Castleman disease: A single-center case series

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

doi:10.1016/j.ijscr.2021.105650

Castleman disease: A single-center case series

Int J Surg Case Rep. 2021 Mar:80:105650. doi: 10.1016/j.ijscr.2021.105650. Epub 2021 Feb 14.

Authors

Kyle Pribyl¹, Victor Vakayil², Najiha Farooqi³, Nivedita Arora⁴, Benjamin Kreitz⁵, Salman Ikramuddin⁶, Michael A Linden⁷, James Harmon⁸

Affiliations

¹ Department of Surgery, University of Minnesota, Minneapolis, MN, USA; University of Minnesota Medical School, Minneapolis, MN, USA.
² Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
³ Department of Surgery, Central Michigan University, Saginaw, MI, USA.
⁴ Department of Medicine, Division of Hematology & Oncology, University of Minnesota, Minneapolis, MN, USA.
⁵ University of Minnesota Medical School, Minneapolis, MN, USA.
⁶ Department of Neurology, University of Minnesota, Minneapolis, MN, USA.
⁷ Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA.
⁸ Department of Surgery, University of Minnesota, Minneapolis, MN, USA; University of Minnesota Medical School, Minneapolis, MN, USA. Electronic address: harm0031@umn.edu.

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.

Keywords: Hyaline vascular; Multicentric Castleman disease; Plasmacytoid; Unicentric Castleman disease.