Pancreatic Castleman disease simulating pancreatic carcinoma on computed tomography

Localized pancreatic Castleman disease presenting with extrahepatic dilatation of bile ducts: A case report and review of published cases

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The authors present a unique case of localized pancreatic Castleman disease with extrahepatic bile duct dilatation.

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Pancreatic Castleman disease mimics gastrointestinal stromal tumor, pancreatic neuroendocrine tumor or adenocarcinoma.

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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.

A Patient with Pancreatic Castleman's Disease Arising around the Main Pancreatic Duct

Castleman's disease of the pancreas is extremely rare. To the best of our knowledge, Castleman's disease arising around the main pancreatic duct has not been previously reported. The patient was a 74-year-old man. Abdominal ultrasonography performed at a health check-up revealed a dilated main pancreatic duct. Pancreatic cancer was strongly suspected on various imaging studies. However, the results of a cytological examination of the pancreatic juice were negative for malignancy. The patient did not want to undergo a histological diagnosis by endoscopic ultrasound-guided fine-needle aspiration, thus pylorus-preserving pancreatoduodenectomy was performed. Pancreatic Castleman's disease arising around the main pancreatic was diagnosed by the histopathological examination.

Pancreatic Castleman disease treated with laparoscopic distal pancreatectomy

BACKGROUND

Castleman disease is an uncommon lymphoproliferative disorder most frequently occurring in the mediastinum. Abdominal forms are less frequent, with pancreatic localization of the disease in particular being extremely rare. Only seventeen cases have been described in the world literature.

METHOD

This report describes an interesting and unusual case of pancreatic Castleman disease treated with laparoscopic resection.

RESULTS

A 48-year-old woman presented with epigastric pain. CT scan showed a well-encapsulated mass on the ventral border of the pancreas. Endosonography with fine needle aspiration biopsy was performed. Biopsy showed lymphoid elements and structures of a normal lymph node. The patient was treated with laparoscopic distal pancreatectomy. The pancreas was transected with a Ligasure device and the pancreatic stump was secured with a manual suture. One year after surgery the patient was complaint-free and showed no signs of recurrence of the disease.

CONCLUSIONS

Laparoscopic distal pancreatectomy is a feasible and safe method for the treatment of lesions in the body and tail of the pancreas. Transection of the pancreas with a Ligasure device offers the advantages of low bleeding and low risk of pancreatic fistula.

Pancreatic Castleman's Disease: Studies of Three Cases And A Cumulative Review of the Literature

Castleman's disease (CD) is a relatively rare and benign disorder. Pancreatic localization of CD is even more rare and is usually indistinguishable from pancreatic neoplasms. We report three cases of CD in which pancreas was all involved. One located in the tail of the pancreas, who accepted distal pancreatectomy, and the others in the head accepted enucleation. In addition, we review current data on its pathogenesis, imaging findings, diagnosis, differential diagnosis, and treatment.

FDG-PET and diffusion-weighted MR imaging appearance in retroperitoneal Castleman's disease: a case report

Castleman's disease is a rare lymphoid neoplasm that is characterized by the proliferation of lymphoid tissue. A case of young woman having the plasma cell type of retroperitoneal Castleman's disease is reported, and radiological findings of the condition are discussed with a review of the radiological literature.

Castleman's disease in the head of the pancreas: report of a rare clinical entity and current perspective on diagnosis, treatment, and outcome

BACKGROUND

Castleman's disease of the pancreas is a very rare condition that may resemble more common disease entities as well as pancreatic cancer.

CASE PRESENTATION

Here we report the case of a 58-year-old African American male with an incidentally discovered lesion in the head of the pancreas. The specimen from his pancreaticoduodectomy contained a protuberant, encapsulated mass, exhibiting microscopic features most consistent with localized/unicentric Castleman's disease. These included florid follicular hyperplasia with mantle/marginal zone hyperplasia along with focal progressive transformation of germinal centers admixed with involuted germinal centers.

CONCLUSION

To date, eight cases of Castleman's disease associated with the pancreas have been described in the world literature. We report the first case of unicentric disease situated within the head of the pancreas. In addition, we discuss the diagnostic dilemma Castleman's disease may present to the pancreatic surgeon and review current data on pathogenesis, treatment, and outcome.

A case of Castleman's disease associated with diffuse idiopathic skeletal hyperostosis and ossification of the posterior longitudinal ligament of the spine

Castleman's disease (CD), diffuse idiopathic skeletal hyperostosis (DISH), and ossification of the posterior longitudinal ligament of the spine (OPLL) are three different entities. Castleman's disease displaying a variety of calcifications in the abdomen and/or pelvis has been reported in some papers. However, there were no reports suggesting an association between CD and ossification/calcification in spine and joints. So far, there has been no case report regarding the coexistence of these diseases in the literature. Herein, we detail a 75-year-old man suffering from CD who demonstrated the features of DISH with coexisting features of OPLL. The cardinal symptoms such as fatigue, high fever, and swollen glands in this case were reduced by corticosteroid therapy. However, it is possible to produce actual symptoms of ossifying/calcified diathesis of entheses and ligaments as a consequence, like the pathology of calcification found in the region of the spleen. In this paper, we describe this patient in order to discuss the association of these diseases.

Parapancreatic Castleman disease: contrast-enhanced sonography and CT features

Castleman disease is a rare lymphoproliferative disorder that can be classified into 3 types: hyaline-vascular, plasma cell, and mixed. We report a rare case of localized para-pancreatic hyaline-vascular Castleman disease that was evaluated using contrast-enhanced sonography and CT.

Unicentric Castleman’s disease of the pancreas with massive central calcification

Unicentric Castleman’s disease of the pancreas is extremely rare, with only six cases described in the worldwide literature. An asymptomatic case of unicentric, hyaline, vascular-type Castleman’s disease (UCD) localized to the tail of the pancreas with central calcification imitating a primary neoplasm of the pancreas is presented. This is the first description of endosonographic and endoscopic retrograde pancreatographic findings of pancreatic UCD. Additionally, computed tomography, histological and serologic findings are reported.

Surgical management of abdominal and retroperitoneal Castleman's disease

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.

Surgical management of abdominal and retroperitoneal Castleman's disease

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.

Pancreatic Castleman's disease: MR findings

Castleman's disease can involve a number of organs/tissues but generally affects the mediastinum. Occurrence of Castleman's disease in the pancreas in either form of the disease, the hyaline vascular or the plasma-cell type, is very rare, with only a few case reports in which the imaging findings were described. The MR imaging of pancreatic Castleman's disease has not been previously reported, to our knowledge. We submit the MRI findings in a patient with the plasma-cell-type of Castleman's disease, which presented as an isolated smoothly marginated pancreatic mass, hypointense on T1-weighted fat-suppressed images, isointense on T2-weighted sequences, and that after contrast material injection showed peripheral rim enhancement during the arterial phase.

CT features of Castleman disease of the abdomen and pelvis

OBJECTIVE

The purpose of this study was to describe the CT features of Castleman disease in the abdomen and pelvis.

CONCLUSION

The most frequent appearance of abdominal or pelvic Castleman disease is of a single, well-defined enhancing mass. Smaller tumors (<5 cm) display homogeneous contrast enhancement; larger tumors (>5 cm) show heterogeneous enhancement and attenuation when correlated with central necrosis and degeneration. Calcification was seen in 31% of the cases. Castleman disease may be considered in the differential diagnosis of a discrete enhancing mass in the abdomen or pelvis.

Castleman disease in the anterior neck: the role of Ga-67 scintigraphy

A case of Castleman disease in the anterior cervical region is presented. Ga-67 scintigraphy revealed moderate uptake in the thyroid region. Thyroid scintigraphy demonstrated the presence of an extrinsic thyroid tumor. Contrast-enhanced CT showed dense homogeneous enhancement within, the tumor. Radionuclide tracer accumulation on gallium scintigraphy as well as dense contrast enhancement on CT scan may be characteristic of Castleman disease. Castleman disease should be considered in the differential diagnosis when increased tracer activity is noted in an anterior cervical extrathyroid tumor on Ga-67 scintigraphy.

Widespread Castleman disease: CT findings

The widespread form of Castleman disease is a rare condition with aggressive, often fatal course. We describe the imaging findings of two patients with extensive Castleman lymphadenopathy. The duration of the disease was 8 years in one patient and 4.5 months in the other.

Castleman's disease of the abdomen and pelvis: report of three cases and a review of the literature

Three cases of Castleman's disease (CD) of the abdomen and pelvis are reported. Tumoral lesions were located in the lymph nodes of the head of the pancreas, the gastropancreatic fold, and around the left iliac artery. Histologically, all the tumoral lesions demonstrated the hyalinevascular type of CD. This unusual presentation made CD difficult to diagnose preoperatively, since these lesions more closely resembled malignant tumors on computed tomography and angiography. We discuss the problems of diagnosing and classifying CD, together with a review of the literature.

Pancreatic Castleman disease: CT findings

Computed tomography findings in a case of pancreatic localization of Castleman disease are presented correlated with histological findings. This is the second observation in the literature of pancreatic involvement with an unusual histological form.

Castleman disease in the child: CT and ultrasound findings

Castleman disease is a relatively rare disorder affecting young adults. We present the CT and ultrasonographic findings of Castleman disease in two children. In one patient with hyaline-vascular type disease, CT showed a well-enhancing mass in the right paratracheal area. In a second patient with plasma cell type disease, there was a solid, homogeneous mass in the retroperitoneal space which was poorly enhancing. Ultrasound showed a uniform hypoechogenic mass in both cases.

Radiological presentations of Castleman's disease

The radiographic appearances of three cases of Castleman's disease of hyaline vascular type are reported. CT demonstrated homogeneous masses with marked contrast enhancement. Calcification was seen in one, and associated lymphadenopathy was seen in two. All tumors were hypervascular with prominent tumor blush on angiography. Sonography showed the masses to be hypoechoic with hyperechoic spots. On MR imaging, all tumors had homogeneous architecture with hypointensity on T1-weighted images and hyperintensity on T2-weighted images. In tumors with above characteristics in areas where lymphoid tissue is normally found, Castleman's disease should be added to the list of differential diagnosis.

Retroperitoneal Castleman's tumors of hyaline vascular type: imaging study. Case report

We report two retroperitoneal Castleman's tumors (giant lymph node hyperplasia) of hyaline vascular type. One was a large tumor situated in the pararenal region, the other was located in the pancreas head. On computed tomography (CT), both tumors were solid and moderately enhanced after administration of contrast material. On angiography, both tumors were hypervascular with dilated feeding arteries, and showed capillary blush. In an appropriate clinical setting, a retroperitoneal tumor showing these findings should include Castleman's tumor in the differential diagnosis.

Castleman's disease with vascular encasement and renal sinus involvement

Castleman's disease is a relatively rare entity. Approximately 4% of cases are located in the retroperitoneum or pelvis. The plasma cell variety accounts for 10% of all cases of Castleman's disease. A case of the plasma cell variant involving the renal sinus and retroperitoneum is presented.