Castleman disease represents a group of polyclonal lymphoproliferative entities. Based on clinicopathological associations, the disease can now be clinically divided into two subtypes: unicentric disease and multicentric disease. The multicentric Castleman disease (MCD) involves multiple lymph nodes from different anatomical sites and represents the other 25% of cases, occurring in 5 out of 1 million patients. MCD is multifactorial and can be subdivided according to its clinical association. It is known that interleukin 6 (IL6) plays an important role in the constitution of iMCD symptoms. The cause of the increase in IL6 is unknown. MCD is commonly associated with constitutional symptoms such as night sweats, weight loss, ascites, and pleural effusion. The treatment for MCD is based on the use of IL6 inhibitors. Consideration should be given to the severity of symptoms present to determine the intensity of targeted therapy. Cytotoxic chemotherapy may be a possibility in cases of the disease with severe organ dysfunction. Data from a systematic review published in 2012 of 404 cases of surgery in DC and demonstrated that there was no long-term benefit if patients in the MCD group underwent resective surgery. New prospective research data are needed to further assess the role of surgery in MCD. A female patient, 25 years old, born in Várzea Paulista, SP, came to the mastology outpatient clinic of the University Hospital of Jundiaí in May 2021 with a complaint of the appearance of a hardened nodule in the left breast for 9 months, with progressive increase, pain on palpation, daily afternoon fever, and weight loss of 6 kg in 2 months. A breast ultrasound showed lymph node enlargement in the left infraclavicular region. Physical examination showed good general condition, conscious, oriented, left axilla with the presence of hardened, enlarged, and mobile lymph nodes of approximately 8 cm. She was tested for HIV, syphilis, and hepatitis B and C negative. B2 microglobulin: 2.4. Core biopsy and immunohistochemistry (IHC) were performed on lymph node enlargement, and the result was inconclusive. Computed tomography of the thorax and abdomen: supraclavicular and infraclavicular and axillary lymph node enlargement on the left, measuring the largest 5.7×2.5 cm and 5.9×4.4 cm, some compressing the subclavian vein on the left; paraortic and prevascular mediastinal lymph node enlargement; and presence of inguinal adenomegaly. The patient was undergoing an excisional biopsy in October 2021, whose IHC showed histological aspects of atypical proliferation of epithelioid cells in the context of chronic lymphadenopathy with regression of germinal centers. Fungal research and BAAR were negative. Such lymphoid features are similar to those identified in Castleman disease, hyaline-vascular form. The association of histopathology data, IHC, clinical picture, and the exclusion of other differential diagnoses allowed us to obtain the diagnosis of iMCD. Because of its primordial manifestation in the left armpit, it was essential to differentiate between lymphoma and occult breast carcinoma, since these are more common diagnoses in clinical practice and have a similar initial clinical picture.
Introduction: The axillary lymph node status is one of the most important prognostic factors in breast cancer. For locally advanced tumors, neoadjuvant chemotherapy favors higher rates of breast lumpectomy and downstaging tumor burden of axilla. The aim of this study was to evaluate the use of a standardized image-guided protocol after neoadjuvant chemotherapy to enable sentinel node dissection in patients with axillary downstaging, avoiding axillary dissection. Methods: Retrospective cohort study of data collected from medical records of patients who underwent neoadjuvant chemotherapy in a single center, from January 2014 to December 2018. The protocol comprises the placement of a metal clip in positive axillary lymph node, in patients with up to two clinically abnormal lymph nodes presented on imaging. After neoadjuvant chemotherapy, and once a radiologic complete response was achieved, sentinel node dissection was performed using blue dye and radiotracer. Axillary dissection were avoided in patients whose clipped sentinel node were negative for metastasis and in patients with three identified and negative sentinel node dissection. Results: A total of 471 patients were analyzed for this study: 303 before and 165 after the implementation of the protocol; 3 cases were excluded. The rate of sentinel node dissection in clinical nodes positive patients was statistically higher in this group when compared to patients treated before the protocol implementation (22.8% vs. 40.8%; p=0.001). Patients with triple negative and HER2-positive tumors underwent sentinel node dissection more frequently when compared to luminal tumors (p=0.03). After multivariate analysis, the variables that were associated with a greater chance of performing sentinel node dissection were clinical staging, type of surgery performed and implementation of the axillary assessment protocol. Conclusions: The results showed that the use of an easily and accessible image-guided protocol can improve sentinel node dissection in selected patients, even if the lymph node was positive previously to neoadjuvant treatment.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.