Castleman's Disease Mayo Clinic Proceedings

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Presentation transcript:

Castleman's Disease Mayo Clinic Proceedings Homayoun Shahidi, M.D., Jeffrey L. Myers, M.D., Paul A. Kvale, M.D. Mayo Clinic Proceedings Volume 70, Issue 10, Pages 969-977 (October 1995) DOI: 10.4065/70.10.969 Copyright © 1995 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 1 Posteroanterior chest roentgenogram of 73-year-old man, showing mediastinal mass that projects over left hilum (arrows). Mayo Clinic Proceedings 1995 70, 969-977DOI: (10.4065/70.10.969) Copyright © 1995 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 2 Computed tomographic scan of chest, showing densely enhancing mass in left side of mediastinum at level of aorticopulmonary window(arrows). Posterior to mass is mildly enlarged, enhancing lymph node. Mayo Clinic Proceedings 1995 70, 969-977DOI: (10.4065/70.10.969) Copyright © 1995 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 3 Photograph showing cut surface of resected anterior mediastinal mass. Tumor was well circumscribed and was 7 cm in greatest dimension. Light brown cut surface has glistening, some what lobulated appearance. Mayo Clinic Proceedings 1995 70, 969-977DOI: (10.4065/70.10.969) Copyright © 1995 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 4 A, Low-magnification photomicrograph of resected mediastinal mass, showing characteristic features of hyaline-vascular Castleman's disease. Multiple lymphoid follicles with germinal centers are separated by diffuse infiltrate of lymphocytes associated with prominent vascular stroma. Proliferation of follicles and expanded interfollicular zones obscure underlying nodal architecture. (Hematoxylin-eosin; original magnification, ×100.) B, High-magnification photomicrograph, illustrating abnormal lymphoid follicles. Centrally located germinal center is surrounded by cuff of small lymphocytes arranged in concentric (“onionskin”) layers. Several capillaries penetrate germinal center. (Hematoxylin-eosin; original magnification, ×290.) Mayo Clinic Proceedings 1995 70, 969-977DOI: (10.4065/70.10.969) Copyright © 1995 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 5 Photomicrograph showing prominent vascular stroma in hyaline-vascular type of Castleman's disease. lnterfollicular zones contain numerous small sclerotic vessels with relatively few associated lymphoid cells. (Hematoxylin-eosin; original magnification, ×290.) Mayo Clinic Proceedings 1995 70, 969-977DOI: (10.4065/70.10.969) Copyright © 1995 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 6 Schema depicting current concepts in pathogenesis of Castleman's disease (CD). Defect in immunoregulation is believed to underlie development of multicentric CD and predispose to emergence of malignant lesions. Interleukin 6 (IL-6) is implicated in pathogenesis of both variants of CD and associated systemic manifestations. Germinal centers of CD (hyaline-vascular type) contain increased numbers of dysplastic follicular dendritic cells (FDR); interfollicular stroma shows pronounced proliferation of high endothelial venules (HEY). KS = Kaposi's sarcoma; POEMS = polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes. (Data from references 4–7, 9, 23, 42, 49, and 53–60.) Mayo Clinic Proceedings 1995 70, 969-977DOI: (10.4065/70.10.969) Copyright © 1995 Mayo Foundation for Medical Education and Research Terms and Conditions