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QUIZ No. 13
A 27-year-old unmarried male presented with vague lower abdominal pain. No significant medical and surgical history. No immunocompromised status / adverse social habits. Screening of the neck and chest was normal. Blood investigations, including the hormonal evaluation and tumour markers, were normal. CECT images are provided. What’s your diagnosis?
ANS – Unicentric Castleman’s Disease
Findings: Well-circumscribed, avidly enhancing soft tissue mass with rich vascular supply located near the aortoiliac bifurcation without infiltration into adjacent organs. Few non enhancing cystic areas seen. No calcifications seen. No significant retroperitoneal lymphadenopathy.
Castleman disease, an unusual benign lymphoproliferative disorder characterized histologically by lymph node hyperplasia and follicles with small, hyalinized foci. It can affect any lymph nodes in the body. It occurs in unicentric and multicentric forms and is associated with human immunodeficiency virus (HIV), human herpes virus 8 (HHV-8), and Kaposis sarcoma. Retroperitoneal involvement is relatively uncommon, accounting for approximately 10–15% of Castleman disease cases, with the majority (~70%) occurring in the thorax and about 10–15% in the neck. Unicentric CD – Surgical removal of involved node is sufficient. Multicentric CD – Surgery, Chemotherapy - IL 6 inhibitor and Prednisolone.
Take home points
· Soft tissue dense mass lesion with intense contrast enhancement and hypervascularity – Differential diagnosis of CASTLEMAN'S DISEASE to be considered.
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