Clinicopathological comparison and therapeutic approach to Castleman disease—a case-based review

Wojtyś, Małgorzata; Piekarska, Agnieszka; Kunc, Michał; Ptaszyński, Konrad; Biernat, Wojciech; Zaucha, Jan Maciej; Waloszczyk, Piotr; Lisowski, Piotr; Kubisa, Bartosz; Grodzki, Tomasz

doi:10.21037/jtd.2019.10.73

Cited by 12 publications

(12 citation statements)

References 47 publications

(92 reference statements)

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“…IL-6 levels and the presence of human immunodeficiency virus should be evaluated as dysregulation of IL-6 and susceptibility of human herpesvirus-8 in those with human immunodeficiency virus are implicated in the development of CD [ 6 ]. Biopsy is the gold standard for the diagnosis of CD, and microscopic examination helps differentiate UCD “hyaline vascular variant” from MCD “plasma cell variant” [ 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

Castleman Disease Presenting as a Mediastinal Mass

García¹,

Fan²

2021

Cureus

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Castleman disease is a complex benign lymphoproliferative disorder characterized by the enlargement of a single lymph node or a group of lymph nodes. Its etiology is unclear, with the mechanism of action of IL-6 and HHV-8 implicated as possibly associated with the development of the disease. Diagnosis depends on the histopathological findings of the involved lymph nodes. Surgical resection can be curative, but a small number of cases may be unresectable and need radiation and chemotherapy with subsequent resection if possible.

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Section: Discussionmentioning

confidence: 99%

Castleman Disease Presenting as a Mediastinal Mass

García¹,

Fan²

2021

Cureus

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“…Unicentric Castleman disease, with a solitary focus of lymphadenopathy, may be successfully treated by excision of the affected overgrowth of lymphoid tissue. In unresectable or recurrent disease, other modalities such as radiotherapy, systemic corticosteroids and rituximab might be warranted [ 1 , 2 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Antiretroviral therapy should also be included for HIV-positive patients. Siltuximab is not recommended since the agent does not bind to viral IL-6 [ 1 , 2 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…It is categorized not only by the extent of involvement (unicentric or Open Access Case Report DOI: 10.7759/cureus.8967 multicentric), but also by pathology (hyaline-vascular, plasma cell or mixed cellularity). Multicentric Castleman disease is also classified by pathogenesis: idiopathic or human herpesvirus-8 (HHV-8)-related or POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal proteins and skin changes) syndrome-associated [1][2][3][4]. Castleman disease appears to be more common in Asians, especially Japanese, for reasons that are unclear.…”

Section: Introductionmentioning

confidence: 99%

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Afebrile Pneumonia in a Patient With Multicentric Castleman Disease on Siltuximab: Infection Without Fever on Anti-Interleukin-6 Therapy

Cohen¹,

Nikanjam

Kato

et al. 2020

Cureus

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Castleman disease is a lymphoproliferative disorder characterized by atypical lymph node hyperplasia and systemic symptoms; it can also affect the skin and blood counts. The condition is categorized by the extent of involvement (unicentric or multicentric) and the observed lymph node pathology (hyaline-vascular, plasma cell or mixed cellularity). Pathogenesis also has a role in the classification and treatment of multicentric Castleman disease; this variant can either be related to the presence of human herpesvirus-8 (HHV-8) infection or associated with POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal proteins and skin changes) syndrome, or idiopathic. The principal cytokine responsible for causing idiopathic multicentric Castleman disease (IMCD) is interleukin-6 (IL-6). Therefore, treatment with agents that bind to IL-6 (such as siltuximab) or block the IL-6 receptor (such as tocilizumab) has been used. We report a woman with IMCD who was successfully being treated with siltuximab; her cutaneous manifestations and systemic disease (lung and lymph nodes) improved within three months. However, nine months after starting siltuximab, she developed a worsening cough and new infiltrates in the right lung on positron emission tomography/computed tomography (PET/CT) scan; there were no other constitutional symptoms such as fever, night sweats or fatigue. Differential diagnosis included Castleman disease recurrence, lung neoplasm and infection. Her pulmonary symptoms and infiltrates on scan resolved after treatment with systemic levofloxacin, indicating that she had an antibiotic-sensitive afebrile pneumonia. We postulate that her siltuximab therapy blocked the IL-6-associated fever and constitutional symptoms that normally are a hallmark of pneumonia. Therefore, patients who are receiving medications such as siltuximab and tocilizumab that block the IL-6 pathway and impair the acute phase inflammatory response may fail to manifest constitutional symptoms such as fever when infected.

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“…The localized or unicentric form is a benign condition, usually asymptomatic, characterized by a unique lymphoid mass, most often localized in the mediastinum and rarely in the neck or abdomen. The multifocal or multicentric form, which involves more than one lymphoid mass, is correlated, in many cases, with human herpes virus-8 (HHV-8) infection or with polyneuropathy, organomegaly, endo-crinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome [32,36]. However, one-third of multicentric form cases are human immunodeficiency virus (HIV) and HHV-8 negative, which is known as idiopathic multicentric Castleman disease [37].…”

Section:  Castleman Diseasementioning

confidence: 99%

Untitled

2020

Rom J Morphol Embryol

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The most frequent tumoral condition of the uterus is represented by uterine myoma. The diagnosis, in most cases, is established by clinical examination and ultrasound scan. Nevertheless, there are rare cases, in which the surgical findings reveal a retroperitoneal tumor instead of a uterine myoma. These could be represented by schwannomas or Castleman disease. The schwannomas are rarely malignant and arise from the Schwann cells of nerve fibers. These tumors are frequently found at the level of the head, neck and mediastinum and rarely in the pelvis. Generally, schwannomas localized at retroperitoneal level are asymptomatic and with a very slow growth rate. The treatment consists in complete surgical resection. The recurrence rate is low and, generally, the prognosis is good. The Castleman disease is considered a rare entity, but it should be always taken into consideration when it comes to a differential diagnosis in a young patient who presents a retroperitoneal mass at imagery exams. The condition affects the lymphatic system and is characterized by a hyperplasia of the lymph nodes, sometimes associated with herpes virus infection. The clinical picture is often non-specific; the pain may be the only symptom. The imaging methods are not always conclusive for the final positive diagnosis and the histopathological examination is always necessary. Pelvic Castleman disease can be misdiagnosed as myoma or an adnexal tumor. In this article, we review the present knowledge regarding the pathogenesis, pathology and management of these rare retroperitoneal tumors. Both conditions, when located in pelvis must be taken into consideration in the differential diagnosis of uterine myomas, especially in the pedunculated form.

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Clinicopathological comparison and therapeutic approach to Castleman disease—a case-based review

Cited by 12 publications

References 47 publications

Castleman Disease Presenting as a Mediastinal Mass

Castleman Disease Presenting as a Mediastinal Mass

Afebrile Pneumonia in a Patient With Multicentric Castleman Disease on Siltuximab: Infection Without Fever on Anti-Interleukin-6 Therapy

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