Follicular dendritic sarcoma within a focus of Castleman's disease. Serial FDG PET/CT in the follow up of recurrence with histopathologic confirmation

Castleman disease in the hilum liver mimicking the lymph node metastasis of hepatocellular carcinoma on 18F-FDG PET/CT: A case report

RATIONALE

Castleman disease is a rare lymphoproliferative disorder which etiology is unknown. It is divided into 2 subtypes: the plasma cell variant and the hyaline vascular variant. The most common site is the hilum of the lungs and mediastinum. Castleman disease is often ignored by clinicians because of not frequently encountering in clinical and the lower uptake of F-FDG. Here, we report a case of hepatocellular carcinoma accompanied by Castleman disease in the hilum of the liver, which was misdiagnosed as the lymph node metastasis in F-FDG PET/CT imaging.

PATIENT CONCERNS

A 63-year-old male with chief complaint of acratia and poor appetite for 2 weeks.

DIAGNOSES

Hepatocellular carcinoma accompanied by Castleman disease in the hilum of liver.

INTERVENTIONS

Right hemihepatectomy and hilar lymph node dissection was performed and preventative transcatheter arterial chemoembolization therapy was given after the surgery.

OUTCOMES

The case had multiple systemic metastasis due to tumor progression.

LESSONS

Castleman disease is a benign and rare lympholiferative disease, and easy to be ignored in clinical. The case of hepatic carcinoma with Castleman disease in the hilum of liver has never been reported before. Here, we report it and hope it provides a differential diagnosis for clinicians in the following similar cases.

Clinical features and outcome of patients with HIV-negative multicentric Castleman's disease treated with combination chemotherapy: a report on 10 patients

To investigate the clinical characteristics and outcome of patients with HIV-negative multicentric Castleman's disease (MCD) treated exclusively with combination chemotherapy, and review literature to improve the diagnosis and management of this disease. A retrospective study was performed on the medical records of 10 patients with HIV-negative MCD treated exclusively with combination chemotherapy at one medical institution from May 2004 to April 2012. And relevant clinical, pathological, radiographic, and laboratory data were examined in order to evaluate treatment responses, with symptom onsets and survival period serving as the endpoints of the assessment. All patients have multifocal lymphadenopathy, and the associated system symptoms are found in 80 % of the cases. All patients were treated with lymphoma-based chemotherapy alone. The duration of follow-up ranged from 5 to 77 months for nine patients. Four patients were treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) alone: One was alive with no evidence of disease, and three were alive with disease. Three patients received cyclophosphamide, vincristine, and prednisone (COP) alone: One remained alive with disease, and two experienced recurrences and passed away. Two had only minimal response to COP and were switched to CHOP, and they were still alive with disease. MCD is a more progressive clinical entity, and long-term follow-up is necessary. CHOP chemotherapy may be an effective treatment option for patients with MCD, whereas when to start chemotherapy, how many cycles of chemotherapy required, and the role of combined radiotherapy remain to be further studied.

FDG PET/CT appearance of multicentric Castleman's disease mimicking lymphoma

We report a case of a multicentric form of Castleman's disease with multiple lymph nodes showing intense FDG uptake on whole body scan mimicking non-Hodgkin's lymphoma. In this report, the patient had multiple cervical, mediastinal, hilar, retroperitoneal and abnormal lymph nodes in the groin. (18)F-fluorodeoxyglucose positron emission tomography/computed tomography was performed before tissue sampling. (18)F-FDG/PET demonstrated multiple areas of increased uptake in cervical, mediastinal, hilar, retroperitoneal and groin lymph nodes, suggesting a generalized disease of the lymphatic system including non-Hodgkin's lymphoma. The final diagnosis is based on the histopathological findings of the material obtained from the cervical lymphadenectomy. The histological diagnosis was multicentric plasma cell variant of Castleman's disease. (18)F fluorodeoxyglucose positron emission tomography/computed tomography scan helped to identify the lymph nodes involved throughout the whole body, but did not help to differentiate non-Hodgkin's lymphoma. The clinical conclusions and PET/CT findings are described in this report.

Autologous stem cell transplantation in a rare multicentric Castleman disease of the plasma cell variant

We present a case of a 52-year-old male who was evaluated due to anorexia, persistent diarrhea, weight loss, and liver enzyme elevations, with no hematologic laboratory abnormalities. Imaging modalities revealed several tissue lesions involving the pancreas, the right kidney, and an axillary lymph node. Diagnosis of Castleman disease was reached only due to the tissue obtained from the lymph node. Chemotherapy and immunosuppression led to a short remission. The patient underwent autologous stem cell transplantation, and has since been in remission. This case demonstrates the cryptogenic and chameleon-like nature of Castleman disease. Challenges in treating Castleman disease patients reflect current limitations and the need for a greater understanding of disease pathogenesis.