A rare presentation of abdominal castleman disease: A case report

Abstract

Unicentric Castleman disease (UCD) is a rare benign lymphoid proliferative disease having solitary or multiple lesions in adjacent organs, limited to the same lymphoid region. Among all the affected stations, mesenteric localization of UCD is very rare and often misdiagnosed due to the absence of typical clinical and imaging features, making preoperative diagnosis difficult. Complete surgical resection remains the standard of care, which shows curative intent in 90% of patients. We report a rare case of an adolescent male with abdominal UCD who presented with intermittent abdominal pain, vomiting, and a firm, mobile lump in the right lower abdomen. Hematological parameters were within normal limits. Ultrasound raised suspicion of mesenteric mass in the right paraumbilical region which on contrast-enhanced CT scan was suggestive of benign mesenteric mass/desmoid tumor. Intraoperatively, a 10 × 9 cm mesenteric mass was noted in the right paraumbilical region attached to root of mesentery along with an inflamed appendix. Excision of the mesenteric mass with appendectomy was done. Histopathology was suggestive of Angio Follicular Lymphoid Hyperplasia (Castleman disease) and inflamed appendix. Castleman disease is an unusual medical case that poses a diagnostic challenge and it must be included in the differential diagnoses of solid abdominal mass. Though multiple treatment options are available, surgical resection is still considered the standard treatment of choice due to its diagnostic and therapeutic advantages.