Enfermedad de Castleman. Reporte de un caso

Fundamento: La enfermedad de Castleman es un proceso poco común y se caracteriza por la proliferación de linfocitos no clonales. Objetivo: Describir la presentación clínica, diagnóstico y tratamiento de un paciente con enfermedad de Castleman. Presentación del caso: Paciente masculino de 53 años de edad, color de la piel blanca, que acudió al servicio de cirugía por presentar una masa en región abdominal. Con la administración de anestesia general se realizó exéresis de la lesión y se diagnosticó por el departamento de Anatomía Patológica una enfermedad de Castleman unicéntrica variedad hialino vascular. Conclusiones: La enfermedad de Castleman es poco frecuente, su sintomatología y tratamiento varían según la presentación clínica; y el diagnóstico definitivo se obtiene del análisis de la biopsia de un ganglio afectado.

Background: Castleman disease is an uncommon process and is characterized by the non-clonal lymphocyte proliferation. Objective: To describe the clinical presentation, diagnosis and treatment in a patient with Castleman disease. Case presentation: 53 years old male patient, fair skin color, who attended to the surgery service for presenting a mass in the abdominal region. With the general anesthesia administration, the lesion was excised and an unicentric Castleman disease was diagnosed by the Pathological Anatomy department, hyaline vascular variety. Conclusions: Castleman disease is not frequent, its symptomatology and treatment vary according to the clinical presentation; and the definitive diagnosis is obtained by a biopsy analysis of an affected ganglion.

Enfermedad de Castleman unicéntrica, una causa infrecuente de masa cervical / Unicentric Castleman disease, an infrequent cause of cervical mass

La enfermedad de Castleman (EC) describe una serie de desórdenes linfoproliferativos de patrones histológicos similares, pero de etiologías, presentaciones clínicas y enfrentamientos notoriamente variables. Se presenta el caso de un paciente que consultó por masa cervical, cuyo estudio final concluyó EC unicéntrica, la cual se resolvió de forma quirúrgica. Además, se presenta una revisión actualizada del tema, con foco en la enfermedad unicéntrica.

Castleman's disease (CD) describes several lymphoproliferative disorders with similar histological patterns, but with notoriously variable etiologies, clinical presentations, and management. We present the case of a patient who consulted with cervical mass, whose final study concluded with unicentric CD, which was treated surgically. In addition, an updated review of the subject is presented, focusing on unicentric disease.

Castleman Disease: A Rare and Intriguing Malady: A Case Series

Castleman disease (CD), first described by Benjamin Castleman as angiofollicular mediastinal lymph杗ode hyperplasia, is a rare benign lymphoproliferative disorder with varied modes of presentation. Its common presentation within the mediastinum misleads the clinician and merits special attention since it is essentially a diagnosis of exclusion. We are sharing our experience with three patients, within a relatively short period of 2 years. All three presented with a mediastinal mass, however, each of them came with an entirely different clinical scenario and diagnosis. All three were successfully operated and Castleman disease [hyaline杤ascular (HV) type] was diagnosed only after the final histopathology.

Clinical features and surgical treatment of abdominal unicentric Castleman's disease / 中华普通外科杂志

Objective:To summarize the clinical manifestations, diagnosis and surgical treatment of abdominal unicentric Castleman's disease.Methods:The clinical data of abdominal unicentric Castleman's disease cases admitted to the General Surgery Department of the First Affiliated Hospital,Nanjing Medical University from Jan 2009 to Dec 2019 was retrospectively analyzed.Results:A total of 18 patients were included with definite pathological diagnosis. The main complaint was abdominal pain and discomfort (50%, 6/12), dizziness and fatigue (25%, 3/12), multiple rash with oral ulcer (16.7%, 2/12) and weight loss (8.3%, 1/12). All patients received surgical resection. Postoperative pathology showed clear vascular type in 15 patients and plasma cell type in 3 patients. There were no major complications nor mortality.Conclusion:Abdominal unicentric Castleman's disease has diverse clinical manifestations, which was difficult for preoperative diagnosis, postoperative prognosis is satisfactory.

Clinicopathological features and possible pathogenesis of Castleman disease / 中国肿瘤临床

Castleman disease (CD) refers to a group of uncommon lymph node proliferative disorders that have highly clinically heterogeneous and obvious pathological features. The etiology and pathogenesis of CD remain unclear. The pathogenesis of unicentric CD (UCD) is most likely driven by clonal proliferation and acquired mutations of tumor stromal cells. Idiopathic multicentric CD (iMCD) intersects with a variety of diseases in terms of its clinical manifestation and pathological features including autoimmune factors, paraneoplastic syndrome, viral infectious factors and inflammatory factor disorders. The pathogenesis of iMCD is probably the common pathway of immune dysregulation and cytokine increase caused by the combined action of multiple etiologies. Here, we aim to summarize the latest reported etiology and pathogenesis of CD, aiming to deepen the understanding of this disease.

Clinical characteristics and treatment of unicentric retroperitoneal Castleman's disease / 中国肿瘤临床

Objective:To investigate the clinical characteristics and treatment analysis of unicentric retroperitoneal Castleman's dis-ease (CD) and to improve its levels of diagnosis and treatment. Methods:The clinical data of 18 patients with unicentric retroperitone-al CD were retrospectively reviewed from January 2002 to December 2016. We analyzed the demographic characteristics, clinical fea-tures, histological diagnosis, treatment, and prognostic characteristics of these patients. Results:The patients comprised 4 males and 14 females with a median age of 44.1 years old (ranging from 24 years old to 70 years old). The tumor was located in the kidney in one case, while it was located in the adrenal region in eight cases. In the other cases, the tumor was in the retroperitoneal region. Seven patients had a clinical atypical abdominal pain, and one patient had moderate anemia. All patients underwent surgical resection. The mean operation time was 153.3 min with a range of 60 min to 260 min. The mean blood loss was 447.2 mL (ranging from 10 mL to 3000 mL). Two cases had blood transfusion after operation, and one had urinary fistula complication. CD was confirmed by histopathol-ogy. Hyaline vascular type of CD was observed in 16 cases, and mixed type of CD was observed in 2 cases. The median follow-up was 25 months. One patient had tumor recurrence after 2 years of operation and died. Other patients remained alive without recurrence. Conclusion:Unicentric retroperitoneal CD is a rare disease that is often misdiagnosed because of the absence of specific clinical mani-festations. The final diagnosis depends on the results of a pathologic examination. Complete surgical resection offers a favorable result for unicentric retroperitoneal CD.

Three cases of Castleman's disease in the head and neck / 实用口腔医学杂志

This report presents 3 cases of Castleman's disease in the head and neck.The clinical symptom,pathlogical and imaging features of the Castleman's disease are introduced.

Drug utilization study in orthopaedic units : Antibiotics prescribed in hospital out-patients in Dhaka, Bangladesh.

Antibiotics are generally prescribed for both as prophylactically (before orthopaedics surgery etc.) or to treat ongoing infection (like septic arthritis, osteomyelitis etc.) in the orthopaedics department. But if antibiotics are not use rationally then there will be increase chances of resistance of bacteria as also as deteriorate the patients’ disease condition which ultimately increase the total cost of treatment. The goal of this study was to see the antibiotics utilization pattern. A prospective cross-sectional, multicentre drug utilization study was conducted for a period of 3 months to evaluate the pattern of antibiotics use in orthopaedic unit of various hospitals of Dhaka City, Bangladesh. A total of 498 prescriptions were studied; in which 160 prescriptions contained mono-antibiotic therapy (51.79%) and 147 prescriptions contained poly-antibiotics therapy (48.21%) and the beta-lactam antibiotics were most commonly prescribed (81.68%). Mono-antibiotics prescriptions were the common pattern than combination and brand name has been prescribed frequently than generic. To minimize cost, it is advisable to promote prescription of generic drugs. Also justifying efforts are needed to improve appropriateness of antimicrobial therapy and minimize the development of antimicrobial resistance. Hence the results of the study showed that there is a considerable scope for improvement in the prescription pattern.

Drug utilization study in orthopaedic units: Antibiotics prescribed in hospital out-patients in Dhaka, Bangladesh.

Antibiotics are generally prescribed for both as prophylactically (before orthopaedics surgery etc.) or to treat ongoing infection (like septic arthritis, osteomyelitis etc.) in the orthopaedics department. But if antibiotics are not use rationally then there will be increase chances of resistance of bacteria as also as deteriorate the patients’ disease condition which ultimately increase the total cost of treatment. The goal of this study was to see the antibiotics utilization pattern. A prospective cross-sectional, multicentre drug utilization study was conducted for a period of 3 months to evaluate the pattern of antibiotics use in orthopaedic unit of various hospitals of Dhaka City, Bangladesh. A total of 498 prescriptions were studied; in which 160 prescriptions contained mono-antibiotic therapy (51.79%) and 147 prescriptions contained poly-antibiotics therapy (48.21%) and the beta-lactam antibiotics were most commonly prescribed (81.68%). Mono-antibiotics prescriptions were the common pattern than combination and brand name has been prescribed frequently than generic. To minimize cost, it is advisable to promote prescription of generic drugs. Also justifying efforts are needed to improve appropriateness of antimicrobial therapy and minimize the development of antimicrobial resistance. Hence the results of the study showed that there is a considerable scope for improvement in the prescription pattern.

Castleman disease

Castleman and Towne described a disease presenting as a mediastinal mass resembling thymoma. It is also known as "giant lymph node hyperplasia", "lymph node hamartoma", "angiofollicular mediastinal lymph node hyperplasia", and "angiomatous lymphoid hyperplasia". The pathogenesis is unknown, but the bulk of evidence points toward faulty immune regulation, resulting in excessive B-lymphocyte and plasma-cell proliferation in lymphatic tissue. In addition to the mediastinal presentation, extrathoracic involvement in the neck, axilla, mesentery, pelvis, pancreas, adrenal gland, and retroperitoneum also have been described. There are 2 major pathologic variations of Castleman disease: (1) hyaline-vascular variant, the most frequent, characterized by small hyaline-vascular follicles and capillary proliferation; and (2) the plasma-cell variant, in which large lymphoid follicles are separated by sheets of plasma cells. The hyaline-vascular cases usually are largely asymptomatic, whereas the less common plasma-cell variant may present with fever, anemia, weight loss, and night sweats, along with polyclonal hypergamma-globulinemia. Castleman disease is a rare lymphoproliferative disorders. Few cases have been described world widely. In this article we reviewed the classification, pathogenesis, pathology, radiological features and up to date treatment with special emphasis on the role of viral stimulation, recent therapeutic modalities and the HIV-associated disease.