Laparoscopic treatment of abdominal unicentric castleman’s disease: a case report and literature review

Abstract

BackgroundCastleman’s disease is a rare lymphoproliferative disorder of unknown etiology that most commonly presents as a mediastinal nodal mass. It is exceptionally uncommon for Castleman’s disease to present in the mesentery and, only 53 cases have ever been described in the literature. Standard treatment for this lymphoproliferative disorder involving a single node is a complete “en bloc” surgical resection which has proven to be a curative approach in almost all cases without recurrence after 20 years of follow up. All 53 reported cases of mesenteric Castleman’s disease, except one, were treated with laparotomy.Case presentationWe report on a case of mesenteric Castleman’s disease localized in the mesentery which is the second reported case if its kind and was treated by a laparoscopic-assisted procedure. Our female patient had an uneventful postoperative course and was discharged in the 5th post-operative day. No signs of recurrence were present as evidenced by physical examination and total body CT scan 24 months after the operation. We compare our case with the other reported cases in which Castleman’s disease presented as an isolated mass in the abdomen.ConclusionAlthough a rare disease, Unicentric Castleman’s disease should always be considered when a solid asymptomatic abdominal mass is occasionally presented. The laparoscopic approach (LA) allows for the achievement of better results than open surgery, including a reduction in postoperative pain and length of hospital stay. In cases of masses of an uncertain nature, LA must be considered the last diagnostic tool and the first treatment one.

Castleman’s disease: a rare presentation in a retroperitoneal accessory spleen, treated with a minimally invasive robotic approach

“…Postsurgically, patients have shorter length of stay, less pain, decreased opioid consumption and attenuated inflammatory response compared to open procedures [2, 9, 10]. Here, the mass, located in a hard to access region surrounded by delicate vasculature, was precisely resected and extracted with minimal blood loss and no perioperative complications.…”

Castleman�s Disease - Clinical, Histological and Therapeutic Features

“…The most frequent cases of UCD are located in the mediastinum and cervical area (chest over 30%, neck and head over 20%), followed by the intra-abdominal space (up to 20%) and the retroperitoneal space, which accounts for up to 10-15% of UCD cases. Other less common sites for UCD are the pelvic area, axilla and the groin region (less than 10% of all cases) [1,3,9,11]. Therefore, depending on the location of the tumor, patients with large tumors may present chest discomfort or pain, dyspnea, cough, haemoptysis, abdominal or back pain, discomfort, urinary obstruction due to ureteral compression which may lead to a renal colic, bowel compression, sub-occlusive intestinal syndrome or icterus [9,26,27].…”

“…Li Yu reported good results using radiotherapy and systemic therapy with rituximab, as an alternative for the patients for whom surgery was not possible at first, obtaining a decrease of the tumor mass with more than 50% in two patients, which then permitted complete surgical resection and complete remission in another case after radiotherapy with 4500 cGY fractioned in 30 sessions [57]. Intensity-modulated radiotherapy has shown lower toxicity due to a reduced dose of radiations that is administered to the adjacent normal structures, therefore it should be preferred to conformal three-dimensional radiotherapy [11]. Systemic options should be considered for the patients for whom surgery and radiotherapy are contraindicated or for the patients for whom these therapeutic options have failed.…”

“…Up to 90% of cases with UCD associates the hyaline vascular type and appears more frequently in young patients, in the third and fourth decade of life, while the plasma cell type is characteristic for MCD and appears in older patients, usually in the sixth life decade [9][10][11]. There are other tumors that are aged related, but this one proves to be much more difficult to manage in elderly [12].…”

Totally laparoscopic approach for a single mesenteric localization of Castelman’s disease: state of the art of laparoscopic surgery

“…It is exceptionally uncommon for Castleman's disease to present in the mesentery and only 54 cases except ours have ever been described in the literature, with 52 of them that underwent a laparotomic excision, and two cases with a laparoscopic-assisted approach. [4] There are three pathologic variants of Castleman's Disease: hyaline vascular CD, plasma cell CD, and mixed type of CD, which is characterized by the presence of both hyaline vascular and plasma cell CD types. Plasmablastic variant of CD, which is considered as a sub-variant of plasma cell type, occurs predominantly in immunosuppressed patients and human immunodeficiency virus (HIV)-positive patients.…”