Neoadjuvant radiotherapy of primary irresectable unicentric Castleman's disease: a case report and review of the literature

Abstract

BackgroundCastleman disease (CD) is a rare benign disorder characterised by hyperplasia of lymphoid tissue that may develop at a single site or throughout the body. The etiology of this disorder is unclear, although the histopathological presentation can be differentiated into a hyaline vascular variant, a plasma cell variant and a mixed variant. Clinically, it has been recorded that 3 manifestations of CD are characterized: a localized unicentric type, a generalized multicentric type and a mixed form. Surgery remains the main treatment for resectable unicentric CD, since removal of the large node is possible without further complications. No consensus has been reached concerning the most adequate treatment for irresectable unicentric CD.MethodsCase report of a 67 year old woman.ResultsThis report, describes the case of a 67-year-old woman with unicentric Castleman disease located in the right lower abdomen. The patient had symptoms of fatigue, dyspnoea and pain in the right lower abdomen. Computed tomography (CT)- examination revealed a tumour, which had grown to form a close relationship with the common iliac vessels and the sacral bone. A Laparotomy procedure revealed that the tumour was an irresectable mass. Neo-adjuvant radiotherapy (40 Gy) was administered in order to downsize the tumour. Six weeks later a new CT-scan revealed a major reduction of the tumour, which enabled a successful radical resection of the tumour to be performed. Histopathological analysis of the tumour showed the hyaline vascular type of CD.ConclusionsNeo-adjuvant radiotherapy should be considered in case of an irresectable unicentric CD.

Castleman Disease Localized On The Right And Left Buccal Mucosa

“…The multicentric type is generally seen with other systemic diseases and shows progress more aggressively (5). Histopathologically, CD is also classified into three different subtypes as vascular, plasma cell, and mixed (1).…”

“…In the treatment, total or near total surgical excision can be performed according the localization (4). Radiotherapy may be used as an adjuvant or a mass reductive modality (5). We herein report a patient with previous NHL history, who had CD lesions localized beneath right and left buccal mucosa.…”

Castleman's disease of a submandibular mass diagnosed on Fine Needle Cytology: Report of a case with histopathological, immunocytochemical and imaging correlations

“…Cytoreduction with radiotherapy and a combination of chemotherapies have been recommended in cases where complete resection is not achievable (30,31), such as the multicentric forms. The prognosis and outcome of the multicentric type are usually poorer due to many factors, like progression rate, infections and comorbidities (32)(33)(34).…”

Intrapulmonary Castleman’s Disease Pretending to Be a Lung Cancer—Work Up of an Intrapulmonary Tumour

“…However, in 12.4% there was no response. 11) In cases of multicentric CD radiotherapy or steroid treatment is the first choice; chemotherapy is only indicated in steroidrefractory cases. 12) The prognosis of Castleman's disease differs between the different types.…”