Diagnosing Castleman’s Disease
Because it resembles many other disorders, early identification of Castleman’s Disease can be challenging.1 The lymph node abnormalities can resemble those in conditions such as chronic viral infections, rheumatoid arthritis, lupus, Sjögren syndrome, HIV infection, lymphoma, and drug sensitivity.2
Diagnosis of Castleman’s Disease involves a work-up to rule out other possible causes, and to identify histology and laboratory abnormalities that are characteristic of the disease.3
Work-up for Castleman’s Disease3
Excisional lymph node biopsy
Pathology, exclude clonal malignancy
HIV and HHV-8 serology with quantitative PCR, if positive
Acute phase reactants
WESR, CRP, fibrinogen
CBC, renal and liver function
ANA, others as indicated
Thyroid function tests, others as indicated
Plasma cell dyscrasias
Immunoglobulins, urine and protein electrophoresis and immunofixation, light chains, bone marrow, 24-hour urine for protein quantification
Echocardiogram, pulmonary function
CT of neck, chest, abdomen, pelvis; CT-PET
Nerve conduction as indicated
ANA = anti-nuclear antibody; CBC = complete blood count;
CRP = C-reactive protein; CT = computed tomography;
CT-PET = computed tomography–positron emission tomography;
HHV-8 = human herpesvirus-8; PCR = polymerase chain reaction;
VEGF = vascular endothelial growth factor; WESR = Westergren erythrocyte sedimentation rate.
- Bonekamp D, Horton KM, Hruban RH, Fishman EK. Castleman disease: the great mimic. Radiographics. 2011;31(6):1793-1807.
- Casper C. The aetiology and management of Castleman disease at 50 years: translating pathophysiology to patient care. Br J Haematol. 2005;129(1):3-17.
- van Rhee F, Stone K, Szmania S, Barlogie B, Singh Z. Castleman's disease in the 21st century: an update on diagnosis, assessment, and therapy. Clin Adv Hematol Oncol. 2010;8(7):486-498.