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Kang MJ, Zhang JC, Fang C, Li B, Su S. Retroperitoneal Castlemans disease mimicking a liver cancer: a case report. Front Oncol 2024; 14:1343157. [PMID: 38410104 PMCID: PMC10896603 DOI: 10.3389/fonc.2024.1343157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/15/2024] [Indexed: 02/28/2024] Open
Abstract
Castleman disease (CD), a distinct lymphoproliferative disorder, is infrequently encountered in clinical practice and poses significant diagnostic challenges. We present the case of a 48-year-old asymptomatic female, admitted for evaluation of a hepatic mass detected in the liver's right lobe. Preoperative laboratory tests were within normal limits. Diagnostic imaging, including contrast-enhanced magnetic resonance imaging (MRI), was suggestive of hepatocellular carcinoma. Furthermore, contrast-enhanced abdominal computed tomography (CT) scans were indicative of hepatic malignancy. Subsequently, the patient underwent laparoscopic surgery targeting a retroperitoneal mass. During the surgical procedure, it was observed that the tumor was a retroperitoneal mass situated posterior to the liver, exhibiting localized adhesion to hepatic tissue. The postoperative histopathological analysis revealed the mass to be hyaline-vascular type Castleman disease (HV-CD), thereby refuting the initial diagnosis of a hepatic malignancy. This case underscores the complexity of diagnosing retroperitoneal Castleman disease, particularly when it masquerades as a hepatic tumor.
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Affiliation(s)
- Mao-Ji Kang
- Department of General Surgery (Hepatopancreatobiliary surgery), The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Jin-Chang Zhang
- Department of General Surgery (Hepatopancreatobiliary surgery), The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Cheng Fang
- Department of General Surgery (Hepatopancreatobiliary surgery), The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Bo Li
- Department of General Surgery (Hepatopancreatobiliary surgery), The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Song Su
- Department of General Surgery (Hepatopancreatobiliary surgery), The Affiliated Hospital of Southwest Medical University, Sichuan, China
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Ferreira Junior EG, Apolinario Costa P, Freire Golveia Silveira LM, Valois Vieira R, Lima Martins Soares HA, Menon Loureiro B, Pertile Salvioni NC, Coelho Ferreira Rocha JR. Localized pancreatic Castleman disease presenting with extrahepatic dilatation of bile ducts: A case report and review of published cases. Int J Surg Case Rep 2018; 54:28-33. [PMID: 30513495 PMCID: PMC6279997 DOI: 10.1016/j.ijscr.2018.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/27/2018] [Accepted: 11/08/2018] [Indexed: 02/07/2023] Open
Abstract
The authors present a unique case of localized pancreatic Castleman disease with extrahepatic bile duct dilatation. Pancreatic Castleman disease mimics gastrointestinal stromal tumor, pancreatic neuroendocrine tumor or adenocarcinoma. Preoperative diagnosis of pancreatic Castleman disease by image-guided biopsy and immunohistochemistry could improve outcome.
Introduction: Castleman disease (CD) is a rare polyclonal lymphoproliferative disorder of unknown etiology, which usually develops in the mediastinum. It can also occur in the cervical, retroperitoneal and axillary regions. Localized pancreatic CD is quite rare [1]. Presentation of case: The authors herein present a case of a 34 years old female that was diagnosed during a symptomatic cholelithiasis evaluation. During the evaluation, an abdominal ultrasonography revealed a tumor at the head of the pancreas, which went on to generate a dilatation of the extrahepatic bile ducts. This finding was confirmed by abdominal magnetic resonance imaging (MRI). Subsequently, the patient underwent a laparotomy, where a capsulated tumor was found at the head of the pancreas with well-defined margins. The decision was made for tumor excision. The histopathology and immunohistochemistry established CD, hyaline vascular variation. Discussion: The authors of the present paper also performed a literature review concerning Pancreatic CD, where there were found only 33 cases until the time of the writing of this paper, and we have subsequently carried out a retrospective analysis of all cases. In a patient with atypical images, there might be a benefit from a preoperative diagnosis of CD, by using immunohistochemistry analysis in an image guided biopsy. Thus, avoiding unnecessary procedures and surgeries. Conclusion: Localized pancreatic CD is a very rare condition with good prognosis, but it can mimic many common diseases, such as gastrointestinal stromal tumor (GIST), pancreatic neuroendocrine tumor or pancreatic adenocarcinoma.
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Affiliation(s)
- Edson Gonçalves Ferreira Junior
- Universidade Federal do Vale do São Francisco, Av. José de Sá Maniçoba, S/N - Centro, CEP: 56304-917, Petrolina, PE, Brazil.
| | - Philippos Apolinario Costa
- Universidade Federal do Vale do São Francisco, Av. José de Sá Maniçoba, S/N - Centro, CEP: 56304-917, Petrolina, PE, Brazil.
| | | | - Rafael Valois Vieira
- Universidade Federal do Vale do São Francisco, Av. José de Sá Maniçoba, S/N - Centro, CEP: 56304-917, Petrolina, PE, Brazil.
| | - Hugo Alessi Lima Martins Soares
- Universidade Federal do Vale do São Francisco, Av. José de Sá Maniçoba, S/N - Centro, CEP: 56304-917, Petrolina, PE, Brazil.
| | - Bruna Menon Loureiro
- Universidade Federal do Vale do São Francisco, Av. José de Sá Maniçoba, S/N - Centro, CEP: 56304-917, Petrolina, PE, Brazil.
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Wang S, Chen SW, Cai SL, Jin BY. A case report of retroperitoneal pararenal Castleman's disease associated with myasthenia gravis. World J Surg Oncol 2014; 12:331. [PMID: 25380562 PMCID: PMC4234864 DOI: 10.1186/1477-7819-12-331] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 10/20/2014] [Indexed: 11/25/2022] Open
Abstract
Background Castleman’s disease (CD) is a relatively rare disorder characterized by the benign proliferation of lymphoid tissue. The combination of an occurrence of retroperitoneal pararenal CD with myasthenia gravis (MG) is extremely rare. Case presentation The patient was admitted to our hospital for investigation of a retroperitoneal pararenal tumor which had been coincidentally diagnosed at a local hospital where he was admitted because of MG. The patient subsequently underwent an exploratory laparotomy and suffered from postoperative myasthenic crisis. Pathological examination revealed a left retroperitoneal mass of CD (hyaline vascular type). There was no recurrence of disease found after 7 months. Conclusions CD with MG is a rare condition. Postoperative myasthenic crisis is a severe complication. The possibility of its occurrence must be in physicians’ minds and the risk of postoperative myasthenic crisis must be carefully considered when evaluating MG patients undergoing surgery.
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Affiliation(s)
| | - Shan-Wen Chen
- The first affiliated hospital of Zhejiang University School of Medcine, Qingchun Road NO,79, Hangzhou, Zhejiang 310003, China.
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Wen X, Jiang X. Paraneoplastic pemphigus in association with Castleman disease of the pararenal retroperitoneum. J Dermatol 2012; 39:662-4. [PMID: 22221261 DOI: 10.1111/j.1346-8138.2011.01475.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Castleman's disease of the mesorectum: report of a case. Surg Today 2011; 41:271-5. [PMID: 21264768 DOI: 10.1007/s00595-009-4206-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Accepted: 08/20/2009] [Indexed: 12/28/2022]
Abstract
Castleman's disease is a benign lymphoid proliferative disorder, which most commonly presents as a solitary mass in the mediastinum, although extrathoracic sites have been reported in the neck, axilla, pelvis, mesentery, pancreas, and retroperitoneum. We report a case of asymptomatic, isolated Castleman's disease in the mesorectum, which is extremely rare. The patient was a 34-year-old woman who underwent investigations for vaginal spotting. A presacral mass was located on the left side of the rectum, 10 cm from the anal verge. Contrast-enhanced computed tomography showed a large, well-demarcated, strongly enhancing mass with internal radiating septa in the mesorectum. The mass was well circumscribed and isointense to muscle on T1-weighted magnetic resonance imaging, appearing as a slightly hyperintense mass on T2-weighted imaging. We performed laparoscopic mesorectal mass excision, and histological examination revealed features typical of the hyaline-vascular type of Castleman's disease. Thus, when a mesorectal mass is being investigated, Castleman's disease should be considered in the differential diagnosis.
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KIM KJ, CHO CS, CHOI JJ. Pararenal retroperitoneal Castleman’s disease mimicking systemic lupus erythematosus. Int J Rheum Dis 2010; 13:e20-5. [DOI: 10.1111/j.1756-185x.2010.01476.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Surabhi VR, Menias C, Prasad SR, Patel AH, Nagar A, Dalrymple NC. Neoplastic and non-neoplastic proliferative disorders of the perirenal space: cross-sectional imaging findings. Radiographics 2008; 28:1005-17. [PMID: 18635626 DOI: 10.1148/rg.284075157] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The perirenal space, located between the anterior and the posterior renal fasciae, is shaped like an inverted cone with an apex that extends into the iliac fossa. Perirenal tumors and pseudotumors primarily originate either from the kidney or as part of a systemic disease process and have characteristic histopathologic features and biologic behavior. The lesions may be classified on the basis of their distribution and imaging features as solitary soft-tissue masses (renal cell carcinoma, lymphangioma, hemangioma, and leiomyoma), rindlike soft-tissue lesions (lymphoma, retroperitoneal fibrosis, and Erdheim-Chester disease), masses containing macroscopic fat (angiomyolipoma, liposarcoma, myelolipoma, and extramedullary hematopoiesis), and multifocal soft-tissue masses (metastases, plasma cell tumors). Because of overlap in imaging findings among these diverse perirenal lesions, a definitive diagnosis in most cases can be established only at histopathologic analysis. However, an imaging pattern-based approach may facilitate the diagnosis and optimal management of perirenal tumors and pseudotumors.
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Affiliation(s)
- Venkateswar R Surabhi
- Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229, USA
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Barber M, Eguiluz I, Cabrera F, Martín A, Plasencia W, García-Hernández J. Enfermedad de Castleman como causa de síndrome nefrótico e insuficiencia renal en una gestante. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2007. [DOI: 10.1016/s0210-573x(07)74500-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Demir MK, Aker FV. Hyaline-vascular type Castleman's disease of the pararenal retroperitoneum: Multidetector CT findings. ACTA ACUST UNITED AC 2007; 51:75-7. [PMID: 17217494 DOI: 10.1111/j.1440-1673.2006.01663.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We describe the case of a 40-year-old woman who presented with a pararenal hyaline-vascular type Castleman's disease that had an arterial supply from the renal artery and a draining vein as showed by multidetector CT. Identification of the renal artery relationship to the feeding vessel of the mass is critical to prevent potential surgical complications.
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Affiliation(s)
- M K Demir
- Department of Radiology, Trayka University School of Medicine, Edirne, Turkey.
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Bucher P, Chassot G, Zufferey G, Ris F, Huber O, Morel P. Surgical management of abdominal and retroperitoneal Castleman's disease. World J Surg Oncol 2005. [PMID: 15941478 DOI: 10.1186/+1477-7819-3-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Abdominal and retroperitoneal Castleman's disease could present either as a localized disease or as a systemic disease. Castleman's disease is a lymphoid hyperplasia related to human Herpes virus type 8, which could have an aggressive behavior, similar to that of malignant lymphoid neoplasm mainly with the systemic type, or a benign one in its localized form. METHODS The authors report two cases of localized Castleman's disease in the retroperitoneal space and review the current and recent progress in the knowledge of this atypical disease. CASES PRESENTATION The two patients were young healthy women presenting with a hyper vascular peri-renal mass suggestive of malignant tumor. Both have been resected in-toto. One of them had an extensive resection with nephrectomy, while the second had a kidney preserving surgery. Pathological examination revealed localized Castleman's disease and surgical margins were free of disease. Postoperative course was uneventful, and after more than 5-years of follow-up no recurrences have been observed. CONCLUSION Localized Castleman's disease should be considered when facing a solid hypervascular abdominal or retroperitoneal mass. A better knowledge of this disorder and its characteristic would help surgeon to avoid unnecessarily extensive resection for this benign disorder when dealing with abdominal or retroperitoneal tumors. Surgical resection is curative for the localized form, when complete, while splenectomy could be indicated for the systemic form.
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Affiliation(s)
- Pascal Bucher
- Clinic of Visceral and Transplantation Surgery, Department of Surgery, Geneva University Hospital, Switzerland.
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Bucher P, Chassot G, Zufferey G, Ris F, Huber O, Morel P. Surgical management of abdominal and retroperitoneal Castleman's disease. World J Surg Oncol 2005; 3:33. [PMID: 15941478 PMCID: PMC1166581 DOI: 10.1186/1477-7819-3-33] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2005] [Accepted: 06/07/2005] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Abdominal and retroperitoneal Castleman's disease could present either as a localized disease or as a systemic disease. Castleman's disease is a lymphoid hyperplasia related to human Herpes virus type 8, which could have an aggressive behavior, similar to that of malignant lymphoid neoplasm mainly with the systemic type, or a benign one in its localized form. METHODS The authors report two cases of localized Castleman's disease in the retroperitoneal space and review the current and recent progress in the knowledge of this atypical disease. CASES PRESENTATION The two patients were young healthy women presenting with a hyper vascular peri-renal mass suggestive of malignant tumor. Both have been resected in-toto. One of them had an extensive resection with nephrectomy, while the second had a kidney preserving surgery. Pathological examination revealed localized Castleman's disease and surgical margins were free of disease. Postoperative course was uneventful, and after more than 5-years of follow-up no recurrences have been observed. CONCLUSION Localized Castleman's disease should be considered when facing a solid hypervascular abdominal or retroperitoneal mass. A better knowledge of this disorder and its characteristic would help surgeon to avoid unnecessarily extensive resection for this benign disorder when dealing with abdominal or retroperitoneal tumors. Surgical resection is curative for the localized form, when complete, while splenectomy could be indicated for the systemic form.
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Affiliation(s)
- Pascal Bucher
- Clinic of Visceral and Transplantation Surgery, Department of Surgery, Geneva University Hospital, Switzerland
| | - Gilles Chassot
- Clinic of Visceral and Transplantation Surgery, Department of Surgery, Geneva University Hospital, Switzerland
| | - Guillaume Zufferey
- Clinic of Visceral and Transplantation Surgery, Department of Surgery, Geneva University Hospital, Switzerland
| | - Frederic Ris
- Clinic of Visceral and Transplantation Surgery, Department of Surgery, Geneva University Hospital, Switzerland
| | - Olivier Huber
- Clinic of Visceral and Transplantation Surgery, Department of Surgery, Geneva University Hospital, Switzerland
| | - Philippe Morel
- Clinic of Visceral and Transplantation Surgery, Department of Surgery, Geneva University Hospital, Switzerland
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Nishie A, Yoshimitsu K, Irie H, Aibe H, Tajima T, Shinozaki K, Nakayama T, Kakihara D, Naito S, Ono M, Muranaka T, Honda H. Radiologic features of Castleman's disease occupying the renal sinus. AJR Am J Roentgenol 2003; 181:1037-40. [PMID: 14500225 DOI: 10.2214/ajr.181.4.1811037] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Our purpose was to describe the radiologic findings in five abnormalities in three patients with Castleman's disease occupying the renal sinus. CONCLUSION Common findings such as mild homogeneous enhancement passing through the mass of the collecting system with mild hydronephrosis on contrast-enhanced CT and hypointense signal on T2-weighted images were obtained. Castleman's disease may be considered in a differential diagnosis of a mass occupying the renal sinus, although it is difficult to differentiate from malignant lymphoma.
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Affiliation(s)
- Akihiro Nishie
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
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Kunishima S, Taniguchi H, Koh T, Yamaguchi A, Yamagishi H. F-18 fluorodeoxyglucose positron emission tomography in mesenterial Castleman's lymphoma. Clin Nucl Med 2001; 26:789-90. [PMID: 11507303 DOI: 10.1097/00003072-200109000-00014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- S Kunishima
- Department of Digestive Surgery, Kyoto Prefectural University of Medicine, 465 Kaiji-cho, Kamigyou-ku, Kyoto 602-8566, Japan.
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Hsu HH, Chen YC, Fang JT, Huang CC, Shih LY, Ghuang CK. Unicentric Castleman's disease associated with hydronephrosis. Urology 2000; 56:856. [PMID: 11068320 DOI: 10.1016/s0090-4295(00)00783-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We describe a patient with an unusual case of unicentric Castleman's disease, which bore a malignant appearance and was located in the pararenal space. She initially presented with hydronephrosis. Two years after surgical removal of the tumor, no recurrence was evident. To our knowledge, only 2 additional cases of this uncommon disease entity associated with hydronephrosis have been reported. Furthermore, our patient was the first to receive conservative surgery. On the basis of our experience, owing to the benign clinical course of this tumor and its excellent response to limited resection, radical surgery may be avoided.
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Affiliation(s)
- H H Hsu
- Division of Nephrology, Department of Medicine, Chang Gung Memorial Hospital, Kweishan, Taoyuan, Taiwan
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