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Paraneoplastic pemphigus caused by pre-existing stroma-rich variant of Castleman disease: from a pathologist’s point of view
  1. Paida Gwiti1,
  2. Zsombor Melegh2,3,
  3. Sarah Johnston4 and
  4. Judit Sutak3
  1. 1Department of Cellular Pathology, Peterborough City Hospital, Peterborough, Cambridgeshire, UK
  2. 2Centre for Medical Education, University of Bristol, Bristol, UK
  3. 3Department of Cellular Pathology, North Bristol NHS Trust, Westbury on Trym, UK
  4. 4Department of Immunology, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
  1. Correspondence to Dr Zsombor Melegh; eghbor{at}


A young woman presented with mucocutaneous blisters and ulcerating lesions, and was diagnosed with erythrodermic pemphigus complicated by bronchiolitis obliterans. Her clinical condition did not improve on immunosuppressive therapy. She had a history of an asymptomatic retroperitoneal mass, presumed to be a dermoid cyst, followed up clinically. Due to the pre-existing nature of the retroperitoneal mass, the paraneoplastic nature of the pemphigus was initially not recognised, but after a multidisciplinary team meeting a biopsy was performed. Histology revealed a rare stroma-rich variant of Castleman disease with a prominent stroma demonstrating a myoid phenotype. Resection of the retroperitoneal tumour resulted in resolution of the cutaneous blisters. This emphasises the importance to consider paraneoplastic disease in treatment-resistant pemphigus as surgical removal of the tumour forms the mainstay of therapy. The differential diagnosis should include Castleman disease and careful evaluation of histology is essential with the awareness of this rare stroma-rich variant.

  • haematology (incl blood transfusion)
  • immunology
  • pathology

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  • Contributors PG: writing the manuscript. ZM: histopathological diagnosis, writing the manuscript. SJ: providing the clinical history, writing the manuscript. JS: histopathological diagnosis, writing the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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