2020 Volume 34 Issue 1 Pages 62-66
The patient was a 73-year-old woman with general malaise. Laboratory examination revealed elevated immunoglobulin and interleukin-6 levels.
Computed tomography (CT) of the chest revealed multiple lymphadenopathy of the right supraclavicular and mediastinal regions. We suspected multicentric Castleman's disease and initiated treatment with corticosteroid therapy, but the steroid therapy was ineffective. The patient subsequently underwent resection of the largest of the upper mediastinal lymph nodes via video-assisted thoracoscopic surgery for diagnosis and disease activity control. Postoperatively, her symptoms and signs resolved. Histopathological findings showed vascularity and follicular dendritic cell prominence of the germinal centers. The expanded mantle zones consisted of concentric rings of lymphocytes with an "onion skin" appearance. These findings were characteristic of the features of the hyaline-vascular type. Other histopathological findings included polytypic plasmacytosis in the interfollicular space, being more typical of the plasma-cell type.
Therefore, the patient was diagnosed with mixed-type multicentric Castleman's disease. Symptomatic treatment with medications is the standard therapy for multicentric Castleman's disease. If medications are ineffective, resection of the most enlarged lymph nodes should be considered as part of the treatment protocol.