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Pedicelli A, Trombatore P, Bartolo A, Camilli A, Rossi ED, Scarcia L, Alexandre AM. Preoperative Direct Puncture Embolization of Castleman Disease of the Parotid Gland: A Case Report. Curr Oncol 2024; 31:2047-2056. [PMID: 38668054 PMCID: PMC11049360 DOI: 10.3390/curroncol31040151] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/17/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Castleman disease (CD) is an uncommon benign lymphoproliferative disease characterized by hypervascular lymphoid hyperplasia. We present a unique case of unicentric CD of the parotid gland treated by preoperative direct puncture embolization. CASE PRESENTATION A 27-year-old female patient was admitted for a right neck mass. Ultrasound examination and MRI scan documented a hypervascular mass within the right parotid gland. Preoperative embolization was performed by direct puncture technique: a needle was inserted into the core of the mass under both ultrasound and fluoroscopic guidance and SQUID 12 was injected into the mass under fluoroscopic control, achieving a total devascularization. CONCLUSION Preoperative direct puncture embolization was safe and effective and provides excellent hemostatic control during the surgical operation, limiting the amount of intraoperative bleeding.
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Affiliation(s)
- Alessandro Pedicelli
- UOSA Interventional Neuroradiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.P.); (A.M.A.)
| | - Pietro Trombatore
- U.O.C. Diagnostic Imaging, Interventional Radiology and Neuroradiology, Garibaldi Hospital, 95123 Catania, Italy;
| | - Andrea Bartolo
- Diagnostic and Therapeutic Neuroradiology Unit, IRCCS INM Neuromed, 86077 Isernia, Italy;
| | | | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, “Agostino Gemelli” School of Medicine, Catholic University of Sacred Heart, 00168 Rome, Italy;
| | - Luca Scarcia
- Department of Neuroradiology, Henri Mondor Hospital, 94000 Creteil, France
| | - Andrea M. Alexandre
- UOSA Interventional Neuroradiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.P.); (A.M.A.)
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Pertusa Mataix R, Loaiza Cabello D, García Morillo JS. [ Castleman's disease, pathophysiology, advances in diagnosis and treatment]. Med Clin (Barc) 2024; 162:283-290. [PMID: 38016855 DOI: 10.1016/j.medcli.2023.10.013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 11/30/2023]
Abstract
Castleman's disease (CD) encompasses a heterogeneous set of reactive lymphoproliferative processes that share well-defined histologic features. CD is considered a rare or minority disease. The incidence of CD is not fully known, although it is estimated at less than 1 per 100,000 inhabitants. It has a bimodal distribution (30-40 years and then 60-80 years). The incidence is similar in both sexes, although the unicentric variant seems to have a slight predominance in women with a 2:1 ratio. CD is classified into a hyalinovascular form (this being the most frequent) and a plasmocellular form, related to the HIV and VHH-8 viruses, which together with other autoimmune mechanisms develop hyperproduction of interleukin-6 (IL-6) by B lymphocytes. There are different lines of treatment, where the use of anti IL-6 stands out, being siltuximab the most used as orphan drug in this pathology.
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Affiliation(s)
- Roberto Pertusa Mataix
- Servicio de Medicina Interna, Departamento de Enfermedades Autoinmunes, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - Daniel Loaiza Cabello
- Servicio de Medicina Interna, Departamento de Enfermedades Autoinmunes, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - José Salvador García Morillo
- Servicio de Medicina Interna, Departamento de Enfermedades Autoinmunes, Hospital Universitario Virgen del Rocío, Sevilla, España
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Wu X, Zhang X, Qian S, Shi C, Li X, Feng X, Zhu L, Ge J, Li Z, Zhang M. The experience of diagnosis and treatment for TAFRO syndrome. Ann Hematol 2023; 102:3515-3520. [PMID: 37713125 DOI: 10.1007/s00277-023-05435-8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
Early identification, diagnosis and treatment of TAFRO syndrome are very importants. We retrospectively analysed 6 patients with TAFRO syndrome. Their clinical manifestations, treatment methods, survival and other aspects were summarized. All patients were pathologically diagnosed with Castleman's disease, with fever, an inflammatory storm state and varying degrees of anasarca. All patients received steroid therapy; four of them also received chemotherapy, and 1 received rituximab. Of the 3 patients with severe disease, only 1 patient who received the recommended dose of glucocorticoids survived. Early administration of glucocorticoids can improve the prognosis, especially in patients with severe disease, and adequate glucocorticoids are important.
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Affiliation(s)
- Xiaolong Wu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, 450052, Henan, People's Republic of China
| | - Xudong Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, 450052, Henan, People's Republic of China
| | - Siyu Qian
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, 450052, Henan, People's Republic of China
| | - Cunzhen Shi
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, 450052, Henan, People's Republic of China
| | - Xin Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, 450052, Henan, People's Republic of China
| | - Xiaoyan Feng
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, 450052, Henan, People's Republic of China
| | - Linan Zhu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, 450052, Henan, People's Republic of China
| | - Jingjing Ge
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, 450052, Henan, People's Republic of China
| | - Zhaoming Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, 450052, Henan, People's Republic of China
| | - Mingzhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China.
- Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, 450052, Henan, People's Republic of China.
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4
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Leite JM, Barrese TZ, Sementilli L, de Freitas LLL, do Espirito Santo KS, Delamain MT, Baiocchi OCCG, Brasil SAB, Chiattone CS. Clinical and histopathology characteristics of Castleman disease: a multicenter study of 51 Brazilian patients. Ann Hematol 2023. [PMID: 36763110 DOI: 10.1007/s00277-023-05116-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 01/26/2023] [Indexed: 02/11/2023]
Abstract
Castleman's disease (CD) is a rare and heterogeneous lymphoproliferative disorder, with limited available clinical information in Brazil. A retrospective study was carried out through information contained in the medical records of 51 patients, between July 1999 and June 2020. Seven patients were excluded, and 44 were analyzed in total. The average age of unicentric CD (UCD) patients was 35 years old and of multicentric CD (MCD) patients was 49 years old (p = 0.013). Regarding gender, there was a predominance of females among patients with UCD (68.4%) and males in patients with MCD (57.9%) (p = 0.103). The most common site of involvement in UCD was the cervical region (36.8%). A total of 73.7% of patients with UCD and 68.4% of patients with MCD presented the histological form hialyne-vascular (HV) (p = 0.499). Most patients with laboratory abnormalities had MCD. A total of 78% of the patients were asymptomatic, with the majority of symptomatic patients with MCD (p = 0.042). Only two of the 27 patients evaluated for the presence of human immunodeficiency virus (HIV) had positive serology. HHV-8 was evaluated in 14 cases, being positive in two. Of the patients with UCD, 94.7% underwent excisional biopsy, against only 41.2% of patients with MCD (p = 0.01). The mean follow-up was 61 months. We observed similarities in the clinical profile between patients in our study and patients described in the literature, such as gender, mean age, B symptoms, visceromegaly, fluid accumulation, and treatment. Unlike the literature, the cervical region was the most affected site, besides the greater association of the HV histological subtype among patients with MCD.
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Albesher MB, Alqahtani S, Alghamdi FR. Castleman disease: Report of a case and review of literature on role of preoperative embolization. Int J Surg Case Rep 2022; 95:107222. [PMID: 35661495 PMCID: PMC9511694 DOI: 10.1016/j.ijscr.2022.107222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/14/2022] [Accepted: 05/15/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Castleman disease, which was first described by Dr. Castleman in 1954, is relatively rare and represents a spectrum of heterogeneous lymphoproliferative disorders with characteristic histological features on biopsy. It is classified based on body location and histology with variable clinical presentations. Its treatment depends on the subtype, and preoperative embolization for Castleman disease has rarely been discussed in the literature. Presentation of case A 22-year old man presented to the ENT clinic with a four-week history of a mass on the left side of the neck, which was associated initially with headache, fever, and fatigue for 2 days. Contrast tomography and magnetic resonance imaging revealed a hypervascular mass located at levels two and three of the left side of the neck with feeding vessels from the external carotid artery. Preoperative embolization was planned; however, the neurointerventionist considered it a lymph node that did not need embolization. Surgical excision was performed with relatively increased operative time and bleeding. A biopsy confirmed a hyaline-vascular type Castleman disease. Discussion We reviewed the evidence-based management of CD. We reviewed the available literature on the role of preoperative embolization in management. Conclusion Based on published articles and the hypervascular nature of the disease, we believe that preoperative embolization helps decrease morbidity. Castleman disease is an angiofollicular lymph node hyperplasia and a form of lymphoproliferative disorder Different disease types have different clinical presentation and management Main treatment of unicentric castleman disease is surgical excision Castleman disease lymph nodes are highly vascular and are prone to intraoperative bleeding and need for blood transfusion Preoperative embolization can help reduce operation time and complications
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Affiliation(s)
- Meshal B Albesher
- Department of Otorhinolaryngology Head and Neck Surgery, Prince Sultan Military Medical City, Riyadh, 12233, Saudi Arabia.
| | - Saeed Alqahtani
- Department of Otorhinolaryngology Head and Neck Surgery, Prince Sultan Military Medical City, Riyadh, 12233, Saudi Arabia
| | - Fareed R Alghamdi
- Department of Otorhinolaryngology Head and Neck Surgery, Prince Sultan Military Medical City, Riyadh, 12233, Saudi Arabia
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Ferrero S, Ragaini S. Dichotomic response to interleukin-6 blockade in idiopathic multicentric Castleman disease: two case reports. J Med Case Rep 2021; 15:105. [PMID: 33676575 PMCID: PMC7937249 DOI: 10.1186/s13256-021-02726-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/10/2021] [Indexed: 01/15/2023] Open
Abstract
Background Human herpervirus-8/human immunodeficiency virus negative Idiopathic multicentric Castleman disease (iMCD) is a lymphoproliferative disorder sustained by a pro-inflammatory condition of hypercytokinemia mostly mediated by Interleukin-6 (IL-6). According to iMCD consensus guidelines, anti-IL-6 blockade should be the first-line therapy for iMCD. However, despite the existing therapeutic alternatives, a large proportion of iMCD patients still lacks an effective therapy. Case presentation Here, we report two real-life iMCD cases with a different response to IL-6 blockade. The first presented patient obtained a prompt resolution of symptoms and a complete regression of adenopathies after IL-6 blockade therapy administration. Conversely, the second patient did not respond neither to Rituximab and Etoposide association nor to IL-6 blockade therapy (both Siltuximab and Tocilizumab). Furthermore, Intravenous immunoglobulin, Cyclosporine A, Sirolimus and anti-Interleukin-1 Anakinra were all attempted without any results. Since no treatment was successful, after a further confirmation of iMCD diagnosis by a second lymph node biopsy, patient has been candidate for thalidomide, cyclophosphamide and prednisone association therapy. Conclusions The iMCD cases we reported are coherent with the evidences that IL-6 blockade is a safe and an effective therapy for iMCD. Despite this, more than half of patients do not respond to anti IL-6 drugs. In such cases, therapeutic alternatives could be represented by Sirolimus, targeting PI3K/AKT/mTOR signaling or by associations of conventional drugs such as thalidomide, cyclophosphamide and prednisone. However, the two reported iMCD cases, confirm the need to more deeply investigate iMCD pathogenesis and to better dissect the heterogeneity of the disease in order to develop novel, effective therapeutic strategies.
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Affiliation(s)
- Simone Ferrero
- Division of Hematology, AOU "Città della Salute e della Scienza di Torino", Torino, Italy. .,Department of Molecular Biotechnologies and Health Sciences, University of Torino, Via Genova 3, 10126, Torino, Italy.
| | - Simone Ragaini
- Division of Hematology, AOU "Città della Salute e della Scienza di Torino", Torino, Italy.,Department of Molecular Biotechnologies and Health Sciences, University of Torino, Via Genova 3, 10126, Torino, Italy
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8
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Paranavitane S, Gooneratne L, Chang T. Polyneuropathy, organomegaly, endocrinopathy, monoclonal band, and skin (POEMS) changes syndrome presenting with a pseudosensory level: a case report. J Med Case Rep 2019; 13:384. [PMID: 31878962 PMCID: PMC6933708 DOI: 10.1186/s13256-019-2309-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/13/2019] [Indexed: 01/09/2023] Open
Abstract
Introduction Polyneuropathy is a key feature of polyneuropathy, organomegaly, endocrinopathy, monoclonal band, and skin changes syndrome, which is a paraneoplastic manifestation of an underlying lymphoproliferative neoplasm. We report the first case of polyneuropathy, organomegaly, endocrinopathy, monoclonal band, and skin changes syndrome presenting with a pseudosensory level. Case presentation A 59-year-old Tamil woman with long-standing diabetes mellitus and hypertension developed painless, progressive inguinal lymphadenopathy. A contrast-enhanced computed tomography scan showed mild hepatomegaly and intra-abdominal lymphadenopathy. A histological examination of an enlarged inguinal lymph node showed features of a plasma cell-type Castleman disease. She was treated with rituximab. Six months later, she developed gradually ascending numbness and weakness of both lower limbs. On examination, she had flaccid paraparesis (power 3/5) with a sensory level to pinprick at thoracic level 9. Joint position sense was preserved. Her cranial nerves and upper limbs were neurologically normal. Nerve conduction studies confirmed peripheral neuropathy with conduction slowing and a magnetic resonance imaging of her spine did not show cord or root compression. Serum protein electrophoresis showed a monoclonal band. A bone marrow biopsy showed a hypercellular marrow with 30% plasma cells. A repeat contrast-enhanced computed tomography scan showed sclerotic bony lesions involving multiple vertebrae in addition to mild hepatomegaly and intra-abdominal lymphadenopathy. Polyneuropathy, organomegaly, endocrinopathy, monoclonal band, and skin changes syndrome was diagnosed and she was treated with intravenously administered pulse therapy of dexamethasone and cyclophosphamide. After three cycles of treatment, she regained normal muscle power and sensation. Conclusions Polyneuropathy in polyneuropathy, organomegaly, endocrinopathy, monoclonal band, and skin changes syndrome can present as a pseudosensory level.
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Affiliation(s)
- Shiran Paranavitane
- University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka.
| | - Lallindra Gooneratne
- Department of Pathology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Thashi Chang
- University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka.,Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Otani K, Inoue D, Fujikura K, Komori T, Abe-Suzuki S, Tajiri T, Itoh T, Zen Y. Idiopathic multicentric Castleman's disease: a clinicopathologic study in comparison with IgG4-related disease. Oncotarget 2018; 9:6691-6706. [PMID: 29467920 PMCID: PMC5805506 DOI: 10.18632/oncotarget.24068] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/03/2018] [Indexed: 02/06/2023] Open
Abstract
The present study aimed to compare clinicopathologic features between idiopathic multicentric Castleman's disease (n=22) and IgG4-related disease (n=26). Histology was analyzed using lymph node and lung biopsies. The expression of IL-6 mRNA in tissue was also examined by in situ hybridization and real-time PCR. Patients with idiopathic multicentric Castleman's disease were significantly younger than those with IgG4-related disease (p<0.001). Splenomegaly was observed in only idiopathic multicentric Castleman's disease (p=0.002), while pancreatitis and sialo-dacryoadenitis were restricted to IgG4-related disease (both p<0.001). Serum IgG4 concentrations were commonly elevated at >135 mg/dL in both groups (p=0.270). However, the IgG4/IgG ratio in IgG4-related disease was significantly higher than that in Castleman's disease (p<0.001). Histologically, sheet-like plasmacytosis was highly characteristic of idiopathic multicentric Castleman's disease (p<0.001), while plasmacytic infiltration in IgG4-related disease was always associated with intervening lymphocytes. Similar to laboratory findings, the IgG4/IgG-positive plasma cell ratio, but not the IgG4-positive cell count, was significantly higher in IgG4-related disease (p=0.002). Amyloid-like hyalinized fibrosis was found in 6/8 lung biopsies (75%) of Castleman's disease. The over-expression of IL-6 mRNA was not confirmed in tissue samples of Castleman's disease by either in situ hybridization or quantitative real-time PCR. In conclusion, useful data for a differential diagnosis appear to be age, affected organs, the serum IgG4/IgG ratio, sheet-like plasmacytosis in biopsies, and the IgG4/IgG-positive cell ratio on immunostaining. Since IL-6 was not over-expressed in tissue of idiopathic multicentric Castleman's disease, IL-6 may be produced outside the affected organs, and circulating IL-6 may lead to lymphoplasmacytosis at nodal and extranodal sites.
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Affiliation(s)
- Kyoko Otani
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Dai Inoue
- Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Kohei Fujikura
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Komori
- Department of Radiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Shiho Abe-Suzuki
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takuma Tajiri
- Department of Diagnostic Pathology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Tomoo Itoh
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoh Zen
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
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Abstract
The emergence of HIV/AIDS more than three decades ago led to an increased incidence of diseases caused by HHV8 co-infection, particularly Kaposi sarcoma, primary effusion lymphoma, and multicentric Castleman disease. Over time, the development of highly effective AIDS therapies has resulted in a decreased incidence of HHV8-associated entities, which are now more commonly found in patients with undiagnosed and/or untreated AIDS. Due to their rarity, some of these diseases may be difficult to recognize without appropriate clinical information. This article provides an overview of HHV8-related disorders, with a focus on their morphologic and phenotypic features, and includes a brief overview of laboratory methods used to detect HHV8. Disease mechanisms by which the HHV8 virion promotes tumorigenesis are also reviewed.
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Affiliation(s)
- Matthew Auten
- Department of Pathology, West Virginia University, United States.
| | - Annette S Kim
- Department of Pathology, Brigham and Women's Hospital, United States.
| | - Kyle T Bradley
- Department of Pathology & Laboratory Medicine, Emory University Hospital, 1364 Clifton Rd NE, Atlanta, GA 30322, United States.
| | - Flavia G Rosado
- Department of Pathology, West Virginia University, 1 Medical Center Dr, Room 2146F/HSC North, United States.
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Nugent DB, Webster D, Mabayoje D, Chung E, El Bouzidi K, O'Sullivan A, Ainsworth J, Miller RF. Use of plasma human herpesvirus-8 viral load measurement: evaluation of practice in three UK HIV treatment centres. Int J STD AIDS 2017; 28:188-191. [PMID: 28120699 DOI: 10.1177/0956462416676031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A retrospective audit of plasma human herpesvirus-8 (HHV-8) viral load testing was performed in three HIV treatment centres over 24 months. Reasons for testing (360 tests) were: symptoms of systemic inflammatory response syndrome (SIRS) (fever, lymphadenopathy and raised inflammatory markers); monitoring in known HHV-8 pathology other than Kaposi sarcoma (KS); investigation of known/suspected KS, and other/no reason. Of patients with multicentric Castleman disease (MCD), 14/16 (88%) had detectable plasma HHV-8, as did 27/45 (60%) with biopsy proven or clinically confirmed KS, and 6/19 (32%) with lymphoma. Neither of the two patients with MCD and no detectable HHV-8 had SIRS symptoms at the time of the test. There was wide variation between centres in the indications prompting HHV-8 testing, with a more conservative approach resulting in a higher proportion of positive results. Measuring plasma HHV-8 in the absence of SIRS symptoms, established HHV-8 disease monitoring, or confirmed/suspected KS is unlikely to yield detectable HHV-8 thus allowing potential cost savings.
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Affiliation(s)
- D B Nugent
- 1 Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - D Webster
- 2 Royal Free London NHS Foundation Trust, London, UK
| | - D Mabayoje
- 2 Royal Free London NHS Foundation Trust, London, UK
| | - E Chung
- 1 Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - K El Bouzidi
- 3 University College London Hospitals NHS Foundation Trust, London, UK.,4 University College London, London, UK
| | - A O'Sullivan
- 5 North Middlesex University Hospital NHS Trust, London, UK
| | - J Ainsworth
- 5 North Middlesex University Hospital NHS Trust, London, UK
| | - R F Miller
- 1 Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK.,3 University College London Hospitals NHS Foundation Trust, London, UK.,4 University College London, London, UK
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12
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Zawawi F, Varshney R, Haegert DG, Daniel SJ. Castleman's Disease: a rare finding in a pediatric neck. Int J Pediatr Otorhinolaryngol 2014; 78:370-2. [PMID: 24332608 DOI: 10.1016/j.ijporl.2013.11.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 11/13/2013] [Accepted: 11/17/2013] [Indexed: 12/31/2022]
Abstract
Castleman's Disease is a rare lymphoproliferative disorder. In the literature, only 29 cases, associated with the neck presentation in children, have been reported. This is another case report regarding a 5-year old child who presented with a persistent cervical lymphadenopathy. Final pathology, after undergoing exploratory neck dissection and surgical excision, revealed Castleman's Disease. This report, augmented with a literature review of all the 29 cases, compares the clinical course of this patient with the other cases. In conclusion, although Castleman's Disease carries a favorable prognosis in children, surgical excision is recommended to confirm the diagnosis and to rule out other causes.
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Affiliation(s)
- Faisal Zawawi
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada; King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Rickul Varshney
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - David G Haegert
- Department of Pathology, McGill University, Montreal, QC, Canada
| | - Sam J Daniel
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada.
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13
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Abstract
The association between Castleman's disease (CD) and cardiomyopathy has been rarely reported and the optimal therapeutic approach remains unknown. We report a previously healthy 20-year-old African American female who presented with fever, dyspnea, anasarca, and generalized lymphadenopathy. Diagnostic workup, including an axillary lymph node biopsy, revealed that she had human immunodeficiency virus-negative and human herpes virus-8-negative multicentric CD. She had a non-anaphylactoid infusion reaction during her fourth rituximab infusion. A few weeks later, she developed new-onset severe cardiomyopathy requiring inotropic therapy, warranting consideration for left ventricular assist device. Several clinical clues indicated her new-onset heart failure was a manifestation of her CD. Interestingly, a trial of tocilizumab (an anti-interleukin-6 receptor monoclonal antibody) resulted in complete resolution of her cardiomyopathy and other manifestations of CD. Tocilizumab received orphan drug approval for the treatment of CD in Japan, but is not yet approved for this indication in the United States. Clinicians should be aware of its potential clinical utility in CD.
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Affiliation(s)
- Louise Man
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
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