IL-6-positive classical Hodgkin’s lymphoma co-occurring with plasma cell type of Castleman’s disease: report of a case

Abstract

We present a case of classical Hodgkin's lymphoma (HL) co-occurring with histological features of Castleman's disease (CD). A 25-year-old man presented with left supraclavicular and axillary lymph node swelling and mediastinal mass. Using an initial biopsy specimen from left axillary lymph node, a tentative diagnosis of multicentric CD of plasma cell type was made. The serum level of interleukin-6 (IL-6) was elevated. The patient was treated with immunosuppressive therapy containing tocilizumab (TCZ). Shrinkage of mediastinal mass and axillary lymph nodes was seen; however, swelling of his left axillary lymph nodes reemerged, even after therapy with TCZ. A second left axillary lymph node biopsy was performed and a diagnosis of nodular sclerosis of classical HL without histologic features of CD was made. The initial biopsy specimen was re-examined, and scattered CD30+ Hodgkin/Reed-Sternberg cells were found in the interfollicular area. Interestingly, Hodgkin/Reed-Sternberg cells and surrounding reactive cells in both lymph nodes were stained with anti-IL-6 antibody. We emphasize that biopsy specimens with HL involvement may also have histologic features reminiscent of those seen in CD. To our knowledge, this is the first report to provide a detailed description of this pathology, including a survey of IL-6 and clinical course upon treatment with TCZ.

Interleukin-6-producing Intravascular Large B-cell Lymphoma with Lymphadenopathy Mimicking the Histology of Multicentric Castleman Disease

“…There are several reports regarding a high IL-6 plasma level in tumors (14,16,19,20), hemophagocytic syndrome (21,22), and IVLBCL (11,23) or IL-6 positivity on immunohistochemistry staining (14,16,19,20,24). These cases also support the possibility that paraneoplastically produced IL-6 can induce an MCD-like clinical presentation.…”

HHV-8-negative, idiopathic multicentric Castleman disease: novel insights into biology, pathogenesis, and therapy

“…Patients with IL-6 secreting hematologic and solid malignancies develop iMCD-like histopathology and symptomatology, which resolve with IL-6 blockade or tumor excision. 48,49 Finally, the administration of pharmacologic doses of recombinant IL-6 to humans can lead to an iMCD-like syndrome. 50 These findings also demonstrate that iMCD histopathology and symptomatology are secondary to hypercytokinemia.…”

“…The iMCD-like features disappeared with anti-IL-6 receptor blockade. 48 Alternative explanations for the frequent association between iMCD and malignancy include the possibility that iMCD is a prelymphoma that eventually transforms, excessive cytokine release promotes malignant transformation, iMCD treatments cause or increase susceptibility to secondary malignancies, or an unidentified virus may be responsible for both the iMCD and the malignancy. 80,81 We suggest that a search for an underlying malignancy be conducted in all newly diagnosed iMCD patients.…”

Markers of inflammation and fibrinolysis in canine lymphoma

“…It was found that it is produced by lymphoblastic cell lines (EMILIE et al, 1992). Earlier studies have suggested that IL-6 is involved in the pathogenesis of human lymphoma and that this cytokine may be useful as an indicator for assessing prognosis and drug therapy (KURZROCK et al, 1993;CHOPRA et al, 2004;BARTSCH et al, 2006;MOMOI et al, 2013) Increased serum IL-6 in diffuse large B-cell human lymphomas was found to be associated with poor prognosis (BARTSCH et al, 2006). The results from our measurements showed that plasma IL-6 concentrations were significantly higher in dogs with lymphoma when compared to the healthy population of dogs (P<0.0002).…”