The unicentric Morbus Castleman – A rare differential diagnosis of cervical tumors

Introduction:

The unicentric M. Castleman represents a rare differential diagnosis in cervical tumors. Generally it can not be distinguished from malignant diseases e.g. lymphomas by clinical examination or image morphology.

Methods:

Case-report on a 30-year old patient with swelling of cervical lymph-nodes together with radiating pain and paresthesia of the right shoulder and arm. Beside clinical examination and differential blood count we conducted ultrasound, MRI and CT. Finally we performed a surgical wedge excision of the lymph node for histological and immunohistochemical examinations.

Results:

Clinically the patient revealed a solid mass in level II-V of the right neck's side. The MRI showed a 3.8 × 1.7 × 6.5 cm large tumor with a precise bordering and a homogeneous absorption of contrast agent. The ultrasound exhibited a strong blood perfusion, wheareas the differential blood count was largely unremarkable. The histological examination revealed the diagnosis of M. Castleman of the hyaline vascular variant without evidence of HHV-8, clonal light chain restriction or IgG4. The CT showed a unicentric distribution.

Conclusions:

This case demonstrates that often a precise distinction of benign and malign cervical lymphnode-diseases is only possible by means of histopathological examination. Nevertheless detailed preoperative imaging with CT, MRI and ultrasound is pivotal to detect multifokal dissemination as this may lead to different prognostic and therapeutic consequences. Even in case of M. Castleman the pattern of involved lymphnodes is relevant for further therapy. The unicentric variant can be cured by pure surgical treatment.

Publication History

Publication Date:
23 April 2019 (online)