Management of isolated retroperitoneal Castelman’s disease
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Castleman’s disease (CD) is a rare disorder characterized by benign angio follicular lymphoid hyperplasia, with gentle behavior. Its etiology and prevalence are unclear. It is usually found in the mediastinal area and it is rare to see this tumor in the retroperitoneum.

A 53 year old male with a retroperitoneal hypervascular calcified mass densely adherent to the psoas muscle that was accidentally encountered on a CT scan. Based on the radiological findings, a provisional diagnosis of atypical retroperitoneal liposarcoma was made and the patient was prepared for surgical resection. The mass being calcified and hypervascular, it was considered any form of pre-operative biopsy (even fine needle) might be difficult and carry a high risk of bleeding.

At laparotomy, a retroperitoneal large mass of size 15cm×8cm was found. The tumor was limited posteriorly by the psoas muscle, forward by the caecum and laterally by the parietal muscles. The retroperitoneal mass was widely dissected and completely excised along with its capsule, carefully and without complications. The histologic examination of the surgically resected specimen disclosed « a hyaline type of Castleman’s disease

Castleman's disease is a rare entity that has often benign and noninvasive behavior but remains a diagnostic challenge. There is no reliable diagnostic method and its definitive diagnosis is based on histopathology report. Although rare it should be included in the differential diagnosis of retroperitoneal mass. For treating the unicentric variant, radical surgical resection is considered to be the gold standard.

Source:https://www.sciencedirect.com/science/article/pii/S2210261220301917
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