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KSHV-associated multicentric Castleman disease: A tangle of different entities requiring multitarget treatment strategies.
[primary effusion lymphoma]
Multicentric
Castleman
Disease
(
MCD
)
is
a
lymphoproliferative
disorder
presenting
with
heterogeneous
pathological
and
clinical
features
.
It
comprises
disease
entities
with
a
complex
aetiology
and
overlapping
pathogenesis
.
MCD
can
be
found
in
association
with
HIV
infection
,
plasma-cell
dyscrasias
,
Kaposi
sarcoma
(
KS
)
,
B-
cell
lymphomas
including
primary
effusion
lymphoma
(
PEL
)
and
its
solid
variant
,
and
Hodgkin
lymphoma
.
In
KSHV-associated
MCD
cases
,
a
common
association
is
KS
and
a
specific
variant
of
lymphoma
referred
to
as
"
plasmablastic
lymphoma
,
"
also
called
"
large
B-
cell
lymphoma
arising
in
KSHV-associated
MCD
"
lacking
EBV
infection
.
MCD
is
often
referred
to
as
human
interleukin-
6
(
hIL-
6
)
syndrome
,
since
an
overproduction
of
IL
-
6
occurs
in
MCD
-associated
diseases
as
well
as
in
MCD
itself
.
hIL-
6
and
a
viral
IL
-
6
(
vIL-
6
)
homolog
encoded
by
KSHV
can
independently
or
together
lead
to
flares
of
KSHV-associated
MCD
.
Recently
,
a
new
clinical
entity
was
proposed
to
describe
a
severe
systemic
infection
/
reactivation
of
KSHV
:
KSHV
inflammatory
syndrome
(
KICS
)
.
KICS
may
contribute
in
inducing
the
inflammatory
symptoms
seen
in
some
patients
with
severe
KS
or
PEL
.
The
precise
relationship
of
KICS
to
KSHV-associated
MCD
is
unclear
and
it
is
possible
that
KICS
may
be
prodromal
symptoms
to
frank
KSHV-associated
MCD
.
Options
for
treatment
of
KSHV-associated
MCD
and
related
diseases
include
monoclonal
antibodies
,
chemotherapy
,
immune
modulators
,
virus-activated
cytotoxic
therapy
and
antiviral
therapies
.
A
comprehensive
understanding
of
the
intricacies
of
the
HIV-KSHV
coinfection
will
probably
lead
to
additional
advances
in
therapy
and
managements
for
these
disorders
.
Diseases
Validation
Diseases presenting
"hodgkin lymphoma"
symptom
esophageal adenocarcinoma
hodgkin lymphoma, classical
monosomy 21
primary effusion lymphoma
severe combined immunodeficiency
systemic capillary leak syndrome
waldenström macroglobulinemia
This symptom has already been validated