IL-6-positive classical Hodgkin's lymphoma co-occurring with plasma cell type of Castleman's disease: report of a case.
We present a case of classical Hodgkin's lymphoma (HL) co-occurring with histological features of Castleman's disease (CD). A 25-year-old man presented with left supraclavicular and axillary lymph node swelling and mediastinal mass. Using an initial biopsy specimen from left axillary lymph node, a tentative diagnosis of multicentric CD of plasma cell type was made. The serum level of interleukin-6 (IL-6) was elevated. The patient was treated with immunosuppressive therapy containing tocilizumab (TCZ). Shrinkage of mediastinal mass and axillary lymph nodes was seen; however, swelling of his left axillary lymph nodes reemerged, even after therapy with TCZ. A second left axillary lymph node biopsy was performed and a diagnosis of nodular sclerosis of classical HL without histologic features of CD was made. The initial biopsy specimen was re-examined, and scattered CD30+ Hodgkin/Reed-Sternberg cells were found in the interfollicular area. Interestingly, Hodgkin/Reed-Sternberg cells and surrounding reactive cells in both lymph nodes were stained with anti-IL-6 antibody. We emphasize that biopsy specimens with HL involvement may also have histologic features reminiscent of those seen in CD. To our knowledge, this is the first report to provide a detailed description of this pathology, including a survey of IL-6 and clinical course upon treatment with TCZ.
Department of Internal Medicine, Niigata Prefectural Central Hospital, 205 Shinnan-chou, Joetsu, Niigata 943-0147, Japan. momoia@npch.lamen.or.jp
Akihito
A
Momoi
Masaru
M
Kojima
Takeshi
T
Sakai
Junya
J
Ajiro
Noriatsu
N
Isahai
Kouichi
K
Nagai
Sadao
S
Aoki
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001706:Biopsy; D005871:Castleman Disease / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000378:metabolism*; D006689:Hodgkin Disease / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000378:metabolism*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood / Q000378:metabolism*; D008198:Lymph Nodes / Q000378:metabolism / Q000473:pathology; D008297:Male; D010950:Plasma Cells / Q000473:pathology*
D015850:Interleukin-6