From the archives of MD Anderson Cancer Center Castleman disease involving the thymus gland: Case report and literature review |
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| Affiliation: | 1. Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, TX, United States of America;2. Department of Medicine, The University of Texas Health Science Center at Houston, TX, United States of America;3. Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America;4. Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America;1. GnomeDX, Powell, OH, USA;2. Ohio State University Medical Center, Columbus, OH, USA;3. Oncolytics Biotech Incorporated, Calgary, AB, Canada;1. Department of Anatomical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand;2. Vajira Pathology-clinical-correlation Target Research Interest Group, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand;1. Department of Pathology, Faculty of Basic Medicine, Chongqing Medical University, Chongqing, China;2. Molecular Medicine Diagnostic and Testing Center, Chongqing Medical University, Chongqing, China;3. Department of Pathology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China;4. Department of Internal Medicine, The First Branch, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China;5. Laboratory of Neuropsycholinguistics, Chongqing Medical University, Chongqing, China;6. Department of Pathology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China;7. Department of Pathology, The Yongchuan Affiliated Hospital, Chongqing Medical University, Chongqing, China;8. Department of Ultrasound, The Daxuecheng Affiliated Hospital, Chongqing Medical University, Chongqing, China;1. La Paz University Hospital, Pathology Department, Spain;2. La Paz University Hospital, Radiology Department, Spain;3. La Paz University Hospital, Medical Oncology Department, Spain;4. La Paz University Hospital, Molecular Pathology and Therapeutic Targets Group, Instituto de Investigación del Hospital Universitario La Paz (IdiPAZ), Spain;5. La Paz University Hospital, Orthopaedics and Traumatology Department, Spain |
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| Abstract: | Castleman disease is a nodal based disease and very rarely involves the thymus gland. We report a 52-year-old man who was found incidentally to have a single thymic mass by computerized tomography scan. Thymectomy was performed, and the gross specimen showed a well-circumscribed, multi-loculated cystic mass. Histologic examination showed thymus involved by Castleman disease, hyaline-vascular variant. The lesion was characterized by lymphoid follicles with wide mantle zones, variably lymphocyte-depleted germinal centers with sclerotic radial blood vessels, and prominent interfollicular/stromal changes including numerous endothelial venules with sclerotic walls and hyaline sclerosis, scattered and frequent dysplastic follicular dendritic cells and foci of dystrophic calcification. Immunohistochemical analysis showed that the follicle mantle zones were composed of numerous B-cells positive for CD20, PAX5, and IgD. Antibodies specific for CD21 and CD23 highlighted prominent follicular dendritic cell networks within follicles. There was no evidence of human herpes virus 8. We searched the literature and could identify only 10 additional cases of thymic CD. Previously reported cases included 8 unicentric and 2 multicentric, classified pathologically as plasma cell variant (n = 4), hyaline vascular variant (n = 3), and mixed (n = 3). Thymectomy, as was done in the currently reported case, most often leads to the diagnosis of Castleman disease and was a mainstay of treatment in other reported cases. |
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