Castleman's disease requiring repeat surgical excision
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Abstract:
Castleman's disease is an uncommon lymphoproliferative disorder that can be found in both unicentric and multicentric forms. Although the multicentric form is typically seen in immunocompromised patients, the unicentric variety often presents as an asymptomatic mass in otherwise healthy patients. While these lesions are rare in the pediatric population, recognizing the potential diagnosis may help dictate pre- and intraoperative imaging and operative technique and approach.Keywords:
Surgical excision
Castleman disease
Lymphoproliferative Disorders
KEY FINDINGSAsymptomatic and pre-symptomatic transmission of SARS-CoV-2 may occur.• Manifestations of COVID-19 are highly varied and may include asymptomatic cases, who do not manifest with anysigns and symptoms despite testing positive for COVID-19 by viral nucleic acid tests. Pre-symptomatic cases areinfected individuals who are still in their incubation period, hence do not exhibit any symptoms yet but eventuallydevelop symptoms.• As of June 2020, only 586 (2.8%) of the 20,990 active cases in the Philippines were classified as asymptomatic,but it is unclear whether cases are pre-symptomatic or carriers (true asymptomatic).• Based on 36 observational studies (case reports, case series, cross-sectional and cohort studies) and 9 statisticalmodeling analysis, asymptomatic and pre-symptomatic transmission of SARS-CoV-2 may occur. However, 3studies reported no transmission from pre-symptomatic and asymptomatic cases.• Studies on viral load comparing symptomatic cases with pre-symptomatic and asymptomatic cases reportedcontradicting results. The duration of viral shedding was significantly longer for symptomatic patients comparedto asymptomatic patients but similar for asymptomatic and pre-symptomatic patients.• Therewas no difference in the transmission rates of symptomatic and asymptomatic cases. However,the estimatedinfectivity and probability of transmission was higherfor symptomatic cases compared to asymptomatic cases, butresults were imprecise due to a wide confidence interval.• The World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) recognize thepossibility of pre-symptomatic and asymptomatic transmission. According to WHO, current evidence suggestsasymptomatic cases are less likely to transmit the virus than symptomatic cases.
Asymptomatic carrier
Viral Shedding
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Human herpesvirus-8 (HHV8) is a lymphotropic virus associated with different lymphoproliferative disorders, including primary effusion lymphoma (PEL), multicentric Castleman's disease (MCD), diffuse large B-cell lymphomas, not otherwise specified, and the rare entity known as germinotropic lymphoproliferative disorder (GLPD). In PELs and GLPD the neoplastic cells also contain Epstein-Barr virus (EBV). In addition, occasional cases with atypical and overlapping features among these entities have been recognised, suggesting that the spectrum of the HHV8-related lesions may not be fully characterised.Here, we report two cases of lymphoproliferative disorder associated with HHV8 and EBV that further expand the spectrum of HHV8/EBV-positive lymphoproliferative disease.Case 1 represented HHV8/EBV-positive extracavitary nodal PEL followed by pleural PEL. The striking characteristic of this case was the almost focal and intrasinusoidal localisation of the neoplastic cells and the association with Castleman's disease features. In the second case, we found the entire spectrum of HHV8-related disorders, i.e. MCD, GLPD, and PEL, coexisting in the same lymph node, underlining the variability, possible overlap and evolution among these entities. Both cases were well analysed with immunohistochemistry, determination of the EBV latency programme, and molecular analysis for clonality of immnoglobulin genes. In both patients, the disease followed an unexpected indolent course, both being still alive after 8 and 12 months, respectively.Our findings represent further evidence of the overlap among HHV8/EBV-positive lymphoproliferative disorders, and underline a grey zone that requires further study; they further confirm the experimental evidence that lytic EBV replication influences HHV8-related tumorigenesis.
Primary effusion lymphoma
Lymphoproliferative Disorders
Castleman disease
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Castleman's disease is a rare and poorly understood condition involving lymph nodes at various sites, predominantly in the mediastinum. Individuals with this disease often present with lymphadenopathy and general symptoms suggestive of lymphomatous disease, and they are at risk of developing malignant lymphoma. It is thus important to distinguish Castleman's disease from other lymphoproliferative disorders. 67Ga scintigraphy is a noninvasive and practical diagnostic tool for the investigation of patients with lymphoproliferative disorders. However, the value of this technique for the diagnosis of Castleman's disease is not clear. Here, we describe five consecutive patients with various types of Castleman's disease and show that none of these individuals exhibited 67Ga uptake. Our results suggest the potential value of 67Ga scintigraphy in both the diagnosis and management of Castleman's disease.(Internal Medicine 42: 735-739, 2003)
Castleman disease
Lymphoproliferative Disorders
Lymphoproliferative disease
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Abstract: Human herpesvirus 8 (HHV8) has been related to some malignant lymphoproliferations, including post‐transplant lymphoproliferative disorders (PTLD). We describe a case of a HHV8 and Epstein–Barr virus (EBV) positive large B‐cell lymphoproliferation coexisting with Castleman's disease in the same lymph node of a long‐term renal transplant recipient. Biopsy revealed mixed type of Castleman's disease and anaplastic cells showing IgA restriction, although molecular analysis failed to detect monoclonality. Only large cells were co‐infected by both EBV and HHV8. After reduction of immunosuppression, the lesion partially regressed. After 1 yr, local evolution required surgery followed by irradiation. The present case represents a unique form of localized monotypic but polyclonal large cell PTLD associated with Castleman's disease. It can be added to PTLD with HHV8 and EBV co‐infection.
Castleman disease
Lymphoproliferative Disorders
Immunosuppression
Gammaherpesvirinae
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Introduction. Our objective was to review articles that report the prevalence of cervical disc herniations in asymptomatic subjects using MRIs and conduct a qualitative systematic review.Methods. A MEDLINE search for articles published between 1974 and 2004 was performed, and five articles were retained in this review.Results. Teresi et al. (1987) studied 35 asymptomatic subjects retrospectively and 65 asymptomatic subjects prospectively, and found 20% of subjects aged 45–54 years, 35% of subjects aged 55–64 years, and 57% of subjects older than 64 years had cervical disc herniations/bulges. Boden et al. (1990) studied 63 asymptomatic subjects and found 10% of subjects of less than 40 years and 5% of subjects older than 40 years had disc herniations. Lehto et al. (1994) studied 89 asymptomatic subjects and found that each of 2 subjects (one 29 and the other 56 years) had a disc prolapse; the prevalence was 2.2%. Matsumoto et al. (1998) studied 497 asymptomatic subjects. They found that 70 of 2480 discs scanned were prolapsed posteriorly (2.8%), and reported that the frequency of these lesions increased after 40 years. Siivola et al. (2002) compared 15 asymptomatic and 16 symptomatic subjects after 7 years and found no disc herniations (0%) in the asymptomatic group and 4 disc herniations (25%) in the symptomatic group.Conclusions. The prevalence of cervical disc herniations in asymptomatic subjects of less than 40 years of age is 3% to 10% and increases to 20% in subjects up to 54 years of age. The prevalence increases with age—from 5% to 35% in subjects between 40 and 64 years of age.
Intervertebral Disc
Disc protrusion
Intervertebral disk
Degenerative Disc Disease
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Introduction: There is no specific recommendation for the management of asymptomatic vaginal mesh erosions post antiincontinence or prolapse surgery, but revision or excision may represent overtreatment. We hypothesize that asymptomatic vaginal exposures remain asymptomatic during follow-up and do not require any intervention. Methods: We evaluated a “no treatment” approach by prospectively following-up women with asymptomatic vaginal exposures after antiincontinence and pelvic organ prolapse surgery. After a 1-month course of vaginal oestrogen, they underwent the “wait and see” protocol. It consisted of no treatment. Women were followed-up every 3 months, for the first year and then every 6 months with history, clinical examination with measurement of size of the exposure, and the evaluation of possible infection signs or vaginal discharge. Results: Forty women were followed-up for a median of 33.52 months (range 8–48 months). All exposures were ≤1 cm (mean 6.5 ± 1.5 mm, range 4–10 mm), patients were asymptomatic and without pain. During the observation period, the size of the exposure did not change and all women remained asymptomatic. Discussion/Conclusion: No treatment seems to be required for asymptomatic and small vaginal mesh exposures after prolapse or incontinence surgery.
Vaginal discharge
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Introduction: The prevalence of peripheral arterial disease (PAD) ranges between 4.5% and 57% and is independently associated with cardiovascular disease burden irrespective of symptoms. Two thirds of cases are thought to be asymptomatic and may go unrecognised. Local prevalence and natural progression of asymptomatic PAD is unknown.Methods: This one year, non-interventional longitudinal study, aimed to determine prevalence and progression of asymptomatic PAD in patients with cardiovascular risk factors. Results: Of 217 patients screened, 36% had asymptomatic disease in 113 legs. Of sixty two who returned for follow-up, eight normal legs developed asymptomatic PAD, and 46%, asymptomatic at baseline showed disease progression. Initial baseline ABI showed significant change over 1 year of follow-up (p=0.001) and 21% (13) of patients eventually developed intermittent claudication. Also, 52% of baseline asymptomatic participants having at least one associated cardiovascular risk factor showed disease progression over 1 year. Those developing claudication demonstrated significant ABI deterioration. Having two or more cardiovascular risk factors significantly affected progression of asymptomatic disease, (p = 0.031). Conclusion: Study confirms high prevalence of asymptomatic PAD in our population and significant disease progression in one year.Key words: Peripheral Artery Disease, Risk Factors, Asymptomatic, Disease Progression
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Intermittent claudication
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Sudden Death
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To define characteristics of pediatric asymptomatic idiopathic intracranial hypertension (IIH).We retrospectively reviewed our Neuro-Ophthalmology database (2000-2006) for all cases of symptomatic and asymptomatic pediatric IIH.Out of 45 IIH cases, 14 (31.1%) were asymptomatic (incidental examination). When compared with children with symptomatic IIH, asymptomatic cases were younger [5.6 (1.8-15) vs 11.0 (5-17) years, P = 0.007], had lower percentage of obesity (14.3% vs 48.4%, P = 0.046), and had male predominance (71.4% vs 38.7%, P = 0.06). Asymptomatic cases required shorter duration of acetazolamide treatment [3 (0-8), vs 6 (0-20) months, P = 0.021], and resulted in complete resolution of swollen discs.We speculate that asymptomatic IIH may be more common in young children and could represent a milder form or a presymptomatic phase before evolving into classic symptomatic IIH. Further studies to assess the clinical significance of asymptomatic IIH are warranted.
Acetazolamide
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