Liu SL, Luo M, Gou HX, Yang XL, He K. Castleman disease of the pancreas mimicking pancreatic malignancy on 68Ga-DOTATATE and 18F-fluorodeoxyglucose positron emission tomography/computed tomography: A case report. World J Gastrointest Surg 2022; 14(5): 514-520 [PMID: 35734619 DOI: 10.4240/wjgs.v14.i5.514]
Corresponding Author of This Article
Kai He, MM, Professor, Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou 646000, Sichuan Province, China. hekai615@126.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. May 27, 2022; 14(5): 514-520 Published online May 27, 2022. doi: 10.4240/wjgs.v14.i5.514
Castleman disease of the pancreas mimicking pancreatic malignancy on 68Ga-DOTATATE and 18F-fluorodeoxyglucose positron emission tomography/computed tomography: A case report
Sheng-Lu Liu, Ming Luo, Hao-Xian Gou, Xiao-Li Yang, Kai He
Sheng-Lu Liu, Ming Luo, Hao-Xian Gou, Xiao-Li Yang, Kai He, Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
Sheng-Lu Liu, Kai He, Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
Sheng-Lu Liu, Kai He, Academician (Expert) Workstation of Sichuan Province, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
Author contributions: He K and Yang XL proposed the idea and supervised, revised the writing; Liu SL collected the data, analyzed the literature, and wrote the manuscript; Luo M assisted with data collection and imaging guidance; He K, Gou HX were the patient's surgeons and participated in the entire operation; all authors read and approved the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kai He, MM, Professor, Department of General Surgery (Hepatobiliary Surgery), The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou 646000, Sichuan Province, China. hekai615@126.com
Received: January 8, 2022 Peer-review started: January 8, 2022 First decision: March 13, 2022 Revised: April 1, 2022 Accepted: May 7, 2022 Article in press: May 7, 2022 Published online: May 27, 2022 Processing time: 136 Days and 21.2 Hours
Abstract
BACKGROUND
Castleman disease is an uncommon nonclonal lymphoproliferative disorder, which frequently mimics both benign and malignant abnormalities in several regions. Depending on the number of lymph nodes or regions involved, Castleman disease (CD) varies in diagnosis, treatment and prognosis. It rarely occurs in the pancreas alone without any distinct clinical feature and tends to be confused with pancreatic paraganglioma (PGL), neuroendocrine tumors (NETs), and primary tumors, thus impeding proper diagnosis and treatment.
CASE SUMMARY
A 28-year-old woman presented with a lesion on the neck of the pancreas, detected by ultrasound during a health examination. Physical examination and laboratory findings were normal. The mass showed hypervascularity on enhanced computed tomography (CT), significantly increased 18F-fluorodeoxyglucose uptake on positron emission tomography (PET)/CT, and slightly increased somatostatin receptor (SSTR) expression on 68Ga-DOTATATE PET/CT, suggesting no distant metastases and subdiagnoses such as pancreatic PGL, NET, or primary tumor. Intraoperative pathology suggested lymphatic hyperplasia, and only simple tumor resection was performed. The patient was diagnosed with the hyaline vascular variant of CD, which was confirmed by postoperative immunohistochemistry. The patient was discharged successfully, and no recurrence was observed on regular review.
CONCLUSION
High glucose uptake and slightly elevated SSTR expression are potentially new diagnostic features of CD of the pancreas.
Core tip: Some rare tumors with high blood supply to the pancreas, such as Castleman disease (CD), paraganglioma, and neuroendocrine tumors are difficult for clinicians to differentially diagnose based on conventional imaging and clinical presentation. In our case, CD of the pancreas had no obvious clinical features as previously reported but showed higher glucose uptake and mildly increased somatostatin receptor expression on positron emission tomography/computed tomography, which might help in the diagnosis.
