Primary hyaline vascular Castleman disease of the kidney: case report and literature review
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CASE REPORT
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Primary hyaline vascular Castleman disease of the kidney: case report and literature review Yunzhu Li1,2, Haixia Zhao2, Bingyin Su2, Chan Yang2, Shurong Li2* and Wanlei Fu1*
Abstract Background: Castleman’s disease (CD) is an uncommon type of benign proliferation of the lymphoid tissue, characterized by local or systemic lymphadenopathy that most frequently appears in the mediastinum; involvement of the kidney is uncommon, and proliferation originating from the kidney is extremely rare. Herein, we report a rare case of hyaline vascular Castleman’s disease (HV-CD) in a 56-year-old male patient and discuss its morphological characteristics and differential diagnoses including mantle cell lymphoma (MCL), follicular lymphoma (FL), and nodal marginal zone lymphoma (NMZL). Case presentation: A right upper-middle renal mass was detected after physical examination in a 56-year-old man without any clinical symptoms and a previous partial resection of the right kidney. Microscopically, the lymphoid follicles were increased in number and had expanded mantle zones and atrophic germinal centers. Vascular proliferation and hyalinization in the interfollicular zones were observed. Immunohistochemical staining showed CD20-positive cells in the mantle zones; CD21 and CD35 were expressed in the dendritic cells, CD3 was positive in a small number of T cells, and CD38 and CD138 were positive in the plasma cells. Additionally, Ki-67 expression was positive in the follicle centers. In contrast, staining for Bcl-2 in the germinal centers and cyclin D1 were negative. The immunohistochemical analysis combined with the morphological results supported the diagnosis of HV-CD. The patient recovered well after surgery. Conclusions: Primarily renal HV-CD without lymph node hyperplasia or clinical symptoms is extraordinarily rare and different from the multicentric-type CD (MCD) with kidney involvement. Therefore, it is extremely important to improve the awareness of this diagnosis. Attention should be paid to the difference between HV-CD and common lymph node reactive hyperplasia, MCL, FL, NMZL, and so on. To avoid misdiagnosis as a renal malignant tumor requiring radical resection, distinguishing these diseases is crucial. Keywords: Castleman’s disease, Hyaline-vascular CD, Kidney, Lymphoid node
Background Castleman’s disease (also known as vascular follicular lymph node hyperplasia, angiofollicular hyperplasia and giant lymph node hyperplasia) is an uncommon type of benign proliferation of the lymphoid tissue; it has been subclassified into five distinct entities on the basis of histologic forms: hyaline vascular CD (HV-CD), plasma cell CD (PC-CD), mixed-type CD, human herpesvirus 8 * Correspondence: [email protected]; [email protected] 2 Development and Regeneration Key Lab of Sichuan Province of Chengdu Medical College, Chengdu 610500, Sichuan, China 1 Department of Pathology, Xinqiao Hospital of Army Medicine University, Chongqing 400037, China
(HHV- 8)-associated CD and multicentric not otherwise specified CD [1].
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