case_images: PMC10799255_01
case_images: Representative laboratory data prior to and after application of different treatment regimens. Hemoglobin (a), albumin (b), CRP (c) levels, and ESR (d) improved with bortezomib combined with dexamethasone. (a: cyclophosphamide + vincristine + prednisone; b: cyclophosphamide + doxorubicin + vincristine + prednisone; c: interferon A + thalidomide; d: rituximab + interferon A + thalidomide; e: bortezomib + dexamethasone. Arrows represent the time of initiation of each treatment regimen.).
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case_images: His laboratory data revealed reduced levels of hemoglobin (11.7 g/dL; normal range, 12.0-16.0 g/dL) and albumin (2.65 g/dL; normal range, 3.5-5.5 g/dL), and elevated serum CRP levels (1.63 mg/dL; normal range, 0.0-0.8 mg/dL) (Figure 1).
case_images: Fluorodeoxyglucose (FDG)-PET/CT scan at initial presentation revealed a mild abnormal accumulation of FDG in bilateral pleural effusion, as well as ascites, and multiple small lymph nodes (located behind the 12th thoracic and 4th lumbar vertebrae, with a diameter between 4 and 9 mm) (maximum standard uptake value: 1.8-2.2).
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case_images: Positron emission tomography-computed tomography (PET-CT) scan showed multiple enlarged retroperitoneal lymph nodes (maximum diameter 4 x 9 mm) (Figure 2).
case_images: Lymph node biopsy showed multicentric Castleman's disease of PC type. (a) Several lymphatic follicles were detected under light microscopy. The surrounding lymph nodes are arranged in concentric circles. The germinal center is atrophic, with a large number of PCs and a few lymphatic infiltrates in the interfollicles (hematoxylin and eosin, x400). (b) Immunohistochemical (IHC) staining of cells by CD20 antibody, which shows positive follicular areas. (c) IHC staining CD138 PC expression is positive and shows cell membrane staining. (d) IHC staining CD3 and (e) CD68 interfollicular areas are scattered positive (IHC staining, x20).
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case_images: As malignancy could not be completely excluded, a puncture biopsy of the enlarged abdominal lymph nodes was performed and the pathology was consistent with multicentric Castleman's disease, PC type (Figure 3).