11/2012] [Indexed: 02/05/2023]
Abstract
We present and discuss the case of a HIV-negative female finally diagnosed upon histopathologic and molecular biologic evaluations with human herpesvirus 8 (HHV8)-positive multicentric Castleman's disease (MCD) of plasma cell type, but with no detectable HHV8-DNA in peripheral blood. She failed to respond to combination immunosuppressive therapeutic trials of corticosteroids and azathioprine, and neither an immunochemotherapy of rituximab-CVP (R-CVP) induced disease resolution. However, monoclonal anti-IL-6R antibody (tocilizumab) immunotherapy resulted in beneficial disease stabilization. A control lymph node biopsy indicated mild polyclonal plasmacytosis, and a negative HHV8 determination. The patient is still receiving tocilizumab. This case emphasizes the individual nature of MCD requiering more personalized disease management.
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Affiliation(s)
- Györgyi Műzes
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary.
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Gomes H, Huyett P, Laver N, Wein RO. A unique presentation of Epstein-Barr virus-associated Castleman's disease. Am J Otolaryngol 2013; 34:262-4. [PMID: 23394816 DOI: 10.1016/j.amjoto.2012.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 12/01/2012] [Indexed: 11/17/2022]
Abstract
Castleman's disease (CD) is a rare, benign lymphoproliferative disorder. The association of human herpes virus 8 (HHV8) and human immunodeficiency virus infections with CD is well established however the role of Epstein-Barr Virus in CD is less well understood. We present a unique case of Castleman's disease in a patient with concomitant EBV infection, which mimicked the clinical presentation of nasopharyngeal carcinoma (NPC) versus lymphoma. After a delayed diagnosis, the patient underwent a left superficial parotidectomy and neck dissection and has had no recurrence of disease.
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Affiliation(s)
- Heather Gomes
- Department of Otolaryngology-Head & Neck Surgery, Tufts Medical Center, Boston, MA, USA
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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.
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Majerčáková D. [Castlemans disease]. Vnitr Lek 2012; 58:216-220. [PMID: 22486288] [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: 05/31/2023]
Abstract
Castlemans disease is a rare but potentially serious diagnosis and, therefore, this paper aims to enhance the medical community's knowledge of this diverse disease. This is a non-malignant angiofollicular nodular hyperplasia. There are three types according to the histological picture - hyalinvascular, plasmocellular and plasmablastic, and two types according to the clinical picture - unicentric and multicentric. The symptoms are rather heterogeneous, from an asymptomatic mass seen in the unicentric form, to life-threatening systemic inflammatory state with systemic symptoms in the multicentric form. Pathophysiological mechanism involves hypersecretion of IL-6 cytokin, although the process trigger is known only in a small proportion of cases. This is HHV-8 infection that, however, is not found in every patient with Castlemans disease. Aetiology in HHV-8 negative patients is unclear. The disease is associated with a range of autoimmune conditions and some haematological malignancies. Surgical resection, some-times followed with radiotherapy, is the gold standard in the treatment of the unicentric form. Anti-IL-6 monoclonal antibodies are the optimal therapy of the multicentric form, although other modalities, including corticosteroids, chemotherapy (CHOP, CVAD), immunomodulators and rituximab, given in monotherapy or in combination, are more accessible in real practice.
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Affiliation(s)
- D Majerčáková
- Lékarská Fakulta MU Brno, Dekan prof. MUDr. Jirí Mayer, CSc.
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Abstract
Castleman's disease is a rare lymphoproliferative disorder in which there has been recent progress in elucidating underlying mechanisms with potential therapeutic implications. Unicentric Castleman's disease is an indolent condition that is often treated with local approaches. In contrast, patients with multicentric Castleman's disease (MCD) have a less favorable prognosis and require systemic treatment. Cytotoxic chemotherapy, with its attendant risk for toxicity, has been widely used to treat MCD, with variable efficacy. The discovery of putative etiologic factors and targets in MCD, particularly human herpes virus 8, CD20, and interleukin (IL)-6, has been translated into the use of rituximab and anti-IL-6-based therapy, as well as antiviral agents. In this article, we review the current state of the art of our understanding of Castleman's disease and its treatment and we provide insight into future treatment strategies based on disease biology.
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Affiliation(s)
- Hazem E El-Osta
- Department of Investigational Cancer Therapeutics (Phase I Clinical Trials Program), MD Anderson Cancer Center, Unit 455, P.O. Box 301402, Houston, Texas 77030, USA
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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.
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Han SL, Chen XX, Zheng XF, Yan JY, Shen X, Zhu GB. The clinicopathological behaviour and surgical treatment of abdominal Castleman's disease. Singapore Med J 2010; 51:813-816. [PMID: 21103818] [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]
Abstract
INTRODUCTION Castleman's disease, a rare atypical lymphoproliferative disorder of the lymphoid tissue with unknown cause, remains a diagnostic challenge. This study was conducted to analyse the clinicopathological behaviour and reasonable surgical treatment for patients with abdominal Castleman's disease. METHODS The medical records of seven patients with abdominal Castleman's disease were reviewed. RESULTS The patients comprised two men and five women, and their median age was 42.3 (range 29-53) years. The main clinical manifestation was an abdominal mass or an enlargement of the retroperitoneal lymph node. Other clinical manifestations included anaemia, loss of body weight and hypoalbuminaemia. The mean size of the tumour was 5.5 (range 4.0-8.0) cm. Postoperatively, all the patients were diagnosed with a hyaline vascular type of the disease, and had localised manifestations of the disease. All seven patients underwent complete surgical resection, two of whom also received adjuvant irregular chemotherapy (CHOP) and steroids postoperatively. All the patients survived, with no evidence of recurrence. One patient had survived for more than two years, four patients for more than three years, and two patients for more than five years. CONCLUSION Abdominal Castleman's disease is difficult to diagnose preoperatively, and surgical excision remains the treatment of choice, especially for localised disease.
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Affiliation(s)
- S L Han
- Department of General Surgery, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou City 325000, Zhejiang Province, China.
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Kutoku Y, Kurokawa K, Murakami T, Sunada Y. [A case of Castleman disease accompanying neuropathy only detected by S-SEP in the tibial nerve]. Rinsho Shinkeigaku 2009; 49:664-666. [PMID: 19999150 DOI: 10.5692/clinicalneurol.49.664] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A 77-year-old woman was admitted with a chief complaint of tingling sensation in the both feet, which gradually developed just after the diagnosis of Castleman disease was made. Neurological examination showed mild weakness in the neck and pelvic girdle muscles, and sensory impairment affecting all modalities in the lower legs. Although these neurological findings suggest a diagnosis of neuropathy, nerve conduction studies (NCS) and F-wave disclosed no abnormalities. However, the short latency somatosensory evoked potential (S-SEP) in the tibial nerve revealed a significant delay in the P15 latency, which is indicative of neuropathy affecting proximal potion of the peripheral nerve. To our knowledge, only a few reports described proximal neuropathy associated with Castleman disease. In our case, the examination of S-SEP was very informative to make a diagnosis of neuropathy.
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Ergul E, Korukluoglu B, Yalcin S, Ozgun YM, Kusdemir A. Castleman's disease of the duodenum. J PAK MED ASSOC 2008; 58:704-706. [PMID: 19157330] [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: 05/27/2023]
Abstract
Castleman's disease is a rare lymphoproliferative disorder of uncertain origin. Just two cases of Castleman's disease of the gastrointestinal tract have been reported. These were found in the stomach. However, as far as we know, Castleman's disease of the duodenum has not been reported. This is the first report of hyaline vascular subtype of Castleman's disease at the duodenum.
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Affiliation(s)
- Emre Ergul
- General Surgery Department, Ankara Ataturk Teaching and Research Hospital, Ankara, Turkey
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Sullivan RJ, Pantanowitz L, Casper C, Stebbing J, Dezube BJ. HIV/AIDS: epidemiology, pathophysiology, and treatment of Kaposi sarcoma-associated herpesvirus disease: Kaposi sarcoma, primary effusion lymphoma, and multicentric Castleman disease. Clin Infect Dis 2008; 47:1209-15. [PMID: 18808357 PMCID: PMC2700291 DOI: 10.1086/592298] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.5] [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] [Indexed: 01/07/2023] Open
Abstract
Kaposi sarcoma-associated herpesvirus infection is associated with the development of 3 proliferative diseases: Kaposi sarcoma, primary effusion lymphoma, and multicentric Castleman disease. These conditions are also intimately associated with human immunodeficiency virus infection, and important synergistic interactions between these 2 viruses have been described. Despite differences in viral gene expression patterns in each condition, Kaposi sarcoma-associated herpesvirus encodes similar oncogenic proteins that promote the activation of sequential and parallel signaling pathways. Therapeutic strategies have been implemented to target these unique signaling pathways, and this sort of molecular targeting is the focus of many current research efforts. The scope of this review is to present contemporary knowledge about the epidemiology, virology, and immunology of Kaposi sarcoma-associated herpesvirus and to highlight several key oncogene products that may be targets for chemotherapy.
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Affiliation(s)
- Ryan J. Sullivan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Division of Hematology/ Oncology, Boston, MA, USA
| | - Liron Pantanowitz
- Baystate Medical Center, Tufts University School of Medicine, Department of Pathology, Springfield, MA, USA
| | - Corey Casper
- Departments of Medicine and Epidemiology, University of Washington, and the Vaccine and Infectious Disease Institute, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Justin Stebbing
- Imperial College School of Science, Technology and Medicine, Department of Medical Oncology, The Hammersmith Hospitals NHS Trust, London, UK
| | - Bruce J. Dezube
- Beth Israel Deaconess Medical Center, Harvard Medical School, Division of Hematology/ Oncology, Boston, MA, USA
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Kumar D. Unusual presentation of hyaline vascular Castleman's disease. J Assoc Physicians India 2008; 56:557-558. [PMID: 18846915] [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: 05/26/2023]
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Westhoff M, Litterst P, Freitag L, Baumbach JI. Ion mobility spectrometry in the diagnosis of sarcoidosis: results of a feasibility study. J Physiol Pharmacol 2007; 58 Suppl 5:739-751. [PMID: 18204189] [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: 05/25/2023]
Abstract
A feasibility study with ion mobility spectrometry (IMS) was started to find characteristic peaks of volatile organic compounds in exhaled air of 10 mL sampling volume, which might be relevant for the diagnosis of sarcoidosis. Therefore, breath samples of 9 patients with sarcoidosis and suspicion of sarcoidosis because of mediastinal lymph node enlargement were investigated. The 5 patients with confirmed sarcoidosis showed a highly congruent distribution of metabolites in exhaled air which was different in main component analyses from patients with unspecific mediastinal lymph node enlargement. These results are a first step in breath analysis by IMS in patients with sarcoidosis. The IMS as a new method in breath analysis and the first results of the investigations are presented and discussed in detail.
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Chahin N, Zeldenrust SR, Amrami KK, Engelstad JK, Dyck PJB. Two causes of demyelinating neuropathy in one patient: CMT1A and POEMS syndrome. Can J Neurol Sci 2007; 34:380-5. [PMID: 17803044 DOI: 10.1017/s0317167100006892] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Saritas U, Ustundag Y, Isitan G, Bastugrul S, Erekul S. Abdominal Castleman disease with mixed histopathology in a patient with iron deficiency anemia, growth retardation and peliosis hepatis. Am J Med Sci 2006; 331:51-4. [PMID: 16415667 DOI: 10.1097/00000441-200601000-00015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In Castleman disease, also known as giant lymph node hyperplasia, lesions are usually located in the chest. Peliosis hepatis is the presence of multiple blood-filled cysts in the liver. The combination of these two disorders in one patient is rare, with only three cases reported to date. We report the case of a 21-year-old man who presented with growth retardation and iron deficiency anemia. Work-up revealed hepatomegaly and multiple conglomerated giant lymph nodes near the splenic hilum. Once the mass was surgically removed, the patient's anemia rapidly resolved and he showed catch-up growth. The lymphoid tissue exhibited mixed histologic type, so the patient was diagnosed with both hyaline vascular type and plasma cell type Castleman disease. A liver biopsy obtained at surgery showed sinusoidal dilatation and blood-filled cysts, indicating peliosis hepatis. This is the fourth documented case of peliosis hepatis associated with Castleman disease. In addition to describing the case features, we discuss the possible pathogenesis of peliosis hepatis in the setting of Castleman disease.
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Affiliation(s)
- Ulku Saritas
- Division of Gastroenterology, Ankara Numune Hospital, Turkey
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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.
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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.
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Abstract
Castleman's disease is a lymphoreticular disorder, often localized and clinically silent. Systemic manifestations may occur. Castleman's disease may be associated with pathologies such as POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes), AIDS, amyloidosis, pemphigus vulgaris, and other types of cancer such as lymphoma and Kaposi's sarcoma. Careful preoperative evaluation is required to determine whether associated mediastinal or spinal canal masses or haematological disorders are present. The significance of these pathologies for anaesthetic management is discussed. We present the case of a 27-year-old female patient with Castleman's disease (hyaline-vascular variant) requiring vaginal reconstruction due to recurrent sores and synechiae.
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Affiliation(s)
- C Suan Rodriguez
- Virgen del Rocio University Hospital (Maternity Hospital), Seville, Spain
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Kojima M, Nakamura S, Iijima M, Murayama K, Sakata N, Masawa N. Lymphoid variant of hyaline vascular Castleman's disease containing numerous mantle zone lymphocytes with clear cytoplasm. APMIS 2005; 113:75-80. [PMID: 15676019 DOI: 10.1111/j.1600-0463.2005.apm1130112.x] [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: 11/28/2022]
Abstract
We report two unusual cases of hyaline vascular type Castleman's disease showing a pale clear cuff of mantle zone lymphocytes presenting a marginal zone distribution pattern. These cells had medium-sized round or slightly indented nuclei and a moderate amount of clear cytoplasm. The histopathologic findings in our cases were similar to those of nodal marginal zone B-cell lymphoma. However, immunohistochemistry demonstrated that both the mantle zone lymphocytes and the pale cuff of the lymphoid cells were CD20+, CD79a+, sIgM+, sIgD+, CD5-, CD10-, CD43-, CD45RO-, Bcl-2+, Bcl-6- and cyclin D1-. The polytypic nature of these cells was demonstrated by immunohistochemistry and polymerase chain reaction. Reactive lymph node lesions only rarely show mantle cell hyperplasia with clear cytoplasm. This unusual mantle cell hyperplasia with clear cytoplasm associated with a hyaline vascular type of Castleman's disease should be differentiated from nodal marginal zone B-cell lymphoma, mantle cell lymphoma and follicular lymphoma. To avoid overdiagnosis and overtreatment, it is suggested that immunophenotypic and genotypic studies might be required, and furthermore careful attention should be paid to the morphologic examination.
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Affiliation(s)
- Masaru Kojima
- Pathology and Clinical Laboratories, Gunma Cancer Center Hospital, Ohta, Japan.
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Kiyuna A, Sunagawa T, Hokama A, Touyama M, Tomiyama R, Sakugawa H, Kinjo F, Saito A. Nodular regenerative hyperplasia of the liver and Castleman's disease: potential role of interleukin-6. Dig Dis Sci 2005; 50:314-6. [PMID: 15745091 DOI: 10.1007/s10620-005-1601-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [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: 12/23/2022]
Affiliation(s)
- Ayako Kiyuna
- First Department of Internal Medicine, University of the Ryukyus, Okinawa, Japan
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Abstract
BACKGROUND Castleman's disease (CD) is a rare low-grade B-cell lymphoproliferative disorder that can be associated with a variety of antibody-mediated paraneoplastic syndromes. The disease is classified clinically by two forms and three histologic variants. METHODS We describe the clinical and pathological features of a 44-year-old woman who presented with an autoimmune hemolytic anemia, thrombocytosis, polyclonal gammopathy, axillary lymphadenopathy, hepatosplenomegaly, and several erythematous and violaceous nodules and plaques without scaling involving the trunk and extremities. RESULTS Histologic examination of the skin lesions revealed a deep dermal and subcutaneous nodular mononuclear infiltrate composed primarily of polyclonal plasmacytoid cells without atypia and an increased vascular proliferation. Additional studies including a bone marrow and lymph node biopsy, serum and urine protein electrophoresis, and computed tomography scans supported the diagnosis of multicentric plasma cell variant of CD with an associated autoimmune paraneoplastic hemolytic anemia. CONCLUSION Cutaneous involvement in CD is part of the multicentric nature and should be considered in the differential diagnosis of a polyclonal plasma cell-rich lymphoproliferative disorder associated with paraneoplastic autoimmune disease.
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Affiliation(s)
- Walter M Klein
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Masjuan Vallejo J, Herrero Valverde A, Mera Campillo J, López Jiménez J. [POEMS Syndrome with central and peripheric nervous system demyelination]. Neurologia 2003; 18:465-9. [PMID: 14615950] [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: 04/27/2023] Open
Abstract
POEMS syndrome is characterized by polyneuropathy, organomegaly, endocrinopathy, monoclonal protein and skin changes. This polyneuropathy belongs to the chronic inflammatory demyelinating polyradiculoneuropathies (CIDP) group. Sporadic reports have emphasized the clinical association between CIDP and central nervous system (CNS) demyelination, but as far as we know not in the context of POEMS syndrome. We report the case of a 67 years old patient who developed POEMS syndrome associated to Castleman's disease, characterized by demyelinating polyradiculoneuropathy, hepatosplenomegaly, mediastinal and supraclavicular adenopathies and monoclonal IgG lambda gammapathy. Cranial magnetic resonance imaging disclosed diffuse alteration of the cerebral white matter highly suggestive of demyelination. CNS demyelination can be another feature of POEMS syndrome. Cranial MRI should be performed in patients with POEMS syndrome in order to verify this new feature.
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Abstract
BACKGROUND Castleman's disease (CD), a rare condition of uncertain etiology, involves a massive proliferation of lymphoid tissues and typically presents as mediastinal masses. We describe a patient with CD who presented with diffuse adenopathy involving the inguinal, paratracheal, retroperitoneal, axillary, and pelvic regions. CASE PRESENTATION Case report describing presentation, work-up, management and clinical course of a patient with Castleman's disease in the setting of a county hospital in metropolitan area. Patient was treated with chemotherapeutic agents. CONCLUSIONS To our knowledge, this represents the first case of CD involving an HIV-positive patient with a negative Human Herpes Virus (HHV-8) viral panel. Because patients with similar clinical histories are at high risk for the development of non-Hodgkin's lymphoma and Kaposi sarcoma, regular medical surveillance is recommended.
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Affiliation(s)
- Ifeoma S Izuchukwu
- Department of Social and Preventive Medicine, State University of New York at Buffalo, 276 Farber Hall, Buffalo, NY. USA
- Department of Internal Medicine, State University of New York at Buffalo, 462 Grider Street, Buffalo, NY 14215. USA
- Division of Cancer Prevention & Population Sciences, Roswell Park Cancer Institute, Buffalo, NY 14263. USA
| | - Kamal Tourbaf
- Department of Internal Medicine, State University of New York at Buffalo, 462 Grider Street, Buffalo, NY 14215. USA
- Department of Hematology & Oncology, ECMC, 462 Grider Street, Buffalo, NY 14215. USA
| | - Martin C Mahoney
- Department of Social and Preventive Medicine, State University of New York at Buffalo, 276 Farber Hall, Buffalo, NY. USA
- Department of Family Medicine, State University of New York at Buffalo, ECMC Clinical Center, 462 Grider Street, Buffalo, NY 14215. USA
- Division of Cancer Prevention & Population Sciences, Roswell Park Cancer Institute, Buffalo, NY 14263. USA
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Abstract
Multicentric Castleman's disease (MCD) is a rare lymphoproliferative disorder of unknown etiology. Although HHV-8 (human herpesvirus type 8) has been suggested as a possible etiologic agent in a subpopulation of cases, appropriate treatment of the HHV-8 infection has not produced regression of the disease. Additionally, other treatment modalities, including steroids and various regimens of chemotherapy, do not consistently provide good control of the disease. Clinical signs and symptoms of the disease are primarily mediated by cytokines, especially interleukin-6 (IL-6). We report a case of multicentric Castleman's disease that responded dramatically to single agent thalidomide. A powerful cytokine disruptor, thalidomide may have good therapeutic efficacy in treating MCD and related cytokine-mediated disorders.
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Affiliation(s)
- Fa-Chyi Lee
- Department of Internal Medicine, Division of Hematology/Oncology, University of New Mexico, 900 Camino de Salud, Albuquerque, NM 87131, USA.
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Sun H, Wang R, Bin H, Na J, Li L, Wang Y, Jiang X, Gao Y. [Localized Castleman disease with paraneoplastic pemphigus and pulmonary involvement: clinical features and histopathology]. Zhonghua Yi Xue Za Zhi 2002; 82:530-3. [PMID: 12133498] [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: 02/25/2023]
Abstract
OBJECTIVE To investigate the clinical, histopathologic and CT features of localized Castleman disease complicated with paraneoplastic pemphigus (PNP) and pulmonary involvement. METHODS The clinical, laboratory, histopathologic records and data of computed tomographic (CT) images of 4 patients of Castleman disease with PNP were reviewed. RESULTS All of the four patients presented with PNP which was confirmed by pathological and immunological studies and also developed lung abnormalities, including bronchiolitis obliterans (n = 3), lung abscess (n = 1) and multiple lung infarction (n = 1), 2 to 5 months after the onset of PNP. Castleman's tumor, which was found incidentally during routine examination, manifested as a solitary and huge mass (5 to 14 cm in size) which markedly enhanced homogeneously on CT in the retroperitoneum (n = 3) and mediastinum (n = 1). Histologically, three cases were of hyaline-vascular type and the other one was of mixed type. Complete remission of PNP occurred 2 weeks to 8 months after surgical resection of the tumor. The condition of two patients with bronchiolitis obliterans failed to be improved. They had been presenting dyspnea and irritable cough 3 to 15 months after surgery. CONCLUSION PNP and lung abnormalities are rare and severe complications of localized Castleman's disease. Early diagnosis and surgery are very important for prognosis.
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Affiliation(s)
- Hongyue Sun
- Department of Radiology, First Hospital, Peking University, Beijing 100034, China
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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.
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Affiliation(s)
- L Aaron
- Service de maladies infectieuses et tropicales, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris, France
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Röhrig G, Engel H, Noack F, Ganser A, Peest D. [Multilocular Castleman's Disease of the mixed type. An rare differential diagnosis in lymphadenopathy with weakness, weight loss and night-sweats]. Dtsch Med Wochenschr 2001; 126:1070-2. [PMID: 11602914 DOI: 10.1055/s-2001-17491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 10/16/2022]
Abstract
HISTORY AND CLINICAL FINDINGS A 36 years old nurse had been suffering from prolonged weakness, weight-loss of 6 kg, night-sweat and painful swelling of neck lymph nodes for one year. On admission she was in a reduced physical condition. Nuchal, cervical and inguinal lymphnodes were enlarged bilaterally. INVESTIGATIONS Computed tomography showed enlarged lymph nodes in the neck and inguinally. Histology of the biopsies revealed the diagnosis of the mixed variant of Castleman's Disease. TREATMENT AND COURSE A steroid treatment was initiated, administering 100 mg prednisone for 2 weeks, 75 mg for another 2 weeks and 50 mg for a month. The dose was then gradually reduced by steps of 10 mg. After 3 months the patient's physical state and lymph nodes were normalized. So treatment was terminated and the nurse was able to take up work again. CONCLUSION If confronted with general lymphadenopathy associated with B-symptoms even without fever a Castleman's Disease should be taken into consideration. The prognosis of the multivariant form is uncertain. Transformation to malignant lymphoma is frequent.
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Affiliation(s)
- G Röhrig
- Abt. für Hämatologie und Onkologie, Medizinische Hochschule Hannover, Germany
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Rieu P, Noël LH, Droz D, Beaufils H, Gessain A, Hermine O, Lesavre P. Glomerular involvement in lymphoproliferative disorders with hyperproduction of cytokines (Castleman, POEMS). Adv Nephrol Necker Hosp 2001; 30:305-31. [PMID: 11068649] [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: 02/18/2023]
Affiliation(s)
- P Rieu
- Service de Néphrologie, Hôpital Necker, Paris, France
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Abstract
BACKGROUND The term "Castleman's disease" (angiofollicular lymph node hyperplasia) comprises a heterogeneous clinicopathologic entity among lymphoproliferative disorders. CASE REPORT We present a rare case with retroperitoneal manifestations, and discuss several aspects of diagnosis, differential diagnosis, the clinical course and therapy of the disease. Finally, we summarize the actual knowledge about the pathogenesis of Castleman's disease.
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Affiliation(s)
- B Bleiber
- Onkologische Abteilung, Kantonsspital Luzern
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36
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Dănăilă C, Mihailovici MS. [Castleman's disease. Discussion related to case report]. Rev Med Chir Soc Med Nat Iasi 2000; 104:133-41. [PMID: 12089914] [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: 02/25/2023]
Abstract
Castleman's disease, also called angiofollicular hyperplasia was first described as a distinct entity by Castleman et al in 1956. Now there are described two forms, a localised and a multicentric one. All forms of disease share the same histopathological features with a highly characteristic angiofollicular lymphoid hyperplasia which is either hyalinovascular or plasmocytic. The clinical and biological signs are varied and heterogeneous. The disorder is of unknown origin, but interleukin 6 plays a central part in this disease. Despite the benignity of this "prelymphoma state", an aggressive course with poor prognosis occur usually in the multicentric form. We report a case of Castleman's disease, multicentric variant. This case provides the opportunity for discussing many aspects of this atypical lymphoproliferative disorder.
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Affiliation(s)
- C Dănăilă
- Clinica de Hematologie, Universitatea de Medicină şi Farmacie Gr.T. Popa Iaşi
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Nishimoto N, Sasai M, Shima Y, Nakagawa M, Matsumoto T, Shirai T, Kishimoto T, Yoshizaki K. Improvement in Castleman's disease by humanized anti-interleukin-6 receptor antibody therapy. Blood 2000; 95:56-61. [PMID: 10607684] [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: 02/14/2023] Open
Abstract
Castleman's disease, an atypical lymphoproliferative disorder, can be classified into 2 types: hyaline-vascular and plasma cell types according to the histologic features of the affected lymph nodes. The plasma cell type is frequently associated with systemic manifestations and is often refractory to systemic therapy including corticosteroids and chemotherapy, particularly in multicentric form. Dysregulated overproduction of interleukin-6 (IL-6) from affected lymph nodes is thought to be responsible for the systemic manifestations of this disease. Therefore, interference with IL-6 signal transduction may constitute a new therapeutic strategy for this disease. We used humanized anti-IL-6 receptor antibody (rhPM-1) to treat 7 patients with multicentric plasma cell or mixed type Castleman's disease. All patients had systemic manifestations including secondary amyloidosis in 3. With the approval of our institution's ethics committee and the consent of the patients, they were treated with 50 to 100 mg rhPM-1 either once or twice weekly. Immediately after administration of rhPM-1, fever and fatigue disappeared, and anemia as well as serum levels of C-reactive protein (CRP), fibrinogen, and albumin started to improve. After 3 months of treatment, hypergammaglobulinemia and lymphadenopathy were remarkably alleviated, as were renal function abnormalities in patients with amyloidosis. Treatment was well tolerated with only transient leukopenia. Histopathologic examination revealed reduced follicular hyperplasia and vascularity after rhPM-1 treatment. The pathophysiologic significance of IL-6 in Castleman's disease was thus confirmed, and blockade of the IL-6 signal by rhPM-1 is thought to have potential as a new therapy based on the pathophysiologic mechanism of multicentric Castleman's disease. (Blood. 2000;95:56-61)
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Affiliation(s)
- N Nishimoto
- Department of Medical Science I, School of Health and Sport Sciences, Osaka University, Suita-city, Osaka, Japan.
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Abstract
Multicentric Castleman's syndrome has an aggressive course with poor prognosis, and its treatment remains uncertain. We report a woman with multicentric Castleman's disease that was successfully treated with prednisone and retinoic acid.
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Fernández-Torre JL, Polo JM, Calleja J, Berciano J. Castleman's disease associated with chronic inflammatory demyelinating polyradiculoneuropathy: a clinical and electrophysiological follow-up study. Clin Neurophysiol 1999; 110:1133-8. [PMID: 10402101 DOI: 10.1016/s1388-2457(99)00053-x] [Citation(s) in RCA: 8] [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
Castleman's disease (CD), or angiofollicular lymph node hyperplasia, is a rare lymphoproliferative disorder that can be associated with peripheral neuropathy. We report the long-term follow-up of a patient with a chronic inflammatory demyelinating polyradiculoneuropathy complicating the mediastinal form of classic CD who improved notably with immunosuppressive therapy. Our findings suggest that serial electrophysiological studies may be useful for monitoring treatment efficacy.
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Affiliation(s)
- J L Fernández-Torre
- Servicio de Neurofisiología Clínica, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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Abstract
Castleman's disease is a relatively rare lymphoproliferative disease. We report an asymptomatic case of Castleman's disease isolated to the mesentery and detected incidentally by sonography. In this case, color Doppler sonography demonstrated an artery penetrating the mass's hilum, suggesting a lymphatic origin of the lesion, as well as fine accessory peripheral arteries, suggesting malignancy. To our knowledge, there has been no previous report of detailed color Doppler findings in Castleman's disease.
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Affiliation(s)
- K Konno
- First Department of Internal Medicine, Akita University School of Medicine, Japan
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Revuelta MP, Nord JA. Successful treatment of multicentric Castleman's disease in a patient with human immunodeficiency virus infection. Clin Infect Dis 1998; 26:527. [PMID: 9502499 DOI: 10.1086/517111] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- M P Revuelta
- Saint Vincent's Hospital and Medical Center, New York, New York 10011, USA
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43
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Abstract
A case of Castleman's disease in a patient with type I neurofibromatosis and pheochromocytoma is reported. The association of pheochromocytoma and neurofibromatosis is well documented, but uncommon. Castleman's disease has not been previously documented in a patient with neurofibromatosis or pheochromocytoma and may represent a previously unrecognized association of this disease. Castleman's disease is an interleukin-6 (IL-6) mediated B-cell proliferation. We postulate a relationship between pheochromocytoma IL-6 secretion and Castleman's disease. The relevant literature relating to this unusual case is reviewed.
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Affiliation(s)
- H T Stelfox
- Department of Medicine, The Toronto Hospital, Ontario, Canada
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Emad A. Prolonged fever as an unusual manifestation of the hyaline vascular type of Castleman's disease in the chest: report and review of the literature. Ann Hematol 1997; 75:161-4. [PMID: 9402850 DOI: 10.1007/s002770050335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Affiliation(s)
- P D Phatak
- Department of Medicine, University of Rochester School of Medicine & Dentistry, New York, USA
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Lee M, Hirokawa M, Matuoka S, Hasegawa H, Nanjo H, Matsushima T, Imatani H, Miura AB. Multicentric Castleman's disease with an increased serum level of macrophage colony-stimulating factor. Am J Hematol 1997; 54:321-3. [PMID: 9092689 DOI: 10.1002/(sici)1096-8652(199704)54:4<321::aid-ajh11>3.0.co;2-e] [Citation(s) in RCA: 8] [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: 02/04/2023]
Abstract
We describe a 74-year-old patient with multicentric Castleman's disease (MCD) whose serum macrophage colony-stimulating factor level was elevated. Serum levels of tumor necrosis factor-alpha and interleukin 6 were also elevated at presentation, and they returned to normal levels after chemotherapy. Although the total serum cholesterol level was below normal on admission, it increased after chemotherapy. These results suggest that the activation of monocytes or macrophages may be involved in certain pathological phenomena in MCD.
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Affiliation(s)
- M Lee
- Department of Internal Medicine, Hakodate Municipal Hospital, Hokkaido, Japan
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Abstract
UNLABELLED We describe the case history of a 13-year-old girl with chronic fatigue and prolonged microcytic anaemia. She received oral iron since the age of 11 but failed to respond to it. Laboratory studies revealed elevated C-reactive protein and hypergammaglobulinaemia. A large solitary mesenterial lymph node could be demonstrated by ultrasonography and CT. A diagnosis of Castleman disease was suspected and confirmed histologically. After surgical removal of the lymphoma the patient recovered completely. CONCLUSION Castleman disease should be considered in cases of chronic fatigue, unexplained fever, microcytic anaemia and hypergammaglobulinaemia.
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48
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Kamińska B, Gradowska L, Paczek L. [Interleukin 6 (IL-6)--clinical significance]. Pol Arch Med Wewn 1996; 95:270-6. [PMID: 8755859] [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: 02/02/2023]
Affiliation(s)
- B Kamińska
- Klinika Immunoterapii Z Instytutu Transplantologii AM w Warszawie
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Ribas A, Ribas-Mundó M. [Multicentric Castleman's disease. Current aspects of pathogenesis and treatment]. Sangre (Barc) 1995; 40:401-6. [PMID: 8553175] [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: 01/31/2023]
Affiliation(s)
- A Ribas
- Sección de Oncología Médica, Hospital General Universitari Vall d'Hebron, Barcelona
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50
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Soma T, Dunbar CE. In vivo models for studying the role of autocrine or paracrine growth factors in hematologic malignancies. Exp Hematol 1995; 23:385-8. [PMID: 7720810] [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: 01/26/2023]
Affiliation(s)
- T Soma
- Hematology Branch, National Heart, Lung and Blood Institute, NIH, Bethesda, MD 20892, USA
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