Castleman disease variant of polyneuropathy, organomegaly, endocrinopathy, monoclonal protein and skin changes syndrome: A case report

Figure 1  Leukonychia and finger clubbing.

Figure 2 Hematoxylin and eosin-stained lymph node biopsy with atretic germinal centres. Mantle zones thickened with lymphocytes arranged in layers give an onion skin appearance (white arrow).

Figure 3 Bone marrow trephine sample. A: Hyper-normocellular marrow with 5% plasma cells (orange arrow) and mild plasmacytosis; B: Aggregation of mature B-cells on CD20 immuno-histochemical stains; C: Rimmed clusters of medium to large plasma cells on CD 138 (× 20 magnification).

Figure 4  Non-enhanced computed tomography brain (axial view) with well-defined hypodensity at right fronto-parietal lobe, suggestive of a chronic watershed region infarct (orange arrow).

Figure 5 Contrast enhanced computed tomography neck. A: Axial computed tomography (CT) with multiple enlarged cervical and supraclavicular lymph nodes (arrows) and patent bilateral carotid and jugular vessels are highlighted within the blue dotted lines; B: Sagittal CT with similarly enlarged nodes as mentioned (arrows).

Figure 6 Contrast enhanced computed tomography thorax and abdomen. A: Axial view depicting enlarged lymph nodes at bilateral axillary region (arrows); B: Axial view at abdominal level showing lymphadenopathy at paraaortic region (arrow).

Figure 7 Positron emission tomography/computed tomography (level of the neck). A: Axial view showing hypermetabolic left thyroid nodule (arrows); B: Contrast enhanced computed tomography neck axial showing heterogeneously enhancing left thyroid nodule.