| Objective:Castleman’s disease(CD),also known as giant lymphadenopathy,is a rare lymphoproliferative disease with different clinical manifestations and pathological features.The pathological features can be characterized by the proliferation of lymphatic follicles,blood vessels and plasma cells to varying degrees.Painless enlarged lymph nodes are the most common,and some may be associated with systemic symptoms and multiple systemic lesions.The purpose of this study is to explore the site,pathological type,histological characteristics and laboratory indicators of CD,so as to provide reference for young physicians.Methods:The clinical data of 54 cases of human immunodeficiency virus(HIV)negative CD patients admitted to our hospital from April 2013 to April 2019 were retrospectively collected.The clinical data were pathologically confirmed and reviewed by at least 2 pathologists.Follow-up was conducted by telephone follow-up visit.SPSS25.0 statistical software was used for statistical difference analysis of the collected data,and the test level was set at P=0.05.Results:(1)General information:Among the 54 patients with CD,there were 22 males(40.7%)and 32 females(59.3%).In UCD,there were 10 males(32.26%)and 21 females(67.74%).In the polycentric type(MCD),there were 12 males(52.17%)and 11 females(47.83%).There was no statistical difference in gender between the two groups(χ~2=3.787,P=0.052).Among the 31 cases of UCD,there were 18 cases of single lymph node involvement in single node station,including 7 males(38.89%)and 11 females(61.11%).There were 13 cases of multiple lymph nodes involved in single lymph node station,including 3 males(23.08%)and 10 females(76.92%).There was no statistically significant difference between the two groups(χ~2=0.864,P=0.153).The age of diagnosis ranged from 17 to 80 years,with a mean age of 43.29 years and a median age of 38.5years.All the 31 UCD patients were less than 60 years old,while 19 patients in the MCD group were 50 years old,and 4 patients were≤50 years old.There was a statistical difference between the two groups(χ~2=15.539,P<0.001).(2)The site of disease:CD could involve almost all parts of the body,including the neck in 31 cases(57.41%),mediastinum in 18 cases(33.33%),axilla in 13 cases(24.07%),retroperitoneal in 13cases(24.07%),groin in 13 cases(24.07%),abdomen in 5 cases(9.26%),chest in 2 cases(3.70%),and pelvic cavity in 1 case(1.85%).After statistical analysis,there were statistical differences in the involved sites in neck,axilla and groin between UCD group and MCD group(all P<0.05),and the incidence of involvement in the above sites in MCD group was higher than that in UCD group,while there were no statistical differences in pelvic cavity,mediastinum and chest(P>0.05).There was no statistically significant difference in the site of involvement between the single lymph node involvement group and the multiple lymph node involvement group(P>0.05).(3)Diameter of lesions:the diameter of UCD lesions ranged from 0.8-12cm,with an average of 2.92-4.28cm.The diameter of MCD lesions ranged from 0.3 to 4.3cm,with an average of 0.64 to 3.13cm.The diameter of UCD lesions was larger than MCD.(4)Pathological classification:in UCD,there were 27 cases of clear vascular type(HV)(87.10%),4 cases of plasma cell type(PC)(12.90%),5 cases of HV type(21.73%),17 cases of PC type(73,91%),and 1 case of mixed type(4.35%)in MCD group.There was statistical difference in pathological types between the two groups(P<0.001).HV type was dominant in UCD group,while PC type was dominant in MCD group.There was no difference in pathological types between the single lymph node involvement group and the multiple lymph node involvement group(P<0.05).(5)Clinical symptoms:there were statistical differences between the UCD group and the MCD group in fever,fatigue,edema/multiserosal effusion,hepatosplenomegaly,anorexia and emaciation(all P<0.05),and the incidence of MCD group was higher than that of the UCD group.There was no statistically significant difference in the systemic performance between the single lymph node involvement group and the multiple lymph node involvement group(all P=>0.05).(6)laboratory tests:MCD group in anemia,prothrombin time,partial activated clotting enzyme live longer,and fibrinogen increased,elevated alkaline phosphatase,C-reactive protein increased,beta 2 microglobulin increases with the UCD,low serum albumin leels with statistical difference(P<0.05),the above rates are higher than the UCD.However,there was a statistical difference in aspartate transaminase between single lymph node involvement group and multiple lymph node involvement group in UCD single lymph node station(P<0.001),and the incidence of pre-high aspartate transaminase was higher.(7)Treatment:All the 31 UCD patients underwent complete surgical resection,and postoperative compression symptoms and abnormal laboratory indicators were basically corrected.By the follow-up date,only one patient had died,with a mortality rate of3.23%.All the surgery patients were in complete remission of disease(CR).Among the23 cases of MCD,14 patients received chemotherapy therapy(including 3 patients with recurrence after surgery),1 patient received oral hormone only,4 patients received no treatment after definite diagnosis,and 4 patients received surgical resection alone.By the date of follow-up,8 cases of MCD were in complete remission and 2 cases were in partial remission,with an effective rate of 43.48%.Five cases died,with a mortality rate of 21.74%.There were differences in the treatment methods between UCD and MCD(P<0.001).Surgical resection of UCD had a better effect and could basically achieve the curative effect,while systemic chemotherapy was needed after resection of MCD.Chemotherapy patients including follow lymphoma treatment solutions,TCP(Sally amine cyclophosphamide dexamethasone),BCD scheme(boron for m Cyclophosphamide dexamethasone),a classic lymphoma treatment,TCP and BCD dosing schedule is more convenient,better security,and the former is cheap,convenient,for MCD is a new choice.Conclusion:The incidence of CD is low,UCD is more common in young women,and MCD is more common in the elderly,with no gender difference.Clinically,UCD is more common than MCD.HV type is the dominant type in UCD,while PC type is the dominant type in MCD.UCD lesions are larger in diameter.The clinical manifestations are highly heterogeneous.Most UCD patients are asymptomatic and the laboratory indicators are basically normal,while MCD is often involved in multiple organs and multiple systems,with more laboratory abnormal indicators such as anemia and low albumin.There were also differences in laboratory indicators between the single node involvement group and the multiple node involvement group at UCD single node station.CD can occur in all parts of the body,which is easily confused with malignant lymphoma in clinical practice.Lymph node biopsy is an important means to diagnose CD,and early detection and early treatment should be achieved for suspected cases.Surgery is the preferred treatment for UCD,and the postoperative survival is relatively long.The prognosis of MCD is worse than that of UCD.In addition to the classical lymphoma chemotherapy regimen,TCP and borteomi-based regiments are convenient and easy to obtain,which may provide a new treatment plan for MCD patients. |
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