Mesenteric Castleman's Disease: Report of a Case

Abstract

A 77-year-old woman was admitted with intermittent abdominal dull pain. Hypochromic anemia, hypergammaglobulinemia, and elevated C-reactive protein were found in this case. Ultrasonography, computed tomography, magnetic resonance imaging, and angiography indicated either mesenteric leiomyoma or leiomyosarcoma, but no definitive preoperative diagnosis could be established. A surgical resection of the tumor revealed a mesenteric Castleman's tumor with small daughter lymphoid tumors of plasma cell type.

Retroperitoneal unicentric Castleman's disease (giant lymph node hyperplasia): case report

“…10 Death in M-PCV cases may be caused by sepsis, systemic infl ammation leading to multiorgan systemic failure, or the development of malignancy, most commonly lymphoma. 2 Although the radiographic fi ndings in cases of the disease are non-specifi c, hypoechoic, well-defi ned, localized abdominal masses with enhancement on dynamic CT, probably due to their high vascularization, these may be considered indicators of CD, 1,3,7 as seen in the patient of the present case report. One distinguishing radiological fi nding in cases of hyaline vascular CD is the central area of low attenuation, which corresponds to the central stellate fi brosis seen in gross pathological examination.…”

“…2 Microscopically, the distinguishing features of U-PCV are sheets of mature plasma cells in the interfollicular tissue and a normal to large-sized follicular center. 1,3 The multicentric plasma cell variant (M-PCV) is the least commonly encountered CD variant (10%), but presents with the most protean manifestations. Patients with M-PCV are typically older than those with unicentric disease and are more likely to have systemic symptoms.…”

“…Physical examination revealed only moderate arterial hypertension without superfi cial lymphadenomegaly, while laboratory tests showed leukopenia (2970/mm 3 ) and discrete anemia (hemoglobin 11.6 g/dl). The values for C-reactive protein, alpha-1 acid glycoprotein and streptococcal antibody titer, along with the erythrocyte sedimentation rate, were all within normal limits.…”

An unusual presentation of Castleman’s disease

“…3 The hyaline vascular form has a poorly formed germinal centre surrounded by an expanded mantle zone, having rims of CD-20 positive mature lymphocytes arranged concentrically in an "onion-skin" or whorled appearance. 2 The…”

“…1 In the majority of reported cases, the disorder is located in the mediastinum, whereas mesenteric involvement is very unusual. 2 Clinically, it may present as unicentric or multicentric disease and histologically it is classified as hyaline vascular, plasmacell and mixed-cellular type. The hyaline vascular type is found most commonly in unicentric disease and plasma-cell type in multicentric disease.…”