title: Bone marrow manifestations in multicentric Castleman disease.
abstract: This study aimed to document the morphological and immunophenotypic features, and describe the diagnostic features of bone marrow (BM) involvement in human herpes virus 8 Multicentric Castleman disease (HHV8-MCD). BM trephine biopsy (BMTB) specimens from 28 patients were revisited. Samples were evaluated for expression of CD3, CD20, CD138, CD68R, glycophorin C, CD42b, HHV8-latency-associated nuclear antigen (LANA1), Epstein-Barr virus-encoded small RNA and light chains. Presence of significant numbers of HHV8-LANA1(+) lymphoid/plasmacytic cells, noted in 10/28 cases, was indicative of BM involvement and was associated with low CD4 and CD8 counts in peripheral blood. The characteristic morphological appearance of MCD seen in lymph nodes is a rare finding in BMTB. 4/5 cases with lymphoid aggregates were involved by MCD, whereas 6/23 cases without lymphoid aggregates were involved by MCD (P = 0·023). 9/18 cases with hypercellular marrow were involved by MCD, whilst only 1/8 cases with normo/hypocellular marrow showed involvement by MCD (P = 0·070). While 9/21 cases with increased marrow reticulin were involved by MCD, none of the cases with no increase in reticulin were involved by MCD (P = 0·080). Reactive plasmacytosis is a frequent finding. We conclude that bone marrow is involved in a significant proportion of patients with MCD (36%), and involvement can be identified by HHV8-LANA1 immunohistochemistry.
authors.affiliation: Department of histopathology, Hammersmith Hospital, Imperial College London, London, UK.|Department of histopathology, Faculty of Medicine, Mansoura University, Egypt.
authors.forename: Hazem A H
authors.initials: HA
authors.lastname: Ibrahim
authors.affiliation: Department of Oncology, Chelsea Westminster Hospital, London, UK*
authors.forename: Kirsty
authors.initials: K
authors.lastname: Balachandran
authors.affiliation: Department of Oncology, Chelsea Westminster Hospital, London, UK*
authors.forename: Mark
authors.initials: M
authors.lastname: Bower
authors.affiliation: Department of histopathology, Hammersmith Hospital, Imperial College London, London, UK.
authors.forename: Kikkeri N
authors.initials: KN
authors.lastname: Naresh
mesh_terms: D000328:Adult; D000368:Aged; D000956:Antigens, Viral / Q000378:metabolism; D001706:Biopsy / Q000379:methods; D001853:Bone Marrow / Q000276:immunology / Q000473:pathology*; D001856:Bone Marrow Examination / Q000379:methods; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology; D005871:Castleman Disease / Q000276:immunology / Q000473:pathology* / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000150:complications; D006566:Herpesviridae Infections / Q000150:complications; D019288:Herpesvirus 8, Human; D006801:Humans; D016130:Immunophenotyping; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009687:Nuclear Proteins / Q000378:metabolism; D012155:Reticulin / Q000378:metabolism
chemical_list: D000956:Antigens, Viral; D009687:Nuclear Proteins; D012155:Reticulin; C109540:latency-associated nuclear antigen
keywords: HHV8; Kaposi sarcoma; bone marrow trephine biopsy; human immunodeficiency virus; multicentric Castleman disease