Castleman’s disease in the retroperitoneal space mimicking a paraspinal schwannoma: a case report

World Journal of Surgical Oncology

Setsuro Komiya³  Suguru Yonezawa²  Yukie Tashiro⁴  Tsubasa Hiraki²  Takao Setoguchi³  Hideyasu Kaieda¹  Takuya Yamamoto¹  Masahiro Yokouchi¹  Satoshi Nagano¹ 

[1] Department of Orthopedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-city, Kagoshima, 890-8520, Japan;Department of Human Pathology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-city, Kagoshima, 890-8520, Japan;The Near-Future Locomotor Organ Medicine Creation Course (Kusunoki Kai), Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-city, Kagoshima, 890-8520, Japan;Department of Pathology, Imakiire General Hospital, 4-16 Shimotatsuocho, Kagoshima-city, Kagoshima, 892-0852, Japan

关键词: Soft-tissue sarcoma;    Paraspinal schwannoma;    Dumbbell shape;    Castleman’s disease;   

Others  :  825400
DOI  :  10.1186/1477-7819-11-108

 received in 2013-01-07, accepted in 2013-05-12,  发布年份 2013

【 摘 要 】

Background

Castleman’s disease is a rare disease characterized by lymph node hyperplasia. Its occurrence in the retroperitoneal space has rarely been reported, making its preoperative diagnosis difficult. Here, we report a case of retroperitoneal Castleman’s disease, which radiologically resembled paraspinal schwannoma.

Case presentation

A 33-year-old Japanese man with epigastric discomfort underwent abdominal ultrasonic examination revealing a solid mass next to the right kidney. Computed tomography demonstrated a well-circumscribed mass with central calcification in the right psoas muscle. Because the mass presented a dumbbell-like shape extending to the intervertebral foramen, neurogenic tumor was suspected. Both iodine-123 metaiodobenzylguanidine and gallium-67 scintigraphies were negative in the mass, whereas thallium-201 mildly accumulated in the tumor, suggesting blood flow to the tumor. Positron emission tomography revealed accumulation of fluorine-18-2-fluoro-2-deoxy-D-glucose in the tumor at a standard uptake value of 4.7, whereas no other abnormal uptake suggestive of metastatic lesion was noted. On the basis of imaging studies, we mostly suspected paraspinal schwannoma, although malignancy was not completely excluded. Angiography showed feeding vessels from the right lumbar arteries, which were embolized with porous gelatin particles in order to reduce intraoperative bleeding. Surgical resection was performed using a retroperitoneal approach, which revealed the tumor in the swollen psoas muscle. Intraoperative pathological examination of a frozen section revealed no evidence of malignancy; thus, marginal excision of the tumor was performed. The tumor adhered tightly to surrounding muscle tissues, resulting in 940 g of intraoperative blood loss. The pathological examination demonstrated infiltration of lymphocytes surrounding small germinal centers with extensive capillary proliferation. Immunostaining revealed that proliferated lymphocytes were CD3-negative and CD79a-positive.

Conclusions

Although a dumbbell-shaped mass in a paraspinal region is indicative of a schwannoma for orthopedic surgeons, the possibility of Castleman’s disease should be considered if a central low-signal area in fissured and a radial pattern is detected on computed tomography or magnetic resonance imaging. Appropriate preparation for massive bleeding during the treatment of Castleman’s disease, including angiography and embolization, would be helpful for performing surgical procedures safely.

【 授权许可】

   
2013 Nagano et al.; licensee BioMed Central Ltd.

【 图 表 】

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