Cardiac Tamponade Secondary to Giant Lymph Node Hyperplasia: Castleman’s Disease

Abstract

Communications for this section will be published as space and priorities permit. The comments should not exceed 350 words in length, with a maximum of five references; one figure or table can be printed. Exceptions may occur under particular circumstances. Contributions may include comments on articles published in this periodical, or they may be reports of unique educational character. Specific permission to publish should be cited in a covering letter or appended as a postscript. Communications for this section will be published as space and priorities permit. The comments should not exceed 350 words in length, with a maximum of five references; one figure or table can be printed. Exceptions may occur under particular circumstances. Contributions may include comments on articles published in this periodical, or they may be reports of unique educational character. Specific permission to publish should be cited in a covering letter or appended as a postscript. To the Editor: We read with great interest the case report by Nicolosi et al,1Nicolosi AC Almassi GH Komorowski R Cardiac tamponade secondary to giant lymph node hyperplasia (Castleman’s disease).Chest. 1994; 105: 637-639Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar which appeared in the February 1994 issue of Chest, concerning the association of giant lymph node hyperplasia (Castleman’s disease) and cardiac tamponade. The authors report a case of multicentric Castleman’s disease of mixed histologic type in a patient with massive pericardial effusion. While pericardial effusion has been previously reported in conjunction with Castleman’s disease,2Goldberg MA Deluca SA Radiographic highlights: Castleman’s disease.Am Fam Physician. 1989; 40: 151-153PubMed Google Scholar the association of cardiac tamponade with that disorder is a rare phenomenon. We too have recently treated a patient with multicentric giant lymph node hyperplasia of the plasma cell type. However, the clinical course of our patient was marked with rapid deterioration and death within 10 months after diagnosis. In sharp contrast to Dr. Nicolosi’s statement that “… surgical excision … is uniformly curative …” and “… the disease is not considered premalignant …,” a careful review of the literature shows that surgical extirpation is curative only in the “localized” type of Castleman’s disease and not always possible in the multicentric form. In a clinicopathologic study of 16 cases, Weisenburger et al3Weisenburger DD Nathwani BN Winberg CD et al.Multicentric angiofollicular lymph node hyperplasia: a clinicopathological study of 16 cases.Hum Pathol. 1985; 16: 162-172Abstract Full Text PDF PubMed Scopus (355) Google Scholar reported a median survival of 26 months (range, 8 to 170 months). They also noted development of malignant lymphoma in four of their patients (25%), an association that has also been reported by others.4Kessler E Multicentric giant lymph node hyperplasia: a report of seven cases.Cancer. 1985; 56: 2446-2451Crossref PubMed Scopus (111) Google Scholar Further, since histologic findings of Castleman’s disease are nonspecific, diagnosis can only be made when other causes of lymphadenopathy, including acquired immune deficiency syndrome (AIDS),5Frizzera G Castleman’s disease: more questions than answers.Hum Pathol. 1985; 16: 202-205Abstract Full Text PDF PubMed Scopus (156) Google Scholar, 6Lachant NA Sun NC Leong LA et al.Multicentric angiofollicular lymph node hyperplasia (Castleman’s disease) followed by Kaposi’s sarcoma in two homosexual males with the acquired immunodeficiency syndrome (AIDS).Am J Clin Pathol. 1985; 83: 27-33Crossref PubMed Scopus (110) Google Scholar is investigated and excluded. While the localized type of Castleman’s disease is often amenable to surgery, the management of the multicentric variety—the subject of the case report—is not clear.3Weisenburger DD Nathwani BN Winberg CD et al.Multicentric angiofollicular lymph node hyperplasia: a clinicopathological study of 16 cases.Hum Pathol. 1985; 16: 162-172Abstract Full Text PDF PubMed Scopus (355) Google Scholar Though a variety of chemotherapeutic regimens have been used, as yet none have consistently been effective. The role of surgery in disseminated disease, however, is limited to local relief of symptoms and treatment of organ compromise. In view of its premalignant potential, we believe this clinical entity requires close and long-term observation for neoplastic transformation. Cardiac Tamponade Secondary to Giant Lymph Node Hyperplasia: To the Editor: Castleman’s DiseaseCHESTVol. 107Issue 2PreviewWe appreciated very much the comments of Drs. Shahidi and Kvale regarding our case report, “Cardiac Tamponade Secondary to Giant Lymph Node Hyperplasia (Castleman’s Disease)” (Chest 1994; 105:637-39). Since this report was published, we too have become aware of the literature that suggests the striking clinical and prognostic differences between the localized and multicentric forms of Castleman’s disease. It is also now apparent that other diseases or syndromes can, at certain stages of their course, exhibit lymph node changes very similar to Castleman’s disease. Full-Text PDF