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From Castleman disease histopathological features to idiopathic multicentric Castleman disease: a multiparametric approach to exclude potential iMCD histopathological mimickers
  1. Laura Rodriguez Merino1,
  2. Aitana Avendaño Pomares2,
  3. Jose Revert Arce1,
  4. Santiago Montes-Moreno3
  1. 1Pathology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain
  2. 2Translational Hematopathology/IDIVAL, Hospital Universitario Marques de Valdecilla, Santander, Spain
  3. 3Anatomic Pathology, Hospital Universitario Marques de Valdecilla, Universidad de Cantabria (UNICAN), Santander, Spain
  1. Correspondence to Dr Santiago Montes-Moreno, Anatomic Pathology, Hospital Universitario Marques de Valdecilla, Santander, CANTABRIA, Spain; santiago.montes{at}scsalud.es

Abstract

Aims International consensus diagnostic criteria for idiopathic multicentric Castleman disease (iMCD) includes lymph node Castleman disease (CD) histopathological features as major criteria. Our aim was to apply those criteria in a series of 42 cases with CD to find differences among unicentric CD, iMCD, HHV-8+multicentric CD (HHV-8+MCD) and POEMS/plasma cell neoplasia (PCN)-associated CD.

Methods Available clinical and laboratory criteria were collected. Histopathological features (germinal centre hyperplasia/regression, plasmacytosis, hypervascularity and follicular dendritic cell (FDC) prominence) were graded and immunohistochemistry with antibodies against CD20, CD3, CD138, HHV-8, Ig isotype (IgG, IgG4, IgA, IgM, IgD), kappa, lambda was performed in all cases.

Results Fourteen cases had hyaline-vascular type unicentric CD, 15 were HHV-8+MCD, 7 cases PCN/POEMS-associated CD and 5 cases were iMCD. One case was consistent with systemic lupus erythematosus (SLE) lymphadenopathy. Differences in grading of the CD-associated histopathological features showed that FDC proliferation was prominent in unicentric CD, hypervascularity was increased in HHV-8 positive MCD and germinal centre hyperplasia was restricted to iMCD cases and SLE. Monotypic plasma cells were readily identifiable in the lymph node biopsies in 43% of PCN/POEMS-associated CD. All three cases had lambda light chain restriction with IgA (two cases) and IgG (one case) isotypes.

Conclusions HHV-8+ MCD and PCN/POEMS-related CD are the major mimickers of iMCD in lymph node biopsies. Grading of the five histopathological features for CD might be useful to, in conjunction with complete ancillary testing, suggest for specific disease entities.

  • lymph nodes
  • autoimmunity
  • immunohistochemistry

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Footnotes

  • Handling editor Vikram Deshpande.

  • Contributors LRM performed research, analysed data and approved the paper, AAP performed research and approved the paper. JRA performed research and approved the paper. SM-M designed research, performed research, analysed data, wrote the paper and approved the paper. SMM acts as guarantor.

  • Funding This study was supported by grants from MINECO (PI19/00041).

  • Competing interests SM-M has received honoraria from Roche, EUSA-Pharma and Janssen related to speaker bureau activities.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.