FDG-PET/ CT for initial staging and response assessment in Castleman disease – retrospective single-center study of 29 cases

Czech version

Authors: R. Koukalová ¹; I. Selingerová ^2,3; Z. Řehák ¹; Z. Adam ⁴; P. Szturz ⁵
Authors‘ workplace: Oddělení nukleární medicíny, MOÚ Brno, Česká republika ¹; Oddělení laboratorní medicíny, MOÚ Brno, Česká republika ²; Výzkumné centrum aplikované molekulární onkologie (RECAMO), MOÚ Brno, Česká republika ³; Interní hematologická a onkologická klinika LF MU a FN Brno, Česká republika ⁴; Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland ⁵
Published in: Klin Onkol 2021; 34(2): 120-127
Category: Original Articles
doi: https://doi.org/10.48095/ccko2021120

Overview

Background: Castleman disease (CD) is a rare lymphoproliferative disorder including unicentric and multicentric forms which can further be divided into four histopathologic variants (hyaline vascular, plasma cell, mixed, and plasmablastic). Multicentric CD typically behaves as an aggressive, relapsing entity with generalized lymphadenopathy and systemic symptoms. PET/CT following ¹⁸F-fluorodeoxyglucose administration (FDG-PET/CT) represents an imaging modality commonly used in malignant lymphomas for staging purposes and response assessment. However, literature data on its role in CD have been limited. Patients and methods: Twenty-nine patients, 18 men and 11 women, diagnosed in 1998–2016 were enrolled in our retrospective study. All patients underwent FDG-PET/CT during initial staging and/or as part of response assessment. We measured the maximum diameter of a lesion and established an index value corresponding to the ratio of the maximum standardized uptake value for the observed lesion and for the liver. The information about imaging examinations, patients, and disease extensions was put in a registry and statistically analyzed. Results: Unicentric and multicentric CD was diagnosed in 17 and 12 patients, respectively. Median age at the diagnosis was comparable between the two groups (51 and 58 years, respectively; P = 0.352). The majority of patients with multicentric CD (83%) were men. In women, the unicentric form prevailed (82 vs. 18%) while the difference between the two forms was of borderline significance in men (44 vs. 56%; P = 0.064). Most of the patients (88%) with unicentric CD had the hyaline vascular pathology type. On the contrary, the plasma cell type was predominant in multicentric CD (42%). The most commonly included anatomic sites included the retroperitoneum (52%) and the thorax (43%). Inguinal node involvement developed only in patients with multicentric CD. In repeatedly examined patients, FDG-PET/CT demonstrated a progressively decreasing size and metabolic activity of a selected lymph node. Conclusion: FDG-PET/CT represents a suitable modality for initial staging and response monitoring of CD, especially in patients with a multicentric form.

Keywords:

Castleman disease – FDG-PET/CT – SUVmax lesion/SUVmax hepar index

Sources

1. Vassos N, Raptis D, Lell M et al. Intra-abdominal localized hyaline-vascular Castleman disease: imaging characteristics and management of a rare condition. Arch Med Sci 2016; 12 (1): 227–232. doi: 10.5114/aoms.2016.57600.

2. Bonekamp D, Horton KM, Hruban RH et al. Castleman disease: the great mimic. Radiographics 2011; 31 (6): 1793–1807. doi: 10.1148/rg.316115502

3. Yabuhara A, Yanagisawa M, Murata T et al. Giant lymph node hyperplasia (Castleman’s disease) with spontaneous production of high levels of B-Cell differentiation factor activity. Cancer 1989; 63 (2): 260–265. doi: 10.1002/1097-0142 (19890115) 63: 2<260:: aid-cncr2820630210>3.0.co; 2-y.

4. Castleman B, Iverson L, Menendez VP. Localizedmediastinal lymphnode hyperplasia resembling thymoma. Cancer 1956; 9 (4): 822–830. doi: 10.1002/10970142 (195607/08) 9: 4<822:: aid-cncr2820090430>3.0.co; 2-4.

5. Ye B, Gao SG, Yang LH et al. A retrospective study of unicentric and multicentric Castleman’s disease: a report of 52 patients. Med Oncol 2010; 27 (4): 1171–1178. doi: 10.1007/s12032-009-9355-0.

6. Dispenzieri A, Fajgenbaum DC. Overview of Castleman disease. Blood 2020; 135 (16): 1353–1664. doi: 10.1182/blood.2019000931

7. Szturz P, Adam Z, Řehák Z et al. Castlemanova choroba: retrospektivní studie léčebných výsledků u 10 pacientů z jednoho centra. Klin Onkol 2013; 26 (2): 124–134.

8. Adam Z, Szturz P, Krejčí M et al. Léčba 14 případů Castlemanovy nemoci: zkušenosti jednoho centra a přehled literatury. Vnitř Lék 2018; 62 (4): 287–298.

9. Moore DF, Preti A, Tran SM et al. Prognostic implications following an indeterminate nondiagnostic workup of lymphoma. Blood 1996; 88 (10): 906.

10. Mehra M, Cossrow N, Stellhorn RA et al. Use of Claims Database to Characterize and Estimate the incidence of Castleman’s Disease. Blood 2012; 120 (21): 4253. doi: 10.1182/blood.V120.21.4253.4253.

11. Haap M, Wiefels J, Horger M et al. Clinical, laboratory and imaging findings in Castleman’s disease – the subtype decides. Blood Rev 2018; 32 (3): 225–234. doi: 10.1016/j.blre.2017.11.005.

12. Zhao S, Wan Y, Huang Z et al. Imaging and clinical features of Castleman disease. Cancer Imaging 2019; 19 (1): 53. doi: 10.1186/s40644-019-0238-0.

13. Meador TL, McLarney JK. CT features of Castleman disease of the abdomen and pelvis. AJR Am J Roentgenol 2000; 175 (1): 115–1188. doi: 10.2214/ajr.175.1.1750115.

14. Ko SF, Hsieh MJ, Ng SH, Lin JW et al. Imaging spectrum of Castleman’s disease. AJR Am J Roentgenol 2004; 182 (3): 769–775. doi: 10.2214/ajr.182.3.1820769

15. Lee ES, Paeng JC, Park CM et al. Metabolic characteristics of Castleman disease on 18F-FDG PET in relation to clinical implication. Clin Nucl Med 2013; 38 (5): 339–342. doi: 10.1097/RLU.0b013e3182816730

16. Madan R, Chen JH, Trotman-Dickenson B et al. The spectrum of Castleman’s disease: Mimics, radiologic pathologic correlation and role of imaging in patient management. Eur J Radiol 2012; 81 (1): 123–131. doi: 10.1016/j.ejrad.2010.06.018

17. Barker R, Kazmi F, Stebbing J et al. FDG-PET/CT imaging in the management of HIV-associated multicentric Castleman’s disease. Eur J Nucl Med Mol Imaging 2009; 36 (4): 648–652. doi: 10.1007/s00259-008-0998-4

18. Han EJ, Jung SE, Park G et al. FDG PET/CT findings of Castleman disease assessed by histologic subtypes and compared with laboratory findings. Diagnostics 2020; 10 (12): 998. doi: 10.3390/diagnostics10120998

19. Halac M, Ergul N, Sager S et al. PET/CT findings in a multicentric form of Castleman’s disease. Hell J Nucl Med 2007; 10 (3): 172–174.

20. Bertagna F, Biasiotto G, Rodella R et al.18F-fluorodeoxyglucose positron emission tomography/computed tomography findings in a patient with human immunodeficiency virus-associated Castleman’s disease and Kaposi sarcoma, disorders associated with human herpes virus 8 infection. Jpn J Radiol 2010; 28 (3): 231–234. doi: 10.1007/s11604-009-0404-6.

21. Enomoto K, Nakamichi I, Hamada K et al. Unicentric and multicentric Castleman’s disease. Br J Radiol 2007; 80 (949): e24–e26. doi: 10.1259/bjr/93847196.