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￭ S-483 ￭
Both HIV and HHV8 negative Multicentric Castleman's Disease
SoonChunHyang University College of Medicine & Hospital
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Hye Ran Kang, Young Woo Jeon, Han Jo Kim, Sang Byung Bae, Kyu Taek Lee
Multicentric Castleman's disease (MCD) is a rare lymphoproliferative disorder with systemic symptoms, poor prognosis and is characterized by an abnormal proliferation of polyclonal plasmablasts in the mantle zone of B-cell follicles. Chronic HIV carriers or active infective patients are correlated with MCD, and human herpes virus type 8 (HHV8) infection is usually strongly involved each other. Though MCD is also diagnosed in HIV-negative patients, in about half of those, there is no evidence of HHV8 infection. The anti-CD20 monoclonal antibody rituximab is now the preferred treatment for HIV-positive MCD. However, it is not clear whether rituximab is effective in HIV-negative patients with MCD, partic- ularly in the HHV8-negative subset. A 30-year-old man with anemia of unknown origin and and polyclonal gammopathy, he had diagnosed with congenital hepatic fibrosis with liver cirrhosis about 2 decades ago. The mediastinal, paratracheal and multiple abdominal lymphadenopathy were confirmed by CT scan. The laboratory findings of transferred date revealed that 6.8 g/dL of hemoglobin, 23,000/uL of platelet, 2.3 g/dL of albu- min, 0.4 of A/G ratio, 3,311 mg/dL of IgG, 488 mg/dL of IgA, and 8.19 ug/mL of β2-microglobulin. the viral markes of HIV and HHV8 were also showed negative. He was gotten biopsy on his xiphoid area and the pathologic finding showed multicentric Castleman's disease with hya- line-vascular variant type. Instantly, chemotherapy with cyclophosphamide and dexamethasone regimen was started and continued with 4th cycle, but , restaging CT scan showed progressive disease (PD). we changed the regimen with CHOP. After forth cycled CHOP regimen treatment showed PD again, we decided to add rituximab (R) on CHOP regimen. Later treatment with second cycled R-CHOP regimen; anemia, thrombocy- topenia, lymphadenopathy and symptoms were improved successfully. Although MCD is a rare disease without a clearly defined standard treat- ments, we report the patient with both HIV and HHV8 negative MCD treated with rituximab regimen successfully, and moreover suggest that the rituximab may be an appropriative option of first line therapy for patients with both negative MCD.
￭ S-484 ￭
A case of gastric cancer manifested as solitary brain metastasis mimicking acoustic neuroma
Department of Internal Medicine, Inha University Hospital, University of Inha College of Medicine, Incheon, Korea
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Ho Yeon Joo, Myoung Hun Chae, Joo Han Lim, Hyeon Gyu Yi, Moon Hee Lee, Chul Soo Kim, Young Hoon Park
At the time of diagnosis, about 20% of patients with gastric cancer have stage IV diseases which have commonly involved liver, lung, and bone.
Brain metastasis from gastric cancer is exceedingly rare, with an incidence of < 1% of clinical cases. Clinical symptom associated with brain metastasis presented as initial sign of gastric cancer is extremely rare since brain metastasis in gastric cancer is a late event in the disease’s clin- ical course. A 59-year-old man was admitted with hearing loss in left ear and left facial palsy for about one month. A magnetic resonance imag- ing (MRI) scan revealed a tumor in the cerebellopontine angle (CPA) extended to inner auditory canal (IAC) which was clinically diagnosed as acoustic neuroma. It was completely removed and was expected to be benign tumor. However, histological examination showed metastatic poorly differentiated carcinoma. Further investigation revealed advanced gastric cancer involving the antrum with no evidence of involving other sites except brain. Palliative total gastrectomy was performed and surgical specimen revealed a poorly cohesive carcinoma which was histopatho- logically identical to that of the resected brain tumor. We report a rare case of gastric cancer initially presenting as solitary brain metastasis mim- icking acoustic neuroma.
