Department of Nephrology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan.
Pathol Int. 2011 Nov;61(11):686-90. doi: 10.1111/j.1440-1827.2011.02727.x. Epub 2011 Oct 21.
Renal involvement is a significant complication of multicentric Castleman's disease (MCD) and various glomerular involvements have been reported. A 45-year-old Japanese man presented with persistent proteinuria, with lymphadenopathy and hypergammaglobulinemia. He had been diagnosed 4 years previously with MCD. As his renal impairment had progressed to renal failure, he underwent a renal biopsy. Histology revealed diffuse and global membranous lesions with large and heterogeneous epimembranous deposits. In addition, mesangial cell proliferation and focal extracapillary lesions were found. Under immunofluorescence, granular staining for anti-IgG, IgG1, IgG2 and IgA was strongly positive in the capillary loop, and weakly positive in the mesangium. As such, there was a diversity of histological features. Our perspective with regard to pathogenesis is that the formation of the immune-complex contributed to the membranoproliferative glomerulonephritis type 3-like lesion. This histological multiform with MCD is valuable for increasing our understanding of the mechanism for onset of immune-complex glomerular deposition and cellular proliferation of glomerulonephritis.
肾脏受累是多发性中心型 Castleman 病（MCD）的一个重要并发症，已有多种肾小球受累的报道。一位 45 岁的日本男性因持续性蛋白尿、淋巴结病和高丙种球蛋白血症就诊。他在 4 年前被诊断为 MCD。由于他的肾功能已经进展为肾衰竭，因此进行了肾脏活检。组织学显示弥漫性和全球性的膜性病变，伴有大而不均匀的上皮膜沉积物。此外，还发现系膜细胞增殖和局灶性毛细血管外病变。免疫荧光检查显示，在毛细血管袢中 IgG、IgG1、IgG2 和 IgA 的颗粒状染色呈强阳性，在系膜中呈弱阳性。因此，存在多种组织学特征。我们对发病机制的看法是，免疫复合物的形成导致了膜增殖性肾小球肾炎 3 型样病变。MCD 的这种组织学多样性有助于我们了解免疫复合物肾小球沉积和细胞增殖性肾小球肾炎的发病机制。
