Castleman disease presenting with jaundice: A case report and review of literature
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摘要
BACKGROUND Castleman disease(CD) is a rare lymphoproliferative disorder that presents with various symptoms. CD accompanied with jaundice is uncommon since there are only 11 cases reported in the literature.CASE SUMMARY Here we report a 62-year-old woman who was admitted to the hospital with signs and symptoms of intermittent jaundice. Biochemical tests showed higher serum levels of total and direct bilirubin, and normal serum levels of tumor markers and interleukin-6. Contrast-enhanced computed tomography detected a6 cm × 4 cm × 2.5 cm mass between the hepatoduodenal ligament and the inferior vena cava. The mass was successfully excised and the patient had a complete resolution of symptoms. A diagnosis of idiopathic unicentric CD was made based upon histological examination, which demonstrated the pathological features of CD of mixed type, including hyperplasia of follicular lymphoids with abundant plasma cells, degenerative germinal centers, interfollicular vascularity and hyaline degeneration. The diagnosis was corroborated by immunohistochemical analysis which detected multiple biomarkers.CONCLUSION This is the first study that describes the clinicopathological features of CD presenting with jaundice, which may deepen and extend our understanding of this disease.
BACKGROUND Castleman disease(CD) is a rare lymphoproliferative disorder that presents with various symptoms. CD accompanied with jaundice is uncommon since there are only 11 cases reported in the literature.CASE SUMMARY Here we report a 62-year-old woman who was admitted to the hospital with signs and symptoms of intermittent jaundice. Biochemical tests showed higher serum levels of total and direct bilirubin, and normal serum levels of tumor markers and interleukin-6. Contrast-enhanced computed tomography detected a6 cm × 4 cm × 2.5 cm mass between the hepatoduodenal ligament and the inferior vena cava. The mass was successfully excised and the patient had a complete resolution of symptoms. A diagnosis of idiopathic unicentric CD was made based upon histological examination, which demonstrated the pathological features of CD of mixed type, including hyperplasia of follicular lymphoids with abundant plasma cells, degenerative germinal centers, interfollicular vascularity and hyaline degeneration. The diagnosis was corroborated by immunohistochemical analysis which detected multiple biomarkers.CONCLUSION This is the first study that describes the clinicopathological features of CD presenting with jaundice, which may deepen and extend our understanding of this disease.
BACKGROUND Castleman disease(CD) is a rare lymphoproliferative disorder that presents with various symptoms. CD accompanied with jaundice is uncommon since there are only 11 cases reported in the literature.CASE SUMMARY Here we report a 62-year-old woman who was admitted to the hospital with signs and symptoms of intermittent jaundice. Biochemical tests showed higher serum levels of total and direct bilirubin, and normal serum levels of tumor markers and interleukin-6. Contrast-enhanced computed tomography detected a6 cm × 4 cm × 2.5 cm mass between the hepatoduodenal ligament and the inferior vena cava. The mass was successfully excised and the patient had a complete resolution of symptoms. A diagnosis of idiopathic unicentric CD was made based upon histological examination, which demonstrated the pathological features of CD of mixed type, including hyperplasia of follicular lymphoids with abundant plasma cells, degenerative germinal centers, interfollicular vascularity and hyaline degeneration. The diagnosis was corroborated by immunohistochemical analysis which detected multiple biomarkers.CONCLUSION This is the first study that describes the clinicopathological features of CD presenting with jaundice, which may deepen and extend our understanding of this disease.
引文
1 Castleman B,Iverson L,Menendez VP.Localized mediastinal lymphnode hyperplasia resembling thymoma.Cancer 1956;9:822-830[PMID:13356266]
2 CASE records of the Massachusetts General Hospital Weekly Clinicopathological Exercises:Case 40011.N Engl J Med 1954;250:26-30[PMID:13111435 DOI:10.1056/NEJM195401072500107]
3 Munshi N,Mehra M,van de Velde H,Desai A,Potluri R,Vermeulen J.Use of a claims database to characterize and estimate the incidence rate for Castleman disease.Leuk Lymphoma 2015;56:1252-1260[PMID:25120049 DOI:10.3109/10428194.2014.953145]
4 Simpson D.Epidemiology of Castleman Disease.Hematol Oncol Clin North Am 2018;32:1-10[PMID:29157611 DOI:10.1016/j.hoc.2017.09.001]
5 Fujimoto S,Koga T,Kawakami A,Kawabata H,Okamoto S,Mizuki M,Yano S,Ide M,Uno K,Yagi K,Kojima T,Mizutani M,Tokumine Y,Nishimoto N,Fujiwara H,Nakatsuka SI,Shiozawa K,Iwaki N,Masaki Y,Yoshizaki K.Tentative diagnostic criteria and disease severity classification for Castleman disease:A report of the research group on Castleman disease in Japan.Mod Rheumatol 2018;28:161-167[PMID:28880697 DOI:10.1080/14397595.2017.1366093]
6 Talat N,Belgaumkar AP,Schulte KM.Surgery in Castleman's disease:a systematic review of 404published cases.Ann Surg 2012;255:677-684[PMID:22367441 DOI:10.1097/SLA.0b013e318249dcdc]
7 Liu AY,Nabel CS,Finkelman BS,Ruth JR,Kurzrock R,van Rhee F,Krymskaya VP,Kelleher D,Rubenstein AH,Fajgenbaum DC.Idiopathic multicentric Castleman's disease:a systematic literature review.Lancet Haematol 2016;3:e163-e175[PMID:27063975 DOI:10.1016/S2352-3026(16)00006-5]
8 Wu D,Lim MS,Jaffe ES.Pathology of Castleman Disease.Hematol Oncol Clin North Am 2018;32:37-52[PMID:29157618 DOI:10.1016/j.hoc.2017.09.004]
9 El-Osta HE,Kurzrock R.Castleman's disease:from basic mechanisms to molecular therapeutics.Oncologist 2011;16:497-511[PMID:21441298 DOI:10.1634/theoncologist.2010-0212]
10 Medvedovic J,Ebert A,Tagoh H,Busslinger M.Pax5:a master regulator of B cell development and leukemogenesis.Adv Immunol 2011;111:179-206[PMID:21970955 DOI:10.1016/B978-0-12-385991-4.00005-2]
11 Cleary ML,Smith SD,Sklar J.Cloning and structural analysis of cDNAs for bcl-2 and a hybrid bcl-2/immunoglobulin transcript resulting from the t(14;18)translocation.Cell 1986;47:19-28[PMID:2875799]
12 Young F,Mizoguchi E,Bhan AK,Alt FW.Constitutive Bcl-2 expression during immunoglobulin heavy chain-promoted B cell differentiation expands novel precursor B cells.Immunity 1997;6:23-33[PMID:9052834]
13 Oliver AM,Martin F,Kearney JF.Mouse CD38 is down-regulated on germinal center B cells and mature plasma cells.J Immunol 1997;158:1108-1115[PMID:9013949]
14 Qin D,Wu J,Carroll MC,Burton GF,Szakal AK,Tew JG.Evidence for an important interaction between a complement-derived CD21 ligand on follicular dendritic cells and CD21 on B cells in the initiation of IgG responses.J Immunol 1998;161:4549-4554[PMID:9794381]
15 Schuh E,Berer K,Mulazzani M,Feil K,Meinl I,Lahm H,Krane M,Lange R,Pfannes K,Subklewe M,Gürkov R,Bradl M,Hohlfeld R,Kümpfel T,Meinl E,Krumbholz M.Features of Human CD3+CD20+TCells.J Immunol 2016;197:1111-1117[PMID:27412413 DOI:10.4049/jimmunol.1600089]
16 Cuylen S,Blaukopf C,Politi AZ,Müller-Reichert T,Neumann B,Poser I,Ellenberg J,Hyman AA,Gerlich DW.Ki-67 acts as a biological surfactant to disperse mitotic chromosomes.Nature 2016;535:308-312[PMID:27362226 DOI:10.1038/nature18610]
17 Giachino C,Padovan E,Lanzavecchia A.kappa+lambda+dual receptor B cells are present in the human peripheral repertoire.J Exp Med 1995;181:1245-1250[PMID:7869042]
18 Affes N,Mseddi A,Feriani N,Beyrouti MI.Extrahepatic cholestasis secondary to Castleman's disease.Rev Med Interne 2009;30:450-452[PMID:18818000 DOI:10.1016/j.revmed.2008.07.009]
19 Al-Salamah SM,Khan IA,Khalid K,Al-Shakweer WA.Castleman disease presenting as obstructive jaundice.Saudi Med J 2005;26:111-113[PMID:15756365]
20 Fichtl J,T?e?ka V,Vodi?ka J,?ulc R,Hes O,TupyR.Castleman disease-unusual finding after operation of retroperitoneal tumor of young patient.Rozhl Chir 2016;95:91-94[PMID:27008172]
21 Heng LZ,Ong KW,Chow PK.An unusual case of recurrent obstructive jaundice.Gastroenterology 2011;140:1401,1699[PMID:21447313 DOI:10.1053/j.gastro.2010.07.064]
22 Mura G,Tauceri F,Feri M,Verdecchia GM.Report of two cases of Castleman's Disease:a case of benign localized disease and a case of fast progressive multicentric disease.Acta Biomed 2011;82:77-81[PMID:22069961]
23 Ozsoy M,Ozsoy Z,Sahin S,Ar?kan Y.Rare Forms of Castleman Disease Mimicking Malignancy:Mesenteric and Pancreatic Involvement.Cureus 2018;10:e2310[PMID:29755906 DOI:10.7759/cureus.2310]
24 Park JB,Hwang JH,Kim H,Choe HS,Kim YK,Kim HB,Bang SM.Castleman disease presenting with jaundice:a case with the multicentric hyaline vascular variant.Korean J Intern Med 2007;22:113-117[PMID:17616028]
25 Przkora R,Bruns C,Zülke C,Heinkelein J,Rümmele P,Schalhorn A,Jauch KW.Castleman's disease causing obstructive jaundice.J Hepatol 2003;38:548-549[PMID:12663253]
26 Xiao X,Feng F,He MX,Zhu MH.Clinicopathologic feaures and differential diagnosis of abdominal Castleman disease.Zhen Duan Bing Li Xue Za Zhi 2014;21:129-133[DOI:10.3969/j.issn.1007-8096.2014.03.001]
27 Zhao TK,Zhang LM,Liang Y,Xiong T,Guo HX,Huang ZP.Clinico-pathologic Analysis of 16 Cases of Castleman.Zhongguo Shi Yan Xue Ye Xue Za Zhi 2015;23:1039-1043[PMID:26314442 DOI:10.7534/j.issn.1009-2137.2015.04.026]
28 Yu L,Tu M,Cortes J,Xu-Monette ZY,Miranda RN,Zhang J,Orlowski RZ,Neelapu S,Boddu PC,Akosile MA,Uldrick TS,Yarchoan R,Medeiros LJ,Li Y,Fajgenbaum DC,Young KH.Clinical and pathological characteristics of HIV-and HHV-8-negative Castleman disease.Blood 2017;129:1658-1668[PMID:28100459 DOI:10.1182/blood-2016-11-748855]
29 Szalat R,Munshi NC.Diagnosis of Castleman Disease.Hematol Oncol Clin North Am 2018;32:53-64[PMID:29157619 DOI:10.1016/j.hoc.2017.09.005]
2 CASE records of the Massachusetts General Hospital Weekly Clinicopathological Exercises:Case 40011.N Engl J Med 1954;250:26-30[PMID:13111435 DOI:10.1056/NEJM195401072500107]
3 Munshi N,Mehra M,van de Velde H,Desai A,Potluri R,Vermeulen J.Use of a claims database to characterize and estimate the incidence rate for Castleman disease.Leuk Lymphoma 2015;56:1252-1260[PMID:25120049 DOI:10.3109/10428194.2014.953145]
4 Simpson D.Epidemiology of Castleman Disease.Hematol Oncol Clin North Am 2018;32:1-10[PMID:29157611 DOI:10.1016/j.hoc.2017.09.001]
5 Fujimoto S,Koga T,Kawakami A,Kawabata H,Okamoto S,Mizuki M,Yano S,Ide M,Uno K,Yagi K,Kojima T,Mizutani M,Tokumine Y,Nishimoto N,Fujiwara H,Nakatsuka SI,Shiozawa K,Iwaki N,Masaki Y,Yoshizaki K.Tentative diagnostic criteria and disease severity classification for Castleman disease:A report of the research group on Castleman disease in Japan.Mod Rheumatol 2018;28:161-167[PMID:28880697 DOI:10.1080/14397595.2017.1366093]
6 Talat N,Belgaumkar AP,Schulte KM.Surgery in Castleman's disease:a systematic review of 404published cases.Ann Surg 2012;255:677-684[PMID:22367441 DOI:10.1097/SLA.0b013e318249dcdc]
7 Liu AY,Nabel CS,Finkelman BS,Ruth JR,Kurzrock R,van Rhee F,Krymskaya VP,Kelleher D,Rubenstein AH,Fajgenbaum DC.Idiopathic multicentric Castleman's disease:a systematic literature review.Lancet Haematol 2016;3:e163-e175[PMID:27063975 DOI:10.1016/S2352-3026(16)00006-5]
8 Wu D,Lim MS,Jaffe ES.Pathology of Castleman Disease.Hematol Oncol Clin North Am 2018;32:37-52[PMID:29157618 DOI:10.1016/j.hoc.2017.09.004]
9 El-Osta HE,Kurzrock R.Castleman's disease:from basic mechanisms to molecular therapeutics.Oncologist 2011;16:497-511[PMID:21441298 DOI:10.1634/theoncologist.2010-0212]
10 Medvedovic J,Ebert A,Tagoh H,Busslinger M.Pax5:a master regulator of B cell development and leukemogenesis.Adv Immunol 2011;111:179-206[PMID:21970955 DOI:10.1016/B978-0-12-385991-4.00005-2]
11 Cleary ML,Smith SD,Sklar J.Cloning and structural analysis of cDNAs for bcl-2 and a hybrid bcl-2/immunoglobulin transcript resulting from the t(14;18)translocation.Cell 1986;47:19-28[PMID:2875799]
12 Young F,Mizoguchi E,Bhan AK,Alt FW.Constitutive Bcl-2 expression during immunoglobulin heavy chain-promoted B cell differentiation expands novel precursor B cells.Immunity 1997;6:23-33[PMID:9052834]
13 Oliver AM,Martin F,Kearney JF.Mouse CD38 is down-regulated on germinal center B cells and mature plasma cells.J Immunol 1997;158:1108-1115[PMID:9013949]
14 Qin D,Wu J,Carroll MC,Burton GF,Szakal AK,Tew JG.Evidence for an important interaction between a complement-derived CD21 ligand on follicular dendritic cells and CD21 on B cells in the initiation of IgG responses.J Immunol 1998;161:4549-4554[PMID:9794381]
15 Schuh E,Berer K,Mulazzani M,Feil K,Meinl I,Lahm H,Krane M,Lange R,Pfannes K,Subklewe M,Gürkov R,Bradl M,Hohlfeld R,Kümpfel T,Meinl E,Krumbholz M.Features of Human CD3+CD20+TCells.J Immunol 2016;197:1111-1117[PMID:27412413 DOI:10.4049/jimmunol.1600089]
16 Cuylen S,Blaukopf C,Politi AZ,Müller-Reichert T,Neumann B,Poser I,Ellenberg J,Hyman AA,Gerlich DW.Ki-67 acts as a biological surfactant to disperse mitotic chromosomes.Nature 2016;535:308-312[PMID:27362226 DOI:10.1038/nature18610]
17 Giachino C,Padovan E,Lanzavecchia A.kappa+lambda+dual receptor B cells are present in the human peripheral repertoire.J Exp Med 1995;181:1245-1250[PMID:7869042]
18 Affes N,Mseddi A,Feriani N,Beyrouti MI.Extrahepatic cholestasis secondary to Castleman's disease.Rev Med Interne 2009;30:450-452[PMID:18818000 DOI:10.1016/j.revmed.2008.07.009]
19 Al-Salamah SM,Khan IA,Khalid K,Al-Shakweer WA.Castleman disease presenting as obstructive jaundice.Saudi Med J 2005;26:111-113[PMID:15756365]
20 Fichtl J,T?e?ka V,Vodi?ka J,?ulc R,Hes O,TupyR.Castleman disease-unusual finding after operation of retroperitoneal tumor of young patient.Rozhl Chir 2016;95:91-94[PMID:27008172]
21 Heng LZ,Ong KW,Chow PK.An unusual case of recurrent obstructive jaundice.Gastroenterology 2011;140:1401,1699[PMID:21447313 DOI:10.1053/j.gastro.2010.07.064]
22 Mura G,Tauceri F,Feri M,Verdecchia GM.Report of two cases of Castleman's Disease:a case of benign localized disease and a case of fast progressive multicentric disease.Acta Biomed 2011;82:77-81[PMID:22069961]
23 Ozsoy M,Ozsoy Z,Sahin S,Ar?kan Y.Rare Forms of Castleman Disease Mimicking Malignancy:Mesenteric and Pancreatic Involvement.Cureus 2018;10:e2310[PMID:29755906 DOI:10.7759/cureus.2310]
24 Park JB,Hwang JH,Kim H,Choe HS,Kim YK,Kim HB,Bang SM.Castleman disease presenting with jaundice:a case with the multicentric hyaline vascular variant.Korean J Intern Med 2007;22:113-117[PMID:17616028]
25 Przkora R,Bruns C,Zülke C,Heinkelein J,Rümmele P,Schalhorn A,Jauch KW.Castleman's disease causing obstructive jaundice.J Hepatol 2003;38:548-549[PMID:12663253]
26 Xiao X,Feng F,He MX,Zhu MH.Clinicopathologic feaures and differential diagnosis of abdominal Castleman disease.Zhen Duan Bing Li Xue Za Zhi 2014;21:129-133[DOI:10.3969/j.issn.1007-8096.2014.03.001]
27 Zhao TK,Zhang LM,Liang Y,Xiong T,Guo HX,Huang ZP.Clinico-pathologic Analysis of 16 Cases of Castleman.Zhongguo Shi Yan Xue Ye Xue Za Zhi 2015;23:1039-1043[PMID:26314442 DOI:10.7534/j.issn.1009-2137.2015.04.026]
28 Yu L,Tu M,Cortes J,Xu-Monette ZY,Miranda RN,Zhang J,Orlowski RZ,Neelapu S,Boddu PC,Akosile MA,Uldrick TS,Yarchoan R,Medeiros LJ,Li Y,Fajgenbaum DC,Young KH.Clinical and pathological characteristics of HIV-and HHV-8-negative Castleman disease.Blood 2017;129:1658-1668[PMID:28100459 DOI:10.1182/blood-2016-11-748855]
29 Szalat R,Munshi NC.Diagnosis of Castleman Disease.Hematol Oncol Clin North Am 2018;32:53-64[PMID:29157619 DOI:10.1016/j.hoc.2017.09.005]