Surgical resection for pelvic retroperitoneal Castleman's disease: A case report and review literature

Comparison of clinical efficacy of MMA embolization combined with subdural perforation drainage and subdural perforation drainage in the treatment of CSDH

BACKGROUND

Chronic subdural hematoma is a frequent neurosurgical illness, and current treatment options mostly include subdural trepanation and drainage alone, as well as middle meningeal artery embolization in conjunction with subdural trepanation and drainage. However, there is currently a lack of extensive study and data support for comparing the clinical results of the two surgical treatment techniques.

OBJECTIVE

The goal of this study is to compare the clinical effects of middle meningeal artery embolization combined with subdural trepanation and drainage versus simple subdural trepanation and drainage in the treatment of chronic subdural hematoma, in order to provide a reliable foundation for clinical selection of appropriate surgical treatment methods.

METHODS

This study included 71 patients with chronic subdural hematoma, who were divided into two groups according to the procedure: observation group (n = 25) and control group (n = 46). The control group received only basic subdural drilling and drainage.

CONCLUSIONS

This study found that MMA embolization combined with subdural trepanation and drainage provides a greater therapeutic benefit in the treatment of chronic subdural hematoma. The observation group outperformed the control group in terms of postoperative CT results, Barthel index, and clinical effect, as well as operating time. Furthermore, the observation group's complications and recurrence rate were much lower than the control group's.

Complete excision and management of large hyaline-vascular pelvic Castleman's disease with coexisting cholecystolithiasis: A rare case report

INTRODUCTION

Castleman's disease (CD) refers to scarce lymphovascular hyperplasia categorized as unicentric (UCD) or multicentric (MCD). Retroperitoneal UCD is uncommon (6.7 %) and frequently grows undetected, making diagnosis challenging. The hypervascular nature of hyaline-vascular variant and the average larger size of UCD may result in complete resection difficulty. We present a case of large pelvic UCD completely resected without previous prophylactic procedures or massive intraoperative bleeding with coexisting cholecystolithiasis, which follows the SCARE 2023 guidelines.

CASE PRESENTATION

A 45-year-old male was accidentally observed with pelvic mass suppressing ureter and right internal iliac artery in preoperative MRI for cholecystolithiasis and cholecystitis. Epigastric pain, vomiting, and jaundice due to the inflamed gallbladder had resolved before mass removal. Biopsy and immunohistochemistry (IHC) tests confirmed the hyaline-vascular CD. Complete resection per laparotomy was done due to lesion adherence and identified a 7x5x2.5 cm solid mass with cystic degeneration suppressing the ureter. After five months, the patient fully recovered with no symptoms.

DISCUSSION

Asymptomatic mass presented as lymphadenopathy on imaging should suggest CD. A prompt lymph node biopsy followed by a pre- or postoperative IHC test is important in diagnosing CD. Total pelvic mass excision with rectum preservation is feasible for larger (>5 cm) hypervascularized masses without remarkable bleeding and promotes recovery without adjunctive treatments.

CONCLUSION

Complete excision per laparotomy is accessible for the uncommon large pelvic retroperitoneal UCD-suppressing ureter.

Castleman disease: Report of a case and review of literature on role of preoperative embolization

Introduction

Castleman disease, which was first described by Dr. Castleman in 1954, is relatively rare and represents a spectrum of heterogeneous lymphoproliferative disorders with characteristic histological features on biopsy. It is classified based on body location and histology with variable clinical presentations. Its treatment depends on the subtype, and preoperative embolization for Castleman disease has rarely been discussed in the literature.

Presentation of case

A 22-year old man presented to the ENT clinic with a four-week history of a mass on the left side of the neck, which was associated initially with headache, fever, and fatigue for 2 days. Contrast tomography and magnetic resonance imaging revealed a hypervascular mass located at levels two and three of the left side of the neck with feeding vessels from the external carotid artery. Preoperative embolization was planned; however, the neurointerventionist considered it a lymph node that did not need embolization. Surgical excision was performed with relatively increased operative time and bleeding. A biopsy confirmed a hyaline-vascular type Castleman disease.

Discussion

We reviewed the evidence-based management of CD. We reviewed the available literature on the role of preoperative embolization in management.

Conclusion

Based on published articles and the hypervascular nature of the disease, we believe that preoperative embolization helps decrease morbidity.

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Castleman disease is an angiofollicular lymph node hyperplasia and a form of lymphoproliferative disorder

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Different disease types have different clinical presentation and management

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Main treatment of unicentric castleman disease is surgical excision

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Castleman disease lymph nodes are highly vascular and are prone to intraoperative bleeding and need for blood transfusion

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Preoperative embolization can help reduce operation time and complications