McCarty M J, Vukelja S J, Banks P M, Weiss R B
Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA.
Cancer Treat Rev. 1995 Jul;21(4):291-310. doi: 10.1016/0305-7372(95)90034-9.
This review provides a comprehensive assessment of angiofollicular lymph node hyperplasia (ALNH) or Castleman's disease including pathogenesis, clinical presentation, histomorphologic and immunophenotypic findings, laboratory results, treatment, and prognosis. A division of ALNH into clinically relevant subtypes provides a framework for the consideration of the disorder. A comprehensive search of the medical literature involving ALNH using Medline was performed. Reports judged to be significant for the understanding of the disorder were analyzed and their findings incorporated into this review. ALNH is divided into localized/unicentric ALNH and generalized/multicentric ALNH due to the profound clinical differences seen between these variants. Localized/unicentric ALNH is separated by clinical and histomorphologic criteria into hyaline-vascular (HV) and plasma-cell (PC) subtypes. Generalized/multicentric ALNH may be divided by clinical criteria into generalized/multicentric ALNH without neuropathy (non-neuropathic) and generalized/multicentric ALNH with neuropathy (POEMS-associated or neuropathic). The dichotomy between these two subtypes is not absolute, with considerable clinical overlap occurring among patients presenting with generalized disease. Immunophenotypic and molecular probe studies demonstrate clonal B-cell lymphocyte populations in some cases, particularly those with generalized/multicentric ALNH. However, the finding of clonal populations is of no value in predicting malignant clinical progression. We conclude that using this division of ALNH, patients presenting with symptoms and histomorphology consistent with ALNH can be subdivided into the appropriate category of ALNH. Localized or unicentric disease, either HV or PC subtype, has an excellent prognosis with surgery being curative in the majority of cases. Generalized or multicentric disease indicates a poor prognosis with short survival, with the neuropathic variant possessing resistance to steroids and chemotherapy and a corresponding worse prognosis.
本综述对血管滤泡性淋巴结增生症（ALNH）或卡斯尔曼病进行了全面评估，内容包括发病机制、临床表现、组织形态学和免疫表型特征、实验室检查结果、治疗及预后。将ALNH分为临床相关亚型可为该疾病的考量提供一个框架。我们使用医学主题词表（Medline）对涉及ALNH的医学文献进行了全面检索。对判定对理解该疾病有重要意义的报告进行了分析，并将其结果纳入本综述。由于这两种变体之间存在显著的临床差异，ALNH分为局限性/单中心性ALNH和全身性/多中心性ALNH。局限性/单中心性ALNH根据临床和组织形态学标准分为透明血管（HV）型和浆细胞（PC）型。全身性/多中心性ALNH根据临床标准可分为无神经病变的全身性/多中心性ALNH（非神经病变性）和伴有神经病变的全身性/多中心性ALNH（POEMS相关或神经病变性）。这两种亚型之间的二分法并非绝对，在患有全身性疾病的患者中存在相当多的临床重叠。免疫表型和分子探针研究在某些病例中显示出克隆性B细胞淋巴细胞群，特别是那些患有全身性/多中心性ALNH的病例。然而，克隆性群体的发现对预测恶性临床进展并无价值。我们得出结论，使用这种ALNH分类方法，出现与ALNH一致的症状和组织形态学表现的患者可被细分为适当的ALNH类别。局限性或单中心性疾病，无论是HV型还是PC型，预后都非常好，大多数病例手术可治愈。全身性或多中心性疾病预后不良，生存期短，神经病变型对类固醇和化疗具有耐药性，预后相应更差。
