Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2022; 10(4): 1278-1285
Published online Feb 6, 2022. doi: 10.12998/wjcc.v10.i4.1278
Unicentric Castleman disease was misdiagnosed as pancreatic mass: A case report
Hong-Yan Zhai, Xin-Yuan Zhu, Gui-Ming Zhou, Li Zhu, Dan-Dan Guo, Hao Zhang
Hong-Yan Zhai, Gui-Ming Zhou, Li Zhu, Dan-Dan Guo, Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin 300005, China
Xin-Yuan Zhu, Department of Cardivascular, Tianjin Medical University General Hospital, Tianjin 300005, China
Hao Zhang, Department of Cardivascular Surgery, Tianjin Medical University General Hospital, Tianjin 300005, China
Author contributions: Zhai HY was the patient’s ultrasound physician, and performed routine ultrasound and contrast-enhanced ultrasound examination; Zhai HY and Guo DD collected the computed tomography, magnetic resonance imaging and pathological results; Zhu XY, Zhou GM, and Zhang H reviewed the literature and contributed to manuscript drafting; Zhu XY analyzed and interpreted the imaging findings; Zhang H was responsible for revision of the manuscript for important intellectual content; all authors gave final approval for the version to be submitted.
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: Hao Zhang, PhD, Doctor, Department of Cardivascular Surgery, Tianjin Medical University General Hospital, No. 154 Anshan Road, Tianjin 300005, China. plover1984@126.com
Received: August 6, 2021
Peer-review started: August 6, 2021
First decision: November 6, 2021
Revised: November 16, 2021
Accepted: December 25, 2021
Article in press: December 25, 2021
Published online: February 6, 2022
Processing time: 171 Days and 5.1 Hours
Abstract
BACKGROUND

Castleman’s disease (CD) is a lymphatic proliferative disorder of unknown cause and is rarely seen clinically. It has been divided into unicentric and multicentric types. Unicentric CD (UCD) occurs as a solitary enlarged mass and mediastinal lymph nodes are the most common site. Surgical excision has proven to be curative for UCD. Multicentric CD (MCD) appears as a systemic disease with peripheral lymphadenopathy. MCD had a poor response to surgery and monoclonal antibodies with rituximab have become a research hotspot.

CASE SUMMARY

A 44-year-old woman presented with a pancreatic mass during routine physical examination. She had no obvious symptoms, such as fever, abdominal pain, abdominal distension, or jaundice. Ultrasound examination indicated a hypoechoic mass between the body of the pancreas, left lobe of the liver and stomach. It had a clear boundary, irregular shape, uneven echo, and no obvious blood flow signals. To clarify the diagnosis, contrast-enhanced ultrasound examination was performed, which showed a benign pancreatic lesion. Neuroendocrine or solid pseudopapillary tumor was a possible diagnosis. The patient underwent further contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging, which were suggestive of solid pseudopapillary tumor or neuroendocrine tumor. All the examinations failed to give a definitive diagnosis, and the patient underwent surgery. The final pathological and immunohistochemical results showed that the mass was CD.

CONCLUSION

This case highlights when lymphadenopathy is encountered clinically, CD should be considered and a biopsy should be performed.

Keywords: Castleman’s disease; Lymphadenopathy; Unicentric; Multicentric; Contrast-enhanced ultrasound; Case report

Core Tip: Castleman’s disease (CD) is a lymphoproliferative disorder of unknown cause. We present a rare case of unicentric CD. A 44-year-old woman presented with a pancreatic mass during routine physical examination. The patient had no obvious symptoms. None of the three enhanced images gave a clear diagnosis. The patient underwent surgery. The final pathological and immunohistochemical results showed that the mass was CD. This case highlights when lymphadenopathy is encountered clinically, CD should be considered and a biopsy performed. It is especially important to rule out diseases with known causes first.