Clinical analysis of 30 cases of Castleman disease with different types of thoracic involvement
10.3760/cma.j.issn.0253-2727.2020.02.012
- VernacularTitle: 30例不同类型胸部受累Castleman病临床分析
- Author:
Xiaoxian ZHANG
1
;
Lei JIANG
2
;
Chunyan WANG
3
;
Yingying GU
1
;
Longguang LI
1
;
Tingting XIA
4
;
Ying HUANG
1
;
Peikai HUANG
5
;
Qingling ZHANG
1
Author Information
1. National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
2. Department of Respiratory and Critical Care Medicine, Huhhot First Hospital, Huhhot 010010, China
3. Department of Hematology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
4. Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
5. Department of Respiratory Medicine, Huizhou Municipal Central Hospital, Huizhou 516001, China
- Publication Type:Journal Article
- Keywords:
Castleman disease;
Thoracic;
Bronchiolitis obliterans
- From:
Chinese Journal of Hematology
2020;41(2):149-156
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To improve the clinical understanding of Castleman disease (CD) with different types of thoracic involvement, including their clinical features, radiological and pathological findings, diagnosis and current treatment strategies.
Methods:Retrospective analysis of 30 patients diagnosed with CD with thoracic involvement and hospitalized between June 2009 and May 2019 in The First Affiliated Hospital of Guangzhou Medical University was performed. Patients were divided into three groups for subsequent analysis based on the clinical data: CD with bronchiolitis obliterans (BO) , unicentric Castleman disease (UCD) without BO, and multicentric Castleman disease (MCD) without BO.
Results:Among the 30 patients, there were 5 (16.7%) patients diagnosed with BO, 18 (60.0%) patients had UCD without BO and 7 (23.3%) patients had MCD without BO. The average age of MCD without BO patients was significantly older than that of BO and UCD without BO patients[ (49.29±5.39) ys vs (27.20±3.76) ys and (37.17±2.87) ys; P=0.005 and 0.034, respectively) ]. Pulmonary symptoms were commonly seen in BO group (100%) and MCD without BO group (71.4%) . while no pulmonary symptoms were seen in UCD without BO group. Key abnormal laboratory findings were erythrocyte sedimentation rate (ESR) increase (40%in BO group and 57.1% in MCD without BO group) and hypoxia (60% in BO group and 28.6% in MCD without BO group) . Other abnormal laboratory findings seen in MCD without BO group included anemia and IgG increase (both 57.1%) . Notably, all patients in BO group had extremely severe mixed ventilation dysfunction in the lung function test. CT scan showed lung parenchyma involvement in BO group (100%) , in UCD without BO group (11.1%) featured by solitary pulmonary nodule and in MCD without BO group (57.1%) featured by diffuse lesions in bilateral lungs. The size of lymph nodes was significantly smaller in MCD without BO group comparing to that in BO group and UCD without BO group[short diameter (1.83±0.51) cm vs (4.73±1.63) cm and (3.62±0.26) cm; P=0.006 and 0.011, respectively]. All patients (100%) in the BO group had a pathological type of transparent vascular variant while the same pathological type accounts for 88.9% in UCD without BO patients. The predominantly pathological type (57.1%) was plasma cell variant in the MCD without BO group. Oral ulcers presented in all patients in BO group but were relieved after the mass resection and immunomodulatory therapy, but the pulmonary symptoms were still progressively aggravated. Thoracoscopic mass excision was the main treatment for UCD without BO patients while chemotherapy, immunomodulatory and targeted therapy were commonly used for MCD without BO treatment.
Conclusion:The age, clinical symptom, laboratory finding, lung function, imaging manifestation, pathology, treatment and prognosis were different among the three groups. This classification could improve clinical understanding of the disease.
