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Philip R, Cadro V, Aouba A, Chantepie S, Bracquemart C, Dumont A. VEXAS syndrome: A new mimicker of idiopathic multicentric Castleman disease. Joint Bone Spine 2024; 91:105731. [PMID: 38583690 DOI: 10.1016/j.jbspin.2024.105731] [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] [Received: 01/22/2024] [Revised: 03/05/2024] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Idiopathic Multicentric Castleman Disease (iMCD) is a complex and poorly understood pathophysiological entity, which encompasses a variety of conditions and can mimic or be associated with autoimmune/autoinflammatory diseases, making it challenging to diagnose and treat. Vacuoles, Enzyme E1, X-linked, Autoinflammatory, Somatic (VEXAS) syndrome is an adult-onset autoinflammatory disorder associated with hematological abnormalities and caused by acquired somatic mutations in the ubiquitin-like modifier activating enzyme 1 gene (UBA1) which shares several common clinical and biological signs with iMCD. In this article, we report a patient with VEXAS syndrome initially presenting as iMCD, questioning the link between these two entities. CASE DESCRIPTION We report here a patient initially presenting as iMCD, proved on lymph node histology, which turns out to have a mutation at the splice acceptor site of exon 3 of UBA1 exhibiting VEXAS syndrome with Castleman-like lymph node. CONCLUSION This is only the second case of VEXAS syndrome presenting as iMCD. VEXAS syndrome should therefore be considered in the presence of iMCD suspicion, including in cases of compatible histology.
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Affiliation(s)
- Rémi Philip
- Department of Clinical Immunology and Internal Medicine, Caen University Hospital, 14000 Caen, France; Normandie University, UNICAEN, Caen University Hospital, 14000 Caen, France.
| | - Vincent Cadro
- Normandie University, UNICAEN, CHU de Caen Normandie, Structure Fédérative d'Oncogénétique cyto-moléculaire (MOCAE), 14000 Caen, France
| | - Achille Aouba
- Department of Clinical Immunology and Internal Medicine, Caen University Hospital, 14000 Caen, France; Normandie University, UNICAEN, Caen University Hospital, 14000 Caen, France
| | - Sylvain Chantepie
- Department of Haematology, Caen University Hospital, 14000 Caen, France
| | - Claire Bracquemart
- Normandie University, UNICAEN, CHU de Caen Normandie, Structure Fédérative d'Oncogénétique cyto-moléculaire (MOCAE), 14000 Caen, France
| | - Anaël Dumont
- Department of Clinical Immunology and Internal Medicine, Caen University Hospital, 14000 Caen, France
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Chang LC, Fu PA, Wang SH, Chang KC, Hsu YT. Kaposi sarcoma herpesvirus/human herpesvirus 8-positive diffuse large B-cell lymphoma characterized by malignant ascites: A case report. Pathol Res Pract 2024; 255:155185. [PMID: 38342036 DOI: 10.1016/j.prp.2024.155185] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/13/2024]
Abstract
Herein, we report a rare case of Kaposi sarcoma herpesvirus/human herpesvirus 8 (KSHV/HHV8)-positive diffuse large B-cell lymphoma (DLBCL), which is characterized by malignant ascites and complex karyotypes. A 72-year-old male patient who tested negative for human immunodeficiency virus presented with thrombocytopenia and lymphadenopathies. He was diagnosed with KSHV/HHV8-associated multicentric Castleman disease (MCD). After three years, he developed progressive lymphadenopathies and massive ascites. The lymphoma cells in the ascitic fluid presented with characteristic immunophenotype and monoclonality, which support the diagnosis of KSHV/HHV8-positive DLBCL. Lymphadenopathies and massive splenomegaly are common manifestations of KSHV/HHV8-positive DLBCL. Nevertheless, peritoneal involvement, as observed in this case, is a rare presentation. This emphasizes the diagnostic complexities of KSHV/HHV8-associated lymphoproliferative disorders. Within the context of preexisting KSHV/HHV8-associated multicentric Castleman disease, the differential diagnosis of this disorder can be challenging.
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Affiliation(s)
- Li-Chang Chang
- Division of Hematology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
| | - Pei-An Fu
- Division of Hematology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
| | - Shu-Hsien Wang
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
| | - Kung-Chao Chang
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
| | - Ya-Ting Hsu
- Division of Hematology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 701401, Taiwan.
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Otoshi R, Kitamura H, Baba T, Muraoka T, Sekine A, Takemura T, Okudela K, Sawazumi T, Ogura T. Concordance between transbronchial lung cryobiopsy and surgical lung biopsy in patients with idiopathic multicentric Castleman disease: A report of four cases. Respir Investig 2024; 62:1-8. [PMID: 37925882 DOI: 10.1016/j.resinv.2023.09.002] [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: 04/13/2023] [Revised: 08/02/2023] [Accepted: 09/07/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Idiopathic multicentric Castleman disease (iMCD) is a rare polyclonal lymphoproliferative disease often associated with pulmonary involvement. Recently, transbronchial lung cryobiopsy (TBLC) has been reported to be useful for the diagnosis of diffuse interstitial lung disease. However, there have been no reports of pathological assessment of TBLC for iMCD. METHOD To clarify the efficacy of TBLC in the diagnosis of iMCD, we retrospectively reviewed four iMCD patients who had undergone both TBLC and surgical lung biopsy (SLB). RESULTS The median age was 44 years; 2 males and 2 females. Two or three TBLC specimens were taken from each patient. All patients had no complications other than minimal bleeding. The size of the TBLC specimens was approximately 5-6 × 3-4 mm, and the alveolar region, and centrilobular and perilobular areas were adequately sampled. As with SLB, the extent of lung lesions and inflammatory cell infiltration could be sufficiently evaluated by TBLC. The presence of lymphoid follicles could also be assessed by TBLC; however, the germinal centers with lymphoid follicles were difficult to evaluate. The TBLC specimens could also be evaluated for immunostaining, especially IgG4 immunostaining, to rule out IgG4-related lung disease. Pulmonary pathological grading showed a high concordance rate between major pathological findings of TBLC and SLB. The pathologist's confidence level of TBLC for the diagnosis of iMCD was high in all cases. CONCLUSIONS TBLC exhibits a high concordance rate with SLB in the pathological evaluation of iMCD, which may be useful for the diagnosis of iMCD.
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Affiliation(s)
- Ryota Otoshi
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan.
| | - Hideya Kitamura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Tomohisa Baba
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Tatsuya Muraoka
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Akimasa Sekine
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Tamiko Takemura
- Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Koji Okudela
- Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tomoe Sawazumi
- Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
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Hatano H, Tsujimoto Y, Watanabe H, Tsukada A, Izumi S, Nagasaka S, Igari T, Suzuki M, Iikura M, Hojo M. A case of idiopathic multicentric Castleman disease with pulmonary hyalinizing granuloma-like multiple pulmonary nodules. Respir Investig 2023; 61:405-408. [PMID: 37099891 DOI: 10.1016/j.resinv.2023.03.003] [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] [Received: 07/22/2022] [Revised: 03/01/2023] [Accepted: 03/15/2023] [Indexed: 04/28/2023]
Abstract
A 41-year-old man presented with chronic cough and chest pain. Laboratory tests revealed anemia, inflammation, hypoalbuminemia, polyclonal hypergammaglobulinemia, and elevated interleukin-6 levels. Computed tomography revealed diffuse bilateral pulmonary nodules and multicentric lymphadenopathy. Histopathology of the pulmonary nodule resembled pulmonary hyalinizing granuloma (PHG), whereas lymph node histopathology was consistent with idiopathic multicentric Castleman disease (iMCD). The patient was diagnosed with iMCD involving PHG-like pulmonary nodules. Little is known about the association between these two diseases, and the present case provides insights regarding the relationship between PHG and iMCD.
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Affiliation(s)
- Hiroto Hatano
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Yoshie Tsujimoto
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan.
| | - Hiromu Watanabe
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Akinari Tsukada
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Shinyu Izumi
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Satoshi Nagasaka
- Department of General Thoracic Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Toru Igari
- Pathology Division of Clinical Laboratory, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Manabu Suzuki
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Motoyasu Iikura
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Masayuki Hojo
- Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
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Darwish I, Costiniuk C, Kronfli N, Haegert D, Routy JP. Concurrent HIV viral blips during two episodes of multicentric Castleman disease in an adult on antiretroviral therapy: Implication for HIV persistence. IDCases 2021; 26:e01315. [PMID: 34786336 PMCID: PMC8577484 DOI: 10.1016/j.idcr.2021.e01315] [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: 04/01/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022] Open
Abstract
Human herpesvirus-8 (HHV8)-associated multicentric Castleman disease (HHV8-MCD) is a rare nonmalignant lymphoproliferative disorder most commonly observed in PLWH. Herein, we describe an HIV-infected adult male from Cameroon with relapsing HHV8-MCD (HIV+MCD). The patient developed constitutional symptoms, diffuse lymphadenopathy, thrombocytopenia and autoimmune hemolytic anemia. Excisional lymph node biopsy findings were consistent with HHV8-MCD. He was successfully treated with corticosteroids and rituximab. One year later, he developed relapsing disease and was successfully treated again with rituximab. Interestingly, HIV viral load blips correlate with MCD flares, suggesting that low-level viremia is linked with T-cell clonal expansion and/or inflammation, rather than a lack of effective antiretroviral therapy. Rituximab either alone or in combination with chemotherapy for aggressive disease is the standard of care, with approximately 95% of treated patients achieving complete remission. Despite highly effective therapy, HIV+MCD often presents with a relapsing and remitting disease course and carries an increased risk for the development of HHV8-associated lymphoma.
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Affiliation(s)
- Ilyse Darwish
- Division of Infectious Diseases, McGill University Health Centre, Montréal, Quebec, Canada
| | - Cecilia Costiniuk
- Division of Infectious Diseases, McGill University Health Centre, Montréal, Quebec, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montréal, Quebec, Canada
- Department of Microbiology and Immunology, McGill University, Montréal, Quebec, Canada
| | - Nadine Kronfli
- Division of Infectious Diseases, McGill University Health Centre, Montréal, Quebec, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montréal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada
| | - David Haegert
- Department of Pathology, McGill University Health Centre, Montréal, Quebec, Canada
| | - Jean-Pierre Routy
- Chronic Viral Illness Service, McGill University Health Centre, Montréal, Quebec, Canada
- Department of Microbiology and Immunology, McGill University, Montréal, Quebec, Canada
- Division of Hematology, McGill University Health Centre, Montréal, Quebec, Canada
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Cui X, Wu Y, Jia L, Chang J, Li C, Guo C, Zhang T, Ma Y, Zhang Y. A case of Castleman disease with hemophagocytic syndrome derived from HHV8 infection. Eur J Med Res 2021; 26:119. [PMID: 34602082 PMCID: PMC8489086 DOI: 10.1186/s40001-021-00589-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/16/2021] [Indexed: 12/24/2022] Open
Abstract
Background For a patient presenting with fever, multiple lymphadenopathy and splenomegaly, pathogen infection should be preferentially considered, followed by lymphoid malignancies. When traditional laboratory and pathological detection cannot find the pathogenic microorganism, metagenomic sequencing (MGS) which targets the person’s genome for exceptional genetic disorders may detect a rare pathogen. Case presentation Here, we introduced the diagnostic clue of a case of multicentric Castleman disease (MCD) with hemophagocytic syndrome which was elicited from the detection of human herpesvirus-8 in the blood of a HIV-1 infected person by MGS technology during pathogen inspection. This case highlights the need to increase the awareness of MCD among clinicians and pathologists. Conclusions MGS technology may play a pivotal role in providing diagnostic clues during pathogen inspection, especially when pathogens are not detectable by conventional methods.
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Affiliation(s)
- Xiao Cui
- Department of Infectious Diseases, Beijing You An Hospital, Capital Medical University, Beijing Institute of Hepatology, Beijing, 100069, China
| | - Yongfeng Wu
- Department of Infectious Diseases, Beijing You An Hospital, Capital Medical University, Beijing Institute of Hepatology, Beijing, 100069, China
| | - Lin Jia
- Department of Infectious Diseases, Beijing You An Hospital, Capital Medical University, Beijing Institute of Hepatology, Beijing, 100069, China
| | - Jing Chang
- Pathology Diagnostic Center, Beijing You An Hospital, Capital Medical University, Beijing, 100069, China
| | - Chuanyun Li
- Department of Hepatobiliary Surgery and You An Liver Transplant Center, Beijing You An Hospital, Capital Medical University, Beijing, 100069, China
| | - Caiping Guo
- Department of Infectious Diseases, Beijing You An Hospital, Capital Medical University, Beijing Institute of Hepatology, Beijing, 100069, China
| | - Tong Zhang
- Department of Infectious Diseases, Beijing You An Hospital, Capital Medical University, Beijing Institute of Hepatology, Beijing, 100069, China
| | - Yingmin Ma
- Department of Respiratory and Infectious Diseases, Beijing You An Hospital, Capital Medical University, Beijing Institute of Hepatology, Beijing, 100069, China
| | - Yulin Zhang
- Department of Respiratory and Infectious Diseases, Beijing You An Hospital, Capital Medical University, Beijing Institute of Hepatology, Beijing, 100069, China.
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Kaga H, Kurahashi H, Kubota A, Hatano Y, Nanjo H, Wakui H, Takahashi N. Successful rituximab treatment of an elderly Japanese patient with HHV8-positive, HIV-negative multicentric Castleman disease. Int J Hematol 2021. [PMID: 34591291 DOI: 10.1007/s12185-021-03222-7] [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: 06/04/2021] [Revised: 09/10/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
Human herpesvirus-8 (HHV8)-positive, human immunodeficiency virus (HIV)-negative multicentric Castleman disease (MCD) is a rare and age-related lymphoproliferative disorder caused by cytokine storm. Rituximab treatment is currently recommended because B-cell depletion eliminates the primary reservoir for HHV8. We report the first case of effective rituximab treatment of a Japanese patient (an 87-year-old woman) with this disorder. Her inflammatory symptoms and lymphadenopathy improved after medium-dose steroid therapy, but these symptoms recurred during steroid tapering. After one course of rituximab therapy, she achieved sustained remission. HHV8-associated MCD should be considered as a possible diagnosis in HIV-negative patients with inflammatory symptoms and lymphadenopathy.
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Kim HJ, Hong YH. Idiopathic multicentric Castleman disease presenting progressive reticular honeycomb infiltration of lung and immunoglobulin G and immunoglobulin G4 dominant hypergammaglobulinemia. Yeungnam Univ J Med 2021; 39:153-160. [PMID: 34218552 PMCID: PMC8913918 DOI: 10.12701/yujm.2021.01039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/25/2021] [Indexed: 11/11/2022] Open
Abstract
Multicentric Castleman disease (MCD) is an uncommon systemic lymphoproliferative disorder that may cause multiple organ damage. Castleman disease-associated diffuse parenchymal lung disease (DPLD) has not been well studied. A 32-year-old man was referred to our hospital for progressive generalized weakness, light-headedness, and dyspnea on exertion for more than one year. Laboratory evaluations showed profound anemia, an elevated erythrocyte sedimentation rate, and an increased C-reactive protein level with polyclonal hypergammaglobulinemia. Chest radiography, computed tomography (CT), and positron emission tomography-CT scan demonstrated diffuse lung infiltration with multiple cystic lesions and multiple lymphadenopathy. In addition to these clinical laboratory findings, bone marrow, lung, and lymph node biopsies confirmed the diagnosis of idiopathic MCD (iMCD). Siltuximab, an interleukin-6 inhibitor, and glucocorticoid therapy were initiated. The patient has been tolerating the treatment well and had no disease progression or any complications in 4 years. Herein, we report this case of human herpesvirus-8-negative iMCD-associated DPLD accompanied by multiple cystic lesions, multiple lymphadenopathy, and polyclonal hypergammaglobulinemia with elevated immunoglobulin G (IgG) and IgG4 levels. We recommend a close evaluation of MCD in cases of DPLD with hypergammaglobulinemia.
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Affiliation(s)
- Hyun-Je Kim
- Division of Rheumatology, Department of Internal Medicine, CHA Gumi Medical Center, CHA University, Gumi, Korea
| | - Young-Hoon Hong
- Division of Rheumatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
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Pribyl K, Vakayil V, Farooqi N, Arora N, Kreitz B, Ikramuddin S, Linden MA, Harmon J. Castleman disease: A single-center case series. Int J Surg Case Rep 2021; 80:105650. [PMID: 33631648 DOI: 10.1016/j.ijscr.2021.105650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 01/11/2023] Open
Abstract
Castleman disease is an overgrowth of lymphatic cells, usually in the chest or abdomen. Multicentric Castleman disease affects lymphatic cells throughout the body. HHV-8 and HIV have been associated with multicentric Castleman disease. Unicentric Castleman disease affects a single group of lymph nodes. Centricity is considered the most important indicator of patient outcomes.
Background Castleman disease (CD) is a rare lymphocytic disorder. Unicentric CD (UCD) has an excellent long-term prognosis after surgical excision; however, multicentric CD (MCD) has a severe clinical course with poor outcomes. Study design We analyzed the clinical presentation of 28 patients treated at a single institution from 1995 to 2017. Demographics, clinical variables, anatomical site, centricity, histopathology, immunochemistry, and surgical approach were reviewed. We evaluated the 5-year recurrence and survival for patients with UCD and MCD. Results Of the 28 patients, 57 % (n = 16) were female, with a mean age of 41.6 ± 15.6 years. CD was asymptomatic in 57 % (n = 16) of patients, 21 % (n = 6) presented with local symptoms such as pain, and 21 % (n = 6) of patients also had systemic symptoms, including weight loss and fever. CD was unicentric in 64 % (n = 18) and multicentric in 36 % (n = 10). The hyaline vascular variant was noted in 57 % (n = 16) of the tumors, plasmacytoid variant in 36 % (n = 10), and mixed variants in 7% (n = 2) of tumors. Anatomical distributions included: head and neck (20 %), thorax and axilla (24 %), retroperitoneal (13 %), abdominopelvic (30 %) regions, and other (13 %). Complete surgical resection was performed in 95 % of patients with UCD. Surgical biopsy and medical therapy were provided to all patients with MCD. The recurrence rate for UCD and MCD was 6 % (n = 1) and 14 % (n = 1), respectively. The five-year disease-free survival rate for UCD was 95 % (n = 19) and MCD was 33 % (n = 2). We found 100 % survival in patients with UCD and histology demonstrating the HV variant. Conclusion CD is rare and often misdiagnosed due to the absence of specific clinical symptoms. Surgeons should include CD in their differential diagnoses when evaluating patients with lymph node hyperplasia. Surgery can be curative in nearly all patients with UCD. Patients with MCD require a combination of surgical therapy, chemotherapy, and immunotherapy; however, cytoreductive surgery benefits for patients with MCD have not been established.
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Han PY, Chi HH, Su YT. Idiopathic multicentric Castleman disease with pulmonary and cutaneous lesions treated with tocilizumab: A case report. World J Clin Cases 2020; 8:4922-4929. [PMID: 33195662 PMCID: PMC7642568 DOI: 10.12998/wjcc.v8.i20.4922] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/24/2020] [Accepted: 09/05/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Human herpes virus-8 (HHV-8)-negative, idiopathic multicentric Castleman disease (iMCD) is a rare and life-threatening disorder driven by proinflammatory cytokines, which is still poorly understood. Pulmonary parenchyma lesion is a rare condition in iMCD, which mainly manifests as lymphocytic interstitial pneumonia and is an indicator of severe iMCD. Cutaneous lesion is also very rare and mainly occurs in Asians. There have been few reports of iMCD patients with both skin and lung parenchyma involvement.
CASE SUMMARY We present a Chinese man who complained about a 3-year history of intermittent dry cough and a 2-year history of diffuse reddish-brown maculopapules. Laboratory examination revealed polyclonal hypergammaglobulinemia and hypercytokinemia including interleukin 6. Chest computed tomography revealed small patchy shadows with ground-glass nodules scattered in two lobes and mediastinal lymphadenopathy. The pathological result of the lymph node was consistent with the plasma cell type of Castleman disease. As serum human immunodeficiency virus test and HHV-8 staining of the lymph node were negative, the patient was finally diagnosed with HHV-8 negative iMCD. He was treated with tocilizumab at an intravenous (i.v.) dose of 8 mg/kg every 2 wk combined with methylprednisolone at an i.v. dose of 80 mg/d initially with gradual dose tapering. Partial remission was achieved 9 mo later.
CONCLUSION iMCD with lung parenchyma and skin involvement is a rare condition that requires clinicians’ attention and awareness for early diagnosis.
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Affiliation(s)
- Ping-Yang Han
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Department of Rheumatology and Immunology, the Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, Zhejiang Province, China
| | - Hui-Hui Chi
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yu-Tong Su
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Wu YJ, Su KY. Updates on the diagnosis and management of multicentric Castleman disease. Tzu Chi Med J 2020; 33:22-28. [PMID: 33505874 PMCID: PMC7821823 DOI: 10.4103/tcmj.tcmj_15_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/13/2020] [Accepted: 04/27/2020] [Indexed: 12/28/2022] Open
Abstract
Multicentric Castleman disease (MCD) is an uncommon systemic lymphoproliferative disease. The diagnosis of this disease is typically challenging and requires collaboration between clinicians and pathologists. Moreover, it is important to exclude other diseases (such as malignancies, autoimmune diseases, and infectious diseases) that have similar clinical manifestations and pathological findings. Patients with untreated severe MCD have high mortality due to devastating cytokine storms. Thus, early diagnosis and prompt treatment is a key imperative. The diagnosis of MCD is based on the clinical signs of systemic inflammation, serological tests, and typical pathological features. In this review article, we provide an overview of MCD with a focus on the emerging evidence pertaining to its diagnosis and treatment.
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Affiliation(s)
- Ya-Ju Wu
- Division of Critical Care Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Kuei-Ying Su
- Division of Rheumatology and Immunology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
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Volkow-Fernández P, Lome-Maldonado C, Quintero-Buenrostro H, Islas-Muñoz B, Cornejo-Juárez P. HIV-associated multicentric Castleman disease: a report of 19 cases at an oncology institution. Int J STD AIDS 2020; 31:318-325. [PMID: 32089093 DOI: 10.1177/0956462420905277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The aim of this study is to describe the clinical characteristics and outcome of multicentric Castleman disease (MCD) in HIV-infected patients at an oncological referral center in Mexico. Clinical records at the HIV-AIDS clinic of all patients diagnosed with MCD from 1994 to 2018 were reviewed. There were 19 patients, mean age was 31.3 ± 8.4 years, and 17 (89.5%) were males. Fifteen patients (79%) had also Kaposi sarcoma (KS). Main clinical characteristics were multiple lymphadenopathy (95%), systemic symptoms (63%), and hepatosplenomegaly (50%). Computed tomography scan and 2-[18F]-fluoro-2-deoxy-d-glucose positron emission tomography showed multiple lymphadenopathy, inversion of the liver:spleen uptake ratio, with an increase in SUVmax (5.7). The histopathology report described plasma cells in 58%, mixed type in 26%, and hyaline vascular in 16%. Eleven patients (57.9%) received different chemotherapy regimens. Seven patients died (36.8%): four related to MCD progression or chemotherapy complications, median survival was eight months. For those patients who survived, median, follow-up was 28 months (p < 0.001). The incidence of MCD in people living with HIV is probably underestimated. In patients with lymphadenopathy, B symptoms, deranged inflammatory markers, and/or disseminated KS, a biopsy of an enlarged lymph node is warranted, and the histology should be reviewed by an experienced pathologist.
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Affiliation(s)
- P Volkow-Fernández
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - C Lome-Maldonado
- Pathology Department, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - H Quintero-Buenrostro
- Pathology Department, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - B Islas-Muñoz
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - P Cornejo-Juárez
- Infectious Diseases Department, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
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13
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Terao T, Yamamoto K, Ikeuchi K, Wakabayashi H, Igawa T, Inoue D, Oda W, Oyama T, Kamoi C, Sumii Y, Shiraishi Y, Yamamoto Y, Niiya D, Shiote Y, Sato Y, Yoshino T, Imajo K. [Hyper-IL-6 syndrome mimicking IgG4-related disease]. Rinsho Ketsueki 2019; 60:392-397. [PMID: 31168001 DOI: 10.11406/rinketsu.60.392] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Distinguishing between IgG4-related disease (IgG4-RD) and hyper-interleukin (IL) -6 syndrome, such as immune mediated conditions, autoimmune diseases, and idiopathic multicentric Castleman disease (iMCD) is challenging. Here, we report the case of a 69-year-old man with cervical lymphadenopathy who was admitted to our hospital and histologically diagnosed with hyper-IL-6 syndrome mimicking IgG4-RD phenotypically. Laboratory data detected polyclonal hypergammaglobulinemia comprising IgG, including IgG4 (2,350 mg/dl). Computed tomography revealed presence of systemic lymphadenopathy, enlarged bilateral submandibular glands, and infiltrative shadow in the right lower lung. Magnetic resonance imaging revealed diffusely enlarged pancreas the size of a sausage and hypointense rim on T2, suggesting autoimmune pancreatitis as part of IgG4-RD. Biopsy of the cervical lymph node revealed proliferation of IL-6-positive mature plasma cells in the expanded interfollicular area with an elevated IgG4+/IgG+ cell ratio (approximately 70%). These histological findings were consistent with hyper-IL-6 syndrome rather than IgG4-RD; however, the serum IL-6 level was slightly elevated. Bone marrow aspiration detected both IgG4- and IL-6-positive mature plasma cells. Although this case cannot be diagnosed as IgG4-RD because it failed to meet its diagnostic criteria, administration of oral prednisolone (0.5 mg/kg) resulted in rapidly improved lymphadenopathy, enlarged pancreas, and serological findings. This report can be helpful for the diagnostic assessment of polyclonal hypergammaglobulinemia conditions.
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Affiliation(s)
| | | | | | | | - Takuro Igawa
- Okayama University Graduate School of Medicine, Dept. of Pathology
| | - Dai Inoue
- Kanazawa University Graduate School of Medical Sciences, Dept. of Radiology
| | - Wakako Oda
- Okayama City Hospital, Dept. of Pathology
| | | | | | - Yuichi Sumii
- Okayama City Hospital, Dept. of Hematology/Oncology
| | | | | | - Daigo Niiya
- Okayama City Hospital, Dept. of Hematology/Oncology
| | | | - Yasuharu Sato
- Okayama University Graduate School of Medicine, Dept. of Pathology
| | - Tadashi Yoshino
- Okayama University Graduate School of Medicine, Dept. of Pathology
| | - Kenji Imajo
- Okayama City Hospital, Dept. of Hematology/Oncology
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14
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Nakayama H, Kikuchi T, Abe R, Tozawa K, Watanuki S, Shimizu T, Mitsuhashi T, Murata M, Okamoto S, Mori T. [Evans syndrome complicated with multicentric Castleman disease successfully treated with tocilizumab]. Rinsho Ketsueki 2019; 59:997-1001. [PMID: 30185717 DOI: 10.11406/rinketsu.59.997] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A 26-year-old man presented with fever, multiple lymphadenopathies, polyclonal hypergammaglobulinemia, and an elevated serum interleukin-6 (IL-6) level. Multicentric Castleman disease (MCD) was diagnosed by lymph node biopsy. Treatment with prednisolone (PSL) was initiated; however, its efficacy was limited. During PSL tapering, rapidly progressive anemia and thrombocytopenia developed concurrently with increased reticulocyte level, elevated serum LDH level, decreased haptoglobin level, and positive direct Coombs test. Based on these findings, Evans syndrome, which is a concurrent development of autoimmune hemolytic anemia and immune thrombocytopenia, was confirmed. The PSL dose was increased but was ineffective. Therefore, treatment with tocilizumab was initiated, and the clinical findings of both MCD and Evans syndrome improved. The clinical course of this case suggests that tocilizumab could be a treatment option for Evans syndrome complicated with MCD. Three other cases of Evans syndrome complicated with MCD have also been reported; however, this is the first case that shows the efficacy of tocilizumab as treatment for both MCD and Evans syndrome.
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Affiliation(s)
- Hitomi Nakayama
- Division of Hematology, Department of Medicine, Keio University School of Medicine
| | - Taku Kikuchi
- Division of Hematology, Department of Medicine, Keio University School of Medicine
| | - Ryohei Abe
- Division of Hematology, Department of Medicine, Keio University School of Medicine
| | - Keiichi Tozawa
- Division of Hematology, Department of Medicine, Keio University School of Medicine
| | - Shintaro Watanuki
- Division of Hematology, Department of Medicine, Keio University School of Medicine
| | - Takayuki Shimizu
- Division of Hematology, Department of Medicine, Keio University School of Medicine
| | | | - Mitsuru Murata
- Department of Laboratory Medicine, Keio University School of Medicine
| | - Shinichiro Okamoto
- Division of Hematology, Department of Medicine, Keio University School of Medicine
| | - Takehiko Mori
- Division of Hematology, Department of Medicine, Keio University School of Medicine
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15
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Abstract
Castleman disease (CD) is divided clinically into unicentric or multicentric type. Pathologically, CD is divided into hyaline-vascular and plasma cell variants. Unicentric CD is most common, about 75% of these cases are hyaline-vascular variant, and surgical excision is often curative. In contrast, there are a number of types of multicentric CD including HHV8-associated, idiopathic, and a subset of cases that arise in association with POEMS syndrome. Therapy is required for most patients with multicentric CD, but there is no consensus approach currently. As is evidence, the designation Castleman disease encompasses a heterogeneous group of diseases of varied pathogenesis and which require different therapies.
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Affiliation(s)
- Wei Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Soudet S, Fajgenbaum D, Delattre C, Forestier A, Hachulla E, Hatron PY, Launay D, Terriou L. Schnitzler syndrome co-occurring with idiopathic multicentric Castleman disease that responds to anti-IL-1 therapy: A case report and clue to pathophysiology. Curr Res Transl Med 2018; 66:83-86. [PMID: 30108026 DOI: 10.1016/j.retram.2018.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/17/2018] [Accepted: 06/10/2018] [Indexed: 01/09/2023]
Abstract
Patients with HHV-8-negative/idiopathic multicentric Castleman disease (iMCD) experience systemic inflammatory symptoms and polyclonal lymphoproliferation due to an unknown etiology. Schnitzler's syndrome (SS) is characterized by recurrent urticarial rash, monoclonal IgM gammopathy, and other clinical signs of inflammation. To our knowledge, we report the first case of iMCD associated with SS and the fourth case of anakinra inducing a complete response for an iMCD patient. A forty-four year old woman with a history of a recurrent urticarial rash, presented to our hospital complaining of 6 months of night sweats, fever, chronic urticaria, iliac bone pain, and generalized lymphadenopathy. An IgM Kappa monoclonal component was measured at 7.8g/L. A lymph node biopsy revealed histopathological features consistent with the plasma cell variant of iMCD. She was diagnosed with SS and iMCD. Anti-IL-1 treatment with anakinra (100mg/day) was introduced. Within 48h, we observed improvement in the fever and the urticarial rash. By one month, we considered the patient in complete remission. Two years later, the remission is persistent while the patient is still under therapy. Though this is only the fourth reported case of anakinra in iMCD, this is yet another case demonstrating the effectiveness of anti-IL-1 blockade in SS. We hypothesize that uncontrolled cytokine production is responsible for both the SS and the iMCD. The etiologies of SS and iMCD are unknown, and future research is necessary.
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Affiliation(s)
- Simon Soudet
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France.
| | - David Fajgenbaum
- Department of Medicine, Division of Translational Medicine & Human Genetics, Leonard Davis Institute of Health Economics, Orphan Disease Center, University of Pennsylvania, Philadelphia, USA
| | | | - Alexandra Forestier
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France
| | - Eric Hachulla
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France; University Lille, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France; Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), Lille, France
| | - Pierre Yves Hatron
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France; University Lille, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France; Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), Lille, France
| | - David Launay
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France; University Lille, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France; INSERM, U995, Lille, France; Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), Lille, France
| | - Louis Terriou
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France
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17
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Mizuno H, Sekine A, Oguro M, Oshima Y, Kawada M, Sumida K, Yamanouchi M, Hayami N, Suwabe T, Hiramatsu R, Hasegawa E, Hoshino J, Sawa N, Fujii T, Takaichi K, Ohashi K, Ubara Y. Renal histology in a patient with TAFRO syndrome: a case report. Hum Pathol 2018; 82:258-263. [PMID: 29626596 DOI: 10.1016/j.humpath.2018.03.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 12/06/2017] [Revised: 03/13/2018] [Accepted: 03/18/2018] [Indexed: 01/12/2023]
Abstract
An 84-year-old Japanese man was admitted due to anasarca, thrombocytopenia, systemic inflammation, and progressive renal insufficiency, resistance to diuretics, glucocorticoid therapy, and plasma exchange. Renal biopsy showed diffuse endocapillary proliferation and mesangiolysis without any immune deposits. Tocilizumab suppressed systemic inflammation, resulting in improvement of anasarca and renal dysfunction, but thrombocytopenia persisted and platelet-associated IgG antibody was elevated. Although romiplostim was effective for thrombocytopenia, the patient died of aspiration pneumonia after cerebral hemorrhage. Autopsy showed hyaline vascular-type Castleman disease-like lymphadenopathy and reticulin myelofibrosis with an increase of megakaryocytes. Renal finding showed that endocapillary injury improved, and collapsed glomeruli were noted. This patient fitted the criteria for TAFRO (thrombocytopenia [T], anasarca [A], fever [F], reticulin myelofibrosis [R], and organomegaly [O]) syndrome. The clinical course suggests that 2 factors, including overproduction of interleukin 6 and autoimmune-mediated thrombocytopenia via thrombopoietin receptor, may have contributed to the pathogenesis of TAFRO syndrome in this patient.
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Affiliation(s)
- Hiroki Mizuno
- Nephrology Center, Toranomon Hospital, Tokyo, 105-0001, Japan.
| | - Akinari Sekine
- Nephrology Center, Toranomon Hospital, Tokyo, 105-0001, Japan
| | - Masahiko Oguro
- Nephrology Center, Toranomon Hospital, Tokyo, 105-0001, Japan
| | - Yoichi Oshima
- Nephrology Center, Toranomon Hospital, Tokyo, 105-0001, Japan
| | - Masahiro Kawada
- Nephrology Center, Toranomon Hospital, Tokyo, 105-0001, Japan
| | - Keiichi Sumida
- Nephrology Center, Toranomon Hospital, Tokyo, 105-0001, Japan
| | | | - Noriko Hayami
- Nephrology Center, Toranomon Hospital, Tokyo, 105-0001, Japan
| | - Tatsuya Suwabe
- Nephrology Center, Toranomon Hospital, Tokyo, 105-0001, Japan
| | | | - Eiko Hasegawa
- Nephrology Center, Toranomon Hospital, Tokyo, 105-0001, Japan
| | - Junichi Hoshino
- Nephrology Center, Toranomon Hospital, Tokyo, 105-0001, Japan
| | - Naoki Sawa
- Nephrology Center, Toranomon Hospital, Tokyo, 105-0001, Japan
| | - Takashi Fujii
- Department of Pathology, Toranomon Hospital, Tokyo, 105-0001, Japan
| | - Kenmei Takaichi
- Nephrology Center, Toranomon Hospital, Tokyo, 105-0001, Japan; Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, 105-0001, Japan
| | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Tokyo, 105-0001, Japan; Department of Pathology, Yokohama City University Hospital Graduate School of Medicine, Yokohama, 236-0004, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital, Tokyo, 105-0001, Japan; Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, 105-0001, Japan
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18
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Hibi A, Mizuguchi K, Yoneyama A, Kasugai T, Kamiya K, Kamiya K, Ito C, Kominato S, Miura T, Koyama K. Severe refractory TAFRO syndrome requiring continuous renal replacement therapy complicated with Trichosporon asahii infection in the lungs and myocardial infarction: an autopsy case report and literature review. Ren Replace Ther 2018; 4:16. [PMID: 34171004 PMCID: PMC7149248 DOI: 10.1186/s41100-018-0157-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/22/2018] [Indexed: 01/09/2023] Open
Abstract
Background TAFRO (thrombocytopenia, anasarca, fever, reticulin myelofibrosis/renal failure, and organomegaly) syndrome is a systemic inflammatory disorder and unique clinicopathological variant of idiopathic multicentric Castleman disease that was proposed in Japan. Prompt diagnosis is critical because TAFRO syndrome is a progressive and life threating disease. Some cases are refractory to immunosuppressive treatments. Renal impairment is frequently observed in patients with TAFRO syndrome, and some severe cases require hemodialysis. Histological evaluation is important to understand the pathophysiology of TAFRO syndrome. However, systemic histopathological evaluation through autopsy in TAFRO syndrome has been rarely reported previously. Case presentation A 46-year-old Japanese man with chief complaints of fever and abdominal distension was diagnosed with TAFRO syndrome through imaging studies, laboratory findings, and pathological findings on cervical lymph node and bone marrow biopsies. Interleukin (IL)-6 and vascular endothelial growth factor (VEGF) levels were remarkably elevated in both blood and ascites. Methylprednisolone (mPSL) pulse therapy was initiated on day 10, followed by combination therapy with PSL and cyclosporine A. However, the amount of ascites did not respond to the treatment. The patient became anuric, and continuous renal replacement therapy was initiated from day 50. However, the patient suddenly experienced cardiac arrest associated with myocardial infarction (MI) on the same day. Although the emergent percutaneous coronary intervention was successfully performed, the patient died on day 52, despite intensive care. Autopsy was performed to ascertain the cause of MI and to identify the histopathological characteristics of TAFRO syndrome. Conclusions Bacterial peritonitis, systemic cytomegalovirus infection, and Trichosporon asahii infection in the lungs were observed on autopsy. In addition, sepsis-related myocardial calcification was suspected. Management of infectious diseases is critical to reduce mortality in patients with TAFRO syndrome. Although the exact cause of MI could not be identified on autopsy, we considered embolization by fungal hyphae as a possible cause. Endothelial injury possibly caused by excessive secretion of IL-6 and VEGF contributed to renal impairment. Fibrotic changes in anterior mediastinal fat tissue could be a characteristic pathological finding in patients with TAFRO syndrome.
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Affiliation(s)
- Arata Hibi
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi 448-8505 Japan
| | - Ken Mizuguchi
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi 448-8505 Japan
| | - Akiko Yoneyama
- Deaprtment of Pathology, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi 448-8505 Japan
| | - Takahisa Kasugai
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi 448-8505 Japan
| | - Keisuke Kamiya
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi 448-8505 Japan
| | - Keisuke Kamiya
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195 Japan
| | - Chiharu Ito
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi 448-8505 Japan
| | - Satoru Kominato
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi 448-8505 Japan
| | - Toshiyuki Miura
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi 448-8505 Japan
| | - Katsushi Koyama
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi 448-8505 Japan
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Abstract
Kaposi sarcoma herpesvirus (KSHV)-associated multicentric Castleman disease (MCD) is a rare, polyclonal lymphoproliferative disorder characterized by flares of inflammatory symptoms, edema, cytopenias, lymphadenopathy, and splenomegaly. Diagnosis requires a lymph node biopsy. Pathogenesis is related to dysregulated inflammatory cytokines, including human and viral interleukin-6. Rituximab alone or in combination with chemotherapy, such as liposomal doxorubicin, has led to an overall survival of over 90% at 5 years. Experimental approaches to treatment include virus activated cytotoxic therapy with high-dose zidovudine and valganciclovir and targeting human interleukin-6 activity. Despite successful treatment of KSHV-MCD, patients remain at high risk for developing non-Hodgkin lymphomas.
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Affiliation(s)
- Kathryn Lurain
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, Bethesda, MD 20892-1868, USA
| | - Robert Yarchoan
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, Bethesda, MD 20892-1868, USA
| | - Thomas S Uldrick
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, Bethesda, MD 20892-1868, USA.
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20
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Abstract
This review aims to describe some of the most frequent lymphoproliferative disorders arising from the lung: pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma, lymphomatoid granulomatosis (LG), multicentric Castleman disease (MCD), primary effusion lymphoma (PEL), and nodular lymphoid hyperplasia (NLH). Primary pulmonary lymphoma is defined as a clonal lymphoproliferative disorder affecting one or both lungs, without extrapulmonary involvement 3 months after diagnosis, and includes pulmonary MALT lymphoma and LG. MALT lymphoma is the most common pulmonary lymphoma. The disease is slow growing, most often asymptomatic, and revealed by chronic alveolar opacity on radiography. The diagnosis should involve minimally invasive techniques, and the prognosis is typically excellent. LG is a rare B-cell lymphoma driven by Epstein-Barr virus infection. The disease may mimic pulmonary vasculitis, often revealed by systemic signs. The diagnosis usually requires surgical lung biopsy. Its evolution is unpredictable, but median survival is poor and chemotherapy is usually proposed. MCD and PEL are both driven by Human herpesvirus 8 infection. Patients with MCD present with fever and lymphadenopathy associated with interstitial lung disease. PEL provokes a febrile, lymphocytic-exudative pleural effusion, without any pleural mass on CT. Specific chemotherapy is urgent for both MCD and PEL. NLH is a benign lymphoproliferative disorder of the lung that is usually asymptomatic and revealed by a single nodular opacity. The prognosis is good, without recurrence after surgical resection.
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Affiliation(s)
- Raphaël Borie
- Service de Pneumologie A, Centre de compétences maladies pulmonaires rares, AP-HP, Hôpital Bichat, Paris, France
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21
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Chadburn A, Said J, Gratzinger D, Chan JKC, de Jong D, Jaffe ES, Natkunam Y, Goodlad JR. HHV8/KSHV-Positive Lymphoproliferative Disorders and the Spectrum of Plasmablastic and Plasma Cell Neoplasms: 2015 SH/EAHP Workshop Report-Part 3. Am J Clin Pathol 2017; 147:171-187. [PMID: 28395104 DOI: 10.1093/ajcp/aqw218] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [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: 12/11/2022] Open
Abstract
OBJECTIVES The 2015 Workshop of the Society for Hematopathology/European Association for Haematopathology aimed to review immunodeficiency-related lymphoproliferative disorders with plasmablastic and plasma cell differentiation. METHODS The workshop panel reviewed human herpes virus 8 (HHV8)/Kaposi sarcoma herpesvirus (KSHV)-associated lesions and other lesions exhibiting plasma cell differentiation, including plasmablastic proliferations with features of myeloma/plasmacytoma, plasmablastic neoplasms presenting in extranodal sites and effusion-based lymphomas, and rendered a consensus diagnosis. RESULTS The spectrum of HHV8/KSHV-associated proliferations ranged from multicentric Castleman disease (MCD) to MCD with plasmablastic aggregates to HHV8+ diffuse large B-cell lymphoma and germinotrophic lymphoproliferative disorder. Comparisons across effusion-based lymphomas with and without HHV8/KSHV and plasmablastic lymphomas in immunodeficient and immunocompetent patients were discussed. CONCLUSIONS The presence or absence of HHV8/KSHV is a defining feature in disorders associated with Castleman disease, although their differential diagnosis and recognition of progression may be challenging. Plasmablastic proliferations overlap with myeloma/plasmacytoma as well as extranodal and effusion-based lymphomas. The involvement of Epstein-Barr virus is typically variable.
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Affiliation(s)
- Amy Chadburn
- From the Weill Medical College of Cornell University, New York, NY
| | - Jonathan Said
- University of California Los Angeles Medical Center, Los Angeles
| | | | | | - Daphne de Jong
- VU University Medical Center, Amsterdam, the Netherlands
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22
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Kantarci FEN, Eren R, Gündoğan C, Huq GE, Doğu MH, Suyanı E. A HHV-8 positive, HIV negative multicentric Castleman disease treated with R-CEOP chemotherapy and valganciclovir combination. J Infect Chemother 2016; 22:483-5. [PMID: 26948831 DOI: 10.1016/j.jiac.2016.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 01/03/2016] [Accepted: 01/05/2016] [Indexed: 11/25/2022]
Abstract
Multicentric Castleman disease (MCD) is a lymphoproliferative disorder characterized by systemic symptoms like recurrent lymphadenopathy, fever and hepatosplenomegaly. Human herpes virus 8 (HHV-8) can be associated with MCD whether the patient is infected with human immunodeficiency virus (HIV) or not. A 59-year-old male patient presented with fatigue, drowsiness and enlarged lymph nodes. Thoracic and abdominal computed tomography showed enlarged mediastinal, axillary, paracardiac, paraaortic, celiac, mesenteric, obturator and inguinal lymph nodes concomitant with enlarged liver and spleen. Cervical lymph node biopsy revealed HHV-8 positive plasma cell MCD. The patient's tests were negative for HIV. R-CEOP (rituximab, cyclophosphamide, etoposide, vincristin, prednisolone) and valganciclovir treatments were started simultaneously. After sixth cycle of R-CEOP, the patient achieved unconfirmed complete remission. Rituximab combined with CEOP protocol and antiviral therapy against HHV-8 might be an effective therapeutic approach without a considerable side effect for HHV-8-positive HIV-negative MCD patients.
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Affiliation(s)
| | - Rafet Eren
- İstanbul Training and Research Hospital, Hematology Department, Turkey
| | - Cihan Gündoğan
- İstanbul Training and Research Hospital, Nuclear Medicine Department, Turkey
| | - Gülben Erdem Huq
- İstanbul Training and Research Hospital, Pathology Department, Turkey
| | - Mehmet Hilmi Doğu
- İstanbul Training and Research Hospital, Hematology Department, Turkey
| | - Elif Suyanı
- İstanbul Training and Research Hospital, Hematology Department, Turkey.
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23
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Song K, Li M. Budd-Chiari syndrome, a rare complication of multicentric Castleman disease: A case report. Oncol Lett 2015; 9:2153-2156. [PMID: 26137030 DOI: 10.3892/ol.2015.3010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 02/02/2015] [Indexed: 11/06/2022] Open
Abstract
A 39-year-old female presented to The First Affiliated Hospital of Jishou University (Jishou, Hunan) with a fever of unknown origin and progressive abdominal distension. Physical examination revealed generalized lymphadenopathy, multiple non-tender cutaneous nodules, hepatomegaly, splenomegaly and abdominal edema. An axillary lymph node biopsy indicated hyaline vascular type Castleman disease, and color Doppler and computed tomography scans suggested Budd-Chiari syndrome (BCS). Based on the abdominal distension and impairments of the liver and kidneys, an inferior vena cavography and balloon dilatation were performed, confirming the diagnosis of BCS and leading to symptomatic improvement. The patient commenced a combination chemotherapy regimen of cyclophosphamide (0.4 g; days 1-3), vindesine (4 mg; day 1) and prednisolone (100 mg; days 1-5), with no melioration of symptoms. Theprubicin was added to suppress the aggravation of the disease on day six of the chemotherapy cycle. The patient exhibited symptomatic remission for one week, however, she subsequently succumbed to intracranial hemorrhage and infections of the lung and intestine due to long-term myelosuppression following chemotherapy. To the best of our knowledge, this is the first report of BCS in a patient with multicentric Castleman disease without human immunodeficiency virus infection.
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Affiliation(s)
- Kui Song
- Department of Hematology, The First Affiliated Hospital of Jishou University, Jishou, Hunan 416000, P.R. China
| | - Min Li
- Department of Pharmacy, The First Affiliated Hospital of Jishou University, Jishou, Hunan 416000, P.R. China
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Izumi Y, Takeshita H, Moriwaki Y, Hisatomi K, Matsuda M, Yamashita N, Kawahara C, Shigemitsu Y, Iwanaga N, Kawakami A, Kurohama H, Niino D, Ito M, Migita K. Multicentric Castleman disease mimicking IgG4-related disease: A case report. Mod Rheumatol 2014; 27:174-177. [PMID: 25528859 DOI: 10.3109/14397595.2014.985356] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 12/16/2022]
Abstract
A 50-year-old woman was referred to our hospital for shoulder joint stiffness. She had a history of polyclonal hypergammaglobulinemia and an elevated C-reactive protein level. Her laboratory data revealed an elevated serum immunoglobulin G4 (IgG4) level, hypergammaglobulinemia, and rheumatoid factor positivity in the absence of anticyclic citrullinated peptide antibody. [18F]-Fluorodeoxyglucose positron emission tomography showed significant [18F]-fluorodeoxyglucose uptake in multiple lymph nodes (axillary, hilar, para-aortic, and inguinal). Biopsy of the inguinal lymph node showed expansion of the interfollicular areas by heavily infiltrating plasma cells, consistent with multicentric Castleman disease (MCD). Immunohistochemical analysis revealed a 37.3% IgG4-positive:IgG-positive plasma cell ratio, indicating overlapping IgG4-related disease. However, serological cytokine analysis revealed elevated levels of interleukin-6 (9.3 pg/ml) and vascular endothelial growth factor (VEGF) (1210 pg/ml), which are compatible with MCD. Corticosteroid treatment resolved the serological and imaging abnormalities. IgG4-related disease can mimic MCD, and it is crucial to distinguish between these two diseases. Serum interleukin-6 and VEGF levels may help to discriminate MCD from IgG4-related disease.
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Affiliation(s)
- Yasumori Izumi
- a Departments of General Internal Medicine and Rheumatology , Nagasaki Medical Center , Omura City, Nagasaki , Japan
| | - Hayato Takeshita
- a Departments of General Internal Medicine and Rheumatology , Nagasaki Medical Center , Omura City, Nagasaki , Japan
| | - Yuji Moriwaki
- b Departments of Hematology , Nagasaki Medical Center , Omura City, Nagasaki , Japan
| | - Keiko Hisatomi
- c Departments of Respiratory Medicine , Nagasaki Medical Center , Omura City, Nagasaki , Japan
| | - Masakazu Matsuda
- a Departments of General Internal Medicine and Rheumatology , Nagasaki Medical Center , Omura City, Nagasaki , Japan
| | - Natsuki Yamashita
- a Departments of General Internal Medicine and Rheumatology , Nagasaki Medical Center , Omura City, Nagasaki , Japan
| | - Chieko Kawahara
- a Departments of General Internal Medicine and Rheumatology , Nagasaki Medical Center , Omura City, Nagasaki , Japan
| | - Yoshika Shigemitsu
- a Departments of General Internal Medicine and Rheumatology , Nagasaki Medical Center , Omura City, Nagasaki , Japan
| | - Nozomi Iwanaga
- a Departments of General Internal Medicine and Rheumatology , Nagasaki Medical Center , Omura City, Nagasaki , Japan
| | - Atsushi Kawakami
- d First Department of Internal Medicine , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Hirokazu Kurohama
- e Departments of Pathology , Nagasaki Medical Center , Omura City, Nagasaki , Japan
| | - Daisuke Niino
- e Departments of Pathology , Nagasaki Medical Center , Omura City, Nagasaki , Japan
| | - Masahiro Ito
- e Departments of Pathology , Nagasaki Medical Center , Omura City, Nagasaki , Japan
| | - Kiyoshi Migita
- a Departments of General Internal Medicine and Rheumatology , Nagasaki Medical Center , Omura City, Nagasaki , Japan
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Sasaki H, Maeda T, Hara Y, Osa M, Imai K, Moriguchi K, Mikita K, Fujikura Y, Kaida K, Kawana A. Human herpes virus-8-associated multicentric Castleman's disease in an HIV-positive patient presenting with relapsing and remitting hyponatraemia. Int J STD AIDS 2014; 26:909-11. [PMID: 25504830 DOI: 10.1177/0956462414562050] [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: 08/26/2014] [Accepted: 11/04/2014] [Indexed: 11/15/2022]
Abstract
We report a case of human herpes virus-8-associated multicentric Castleman's disease in an HIV-positive patient with hyponatraemia. A 65-year-old man was admitted with relapsing and remitting fever, scattered skin eruptions and hepatosplenomegaly following combination antiretroviral therapy for his HIV infection. Based on histopathological findings, he was diagnosed as having human herpes virus-8-associated multicentric Castleman's disease and was treated with four-weekly infusions of rituximab. Prior to receiving chemotherapy, we observed several suspected biomarkers of disease activity, positive correlations between plasma human herpes virus-8 viral load and the levels of plasma interleukin-6, C-reactive protein and soluble interleukin-2 receptor, and negative correlations between platelet count, albumin levels and especially serum sodium levels. We hypothesize that non-osmotic release of plasma antidiuretic hormone is a cause of hyponatraemia in human herpes virus-8-associated multicentric Castleman's disease and that relapsing and remitting hyponatraemia could be correlated with plasma human herpes virus-8 viral load.
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Affiliation(s)
- Hiroaki Sasaki
- Division of Infectious Diseases and Pulmonary Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Takuya Maeda
- Division of Infectious Diseases and Pulmonary Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Yu Hara
- Division of Infectious Diseases and Pulmonary Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Morichika Osa
- Division of Infectious Diseases and Pulmonary Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Kazuo Imai
- Division of Infectious Diseases and Pulmonary Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Kota Moriguchi
- Division of Neurology, Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Kei Mikita
- Division of Infectious Diseases and Pulmonary Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Yuji Fujikura
- Division of Infectious Diseases and Pulmonary Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Kenichi Kaida
- Division of Neurology, Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Akihiko Kawana
- Division of Infectious Diseases and Pulmonary Medicine, Department of Internal Medicine, National Defense Medical College, Saitama, Japan
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Courville EL, Sohani AR, Hasserjian RP, Zukerberg LR, Harris NL, Ferry JA. Diverse clinicopathologic features in human herpesvirus 8-associated lymphomas lead to diagnostic problems. Am J Clin Pathol 2014; 142:816-29. [PMID: 25389336 DOI: 10.1309/ajcpuli3w6wuggpy] [Citation(s) in RCA: 42] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Human herpesvirus 8 (HHV8)-associated lymphomas are uncommon, mainly affect men infected with the human immunodeficiency virus (HIV), and usually have a poor prognosis. We sought to characterize the HHV8+ lymphomas seen at our institution since the mid-1990s. METHODS We identified 15 patients with HHV8-associated lymphomas and evaluated their clinical and pathologic features. RESULTS Diagnoses included primary effusion lymphoma (PEL) (n = 2), extracavitary PEL (n = 8), intravascular large B-cell lymphoma (n = 1), HHV8+ plasmablastic microlymphoma (n = 3), and germinotropic lymphoproliferative disorder (GLD) (n = 1). The case of GLD progressed to a high-grade HHV8+ Epstein-Barr virus-positive lymphoma, an evolution that has not been previously reported. Four patients were HIV-(three from an HHV8-endemic area). Potentially misleading pathologic features in our series of extracavitary PEL included classic Hodgkin lymphoma-like features, lymph node sinus involvement, and T-cell antigen expression. CONCLUSIONS HHV8-associated lymphomas can be clinically and pathologically heterogeneous, with features that may lead to misdiagnosis as other types of lymphoma.
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Affiliation(s)
- Elizabeth L. Courville
- James Homer Wright Pathology Laboratories of the Massachusetts General Hospital, the Department of Pathology, Harvard Medical School, Boston, MA
| | - Aliyah R. Sohani
- James Homer Wright Pathology Laboratories of the Massachusetts General Hospital, the Department of Pathology, Harvard Medical School, Boston, MA
| | - Robert P. Hasserjian
- James Homer Wright Pathology Laboratories of the Massachusetts General Hospital, the Department of Pathology, Harvard Medical School, Boston, MA
| | - Lawrence R. Zukerberg
- James Homer Wright Pathology Laboratories of the Massachusetts General Hospital, the Department of Pathology, Harvard Medical School, Boston, MA
| | - Nancy L. Harris
- James Homer Wright Pathology Laboratories of the Massachusetts General Hospital, the Department of Pathology, Harvard Medical School, Boston, MA
| | - Judith A. Ferry
- James Homer Wright Pathology Laboratories of the Massachusetts General Hospital, the Department of Pathology, Harvard Medical School, Boston, MA
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Alzahrani M, Hull MC, Sherlock C, Griswold D, Leger CS, Leitch HA. Human immunodeficiency virus-associated multicentric Castleman disease refractory to antiretroviral therapy: clinical features, treatment and outcome. Leuk Lymphoma 2014; 56:1246-51. [PMID: 25093377 DOI: 10.3109/10428194.2014.935368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Human immunodeficiency virus (HIV)-associated multicentric Castleman disease (MCD) is a lymphoproliferation associated with human herpes virus-8 (HHV-8). Optimal treatment in patients not responding to antiretroviral therapy (ART) is undefined. We report 12 patients with ART refractory HIV-MCD. Patients with HIV-MCD were identified and baseline characteristics, treatment and outcome considered. Median CD4 count at HIV-MCD diagnosis was 295 (60-950) cells/mL. All patients had waxing and waning systemic symptoms, lymphadenopathy and/or splenomegaly, with non-Hodgkin lymphoma (NHL) in three. Treatment included: anti-HHV-8 therapy, n = 8; alone, n = 4; with systemic chemotherapy (CT) ± immunotherapy (IT), n = 4; CT ± IT only, n = 2. Initial median HHV-8 viral load (VL) was 7 × 10(4) copies/mL and at follow-up < 40 in 6/7 survivors; and 403-7.2 × 10(6) in 4/5 who died. One patient developed NHL despite an HHV-8 VL < 40. HIV-MCD is challenging to treat. Suppression of plasma HHV-8 VL did not prevent development of NHL. Anti-HHV-8 therapy should probably be considered adjunctive to cytotoxic therapies.
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Affiliation(s)
- Musa Alzahrani
- Hematology Program, University of British Columbia and King Saud University , Riyadh , Saudi Arabia
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Abstract
Castleman and Towne described a disease presenting as a mediastinal mass resembling thymoma. It is also known as "giant lymph node hyperplasia", "lymph node hamartoma", "angiofollicular mediastinal lymph node hyperplasia", and "angiomatous lymphoid hyperplasia". The pathogenesis is unknown, but the bulk of evidence points toward faulty immune regulation, resulting in excessive B-lymphocyte and plasma-cell proliferation in lymphatic tissue. In addition to the mediastinal presentation, extrathoracic involvement in the neck, axilla, mesentery, pelvis, pancreas, adrenal gland, and retroperitoneum also have been described. There are 2 major pathologic variations of Castleman disease: (1) hyaline-vascular variant, the most frequent, characterized by small hyaline-vascular follicles and capillary proliferation; and (2) the plasma-cell variant, in which large lymphoid follicles are separated by sheets of plasma cells. The hyaline-vascular cases usually are largely asymptomatic, whereas the less common plasma-cell variant may present with fever, anemia, weight loss, and night sweats, along with polyclonal hypergamma-globulinemia. Castleman disease is a rare lymphoproliferative disorders. Few cases have been described world widely. In this article we reviewed the classification, pathogenesis, pathology, radiological features and up to date treatment with special emphasis on the role of viral stimulation, recent therapeutic modalities and the HIV-associated disease.
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Affiliation(s)
- Ibrahiem Saeed-Abdul-Rahman
- Division of Nephrology, Department of Internal Medicine, King Fahd University Hospital, Dammam University, Al-Khobar, Saudi Arabia
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Seo HY, Kim EB, Kim JW, Shin BK, Kim SJ, Kim BS. Complete remission in a patient with human herpes virus-8 negative multicentric Castleman disease using CHOP chemotherapy. Cancer Res Treat 2009; 41:104-7. [PMID: 19707509 DOI: 10.4143/crt.2009.41.2.104] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 03/11/2009] [Indexed: 01/08/2023] Open
Abstract
Multicentric Castleman disease (MCD) is a rare lymphoproliferative disorder. Although MCD pathogenesis is unclear, studies have suggested that human herpesvirus 8 (HHV-8) may be associated with the disorder. Recent reports have identified MCD cases without viral infection. A 43-year-old woman presented to our hospital for fever and myalgia of 6 months' duration. The complete blood count revealed an elevated leukocyte count (15.1x10(3)/microL) and a decreased hemoglobin level of 10.0 g/dL. The C-reactive protein level was elevated at 276.5 mg/L. Thoracic computed tomography (CT) scans revealed bilateral axillary lymphadenopathy. There was no evidence of HHV-8, human immunodeficiency virus (HIV), or Mycobacterium infection. Histologic evaluation of a lymph node biopsy from the left axilla yielded a diagnosis of MCD. Cyclophosphamide, adriamycin, vincristine, and prednisone (CHOP) were administered for a total of 4 cycles. The patient's fever and lymphadenopathy resolved after the course of chemotherapy. She has been in complete remission for 24 months at this writing. As previously reported, this case report suggests that MCD can develop without viral infection. CHOP chemotherapy may be an effective treatment option for newly diagnosed MCD patients.
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Affiliation(s)
- Hee Yeon Seo
- Division of Oncology and Hematology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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