Castleman disease: A single-center case series

Kyle Pribyl, Victor A Vakayil, Najiha Farooqi, Nivedita Arora, Benjamin Kreitz, Salman Ikramuddin, Michael A. Linden, James Harmon

Research output: Contribution to journalShort surveypeer-review

Abstract

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.

Original languageEnglish (US)
Article number105650
JournalInternational Journal of Surgery Case Reports
Volume80
DOIs
StatePublished - Mar 2021

Bibliographical note

Funding Information:
We acknowledge the support from the William W. Harmon Surgical Education and Research Fund .

Publisher Copyright:
© 2021 The Authors

Keywords

  • Hyaline vascular
  • Multicentric Castleman disease
  • Plasmacytoid
  • Unicentric Castleman disease

PubMed: MeSH publication types

  • Journal Article

Fingerprint

Dive into the research topics of 'Castleman disease: A single-center case series'. Together they form a unique fingerprint.

Cite this