Clinicopathological Characteristics Of 22 Cases Of Castleman's Disease In Chinese Patients: A Possible Role Of HBV Infection In Its Etiology?

Objective:To investigate the distinguished clinicopathological features of Chinese patients with Castleman's disease(CD)and the possible role of Hepatitis B Virus (HBV) infection in its etiology.Method:We reviewed the medical records including HBV infection status data of 22 Chinese patients diagnosed with Castleman's disease in our hospital, between Jan 2004 and Jun 2009. Then, we compared the positive incidence of serum Hepatitis B surface antigen (HBsAg) in CD patients with that of the general patients admitted in our hospital in the same period. Finally, we compared Clinicopathological features of our patients with those of two published case series from Korea and the United States.Results:A total of 22 patients were diagnosed of CD in our hospital,10 patients were male and 12 were female with a median age of 39 years (range,9-76 y).13 patients (8 females and 5 males) were of unicentric CD(UCD) including 10 patients of the hyaline vascular subtype (HV subtype),2 patients of the mixed variant subtype (MV subtype) and 1 patient of the plasma cell subtype (PC subtype). None of the patients in this group complained of fever, loss of weight or other systemic symptoms. The median overall survival (OS) in this group was 25months (range,4-49months).9 cases (5 males and 4 females) were of multicentric CD (MCD) including 7 patients of the HV subtype and the remaining 2 of the PC subtype. There was a high rate of patients with constitutional symptoms (8 patients,88.9%) in the MCD group. The median OS of MCD group was 11.5 months (range,0-41 months). A total of 5 patients were HBsAg positive. All of these 5 patients were HV subtype. CD patients had a higher rate of HBsAg positive compared with that of the general patients admitted at the same period (22.7%VS 8.33%,P=0.039). At least,11 patients (50.0%) had the evidence of previous or present HBV infection (either HBsAg+,or Hepatitis B Virus e antigen (HBeAg)+,or Hepatitis B Virus e antibody (HBeAb)+, or Hepatitis B Virus core antibody (HBcAb)+), including 9 patients of the HV subtype, the other 2 of the MV subtype and none of the PC subtype. Furthermore, there was a higher frequency of HV subtype (17/22)(P=0.0029)and splenomegaly (11/22) (P=0.00084) in Chinese patients compared with Koreans and Americans.Conclusion:Chinese patients with castleman's disease have their own distinguished features and HBV infection may play an important role in its etiology, especially in the HV subtype.