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Human immunodeficiency virus-negative multicentric Castleman's disease coexistent with Kaposi's sarcoma on 18F-FDG
Jae Pil Hwang1, Jiyoon Kim2, Jung Mi Park1
1Department of Nuclear Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Gyeonggi 420-767, Republic of Korea.
Insights
This case study highlights a rare instance of human immunodeficiency virus (HIV)-negative multicentric Castleman's disease coexisting with Kaposi's sarcoma. Treatment with chemotherapy led to near-complete remission of the hypermetabolic lesions.
Area of Science:
- Oncology
- Infectious Diseases
- Radiology
Background:
- Multicentric Castleman's disease (MCD) and Kaposi's sarcoma (KS) are often associated with human immunodeficiency virus (HIV) infection.
- However, a significant proportion (40-50%) of MCD and KS cases occur in HIV-negative individuals.
- This underscores the importance of considering these diagnoses in HIV-negative patients presenting with relevant symptoms.
Purpose of the Study:
- To report a case of coexisting HIV-negative multicentric Castleman's disease and Kaposi's sarcoma.
- To illustrate the diagnostic utility of advanced imaging techniques in such rare conditions.
- To present the treatment outcome and response to chemotherapy.
Main Methods:
- A 61-year-old male patient presented with palpable masses.
- Diagnostic workup included contrast-enhanced computed tomography (CT) and fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET)/CT.
- Excisional biopsy with immunohistochemical analysis confirmed the diagnosis.
Main Results:
- Imaging revealed multiple enlarged, hypermetabolic lymph nodes across cervical, thoracic, and abdominopelvic regions.
- Histopathology confirmed coexisting HIV-negative multicentric Castleman's disease and Kaposi's sarcoma.
- Following steroid therapy and four cycles of chemotherapy, follow-up 18F-FDG PET/CT showed near-complete remission of malignant lesions.
Conclusions:
- This case demonstrates the possibility of co-occurrence of HIV-negative MCD and KS.
- Integrated imaging like 18F-FDG PET/CT is crucial for accurate diagnosis and staging.
- Chemotherapy can be an effective treatment modality for this rare combination, leading to significant clinical improvement.
Abstract:
Multicentric Castleman's disease and Kaposi's sarcoma are more frequently observed in human immunodeficiency virus (HIV)-infected patients; however, 40-50% of the cases are HIV-negative. The present study reports the case of a 61-year-old man who presented with palpable masses in the axillary and right inguinal areas. The blood test results revealed increased serum erythrocyte sedimentation rate and C-reactive protein level, with negative serological markers, including for HIV. The patient was investigated using contrast-enhanced computed tomography (CT) and fluorine- 18fluorodeoxyglucose positron emission tomography (18F-FDG PET)/CT; the images revealed multiple enlarged and intensely hypermetabolic lymph nodes in the cervical, thoracic and abdominopelvic areas. Excisional biopsy and immunohistochemical analysis were performed, which confirmed the diagnosis of HIV-negative multicentric Castleman's disease coexisting with Kaposi's sarcoma. The patient received steroid therapy followed by chemotherapy. After 4 cycles of chemotherapy, the follow-up 18F-FDG PET/CT scan revealed nearly complete remission of the hypermetabolic malignant lesions of the neck, axilla and thoracoabdominal region.
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