Routine ultrasound in a patient with hemangioma revealed a mass in the abdomen, doctors suspected it to be of pancreatic origin
A 32-year-old man underwent an abdominal ultrasound during routine investigations. The ultrasound identified a mass in the abdomen. The patient had a history of hepatic hemangioma for the past 10 years.
Cardiac and respiratory examinations were unremarkable. Moreover, the physical examination did not reveal any enlarged lymph nodes.
Serological investigations revealed normal tumour markers.
The doctors decided to perform computed tomography (CT) scan of the abdomen. The CT scan identified a well-circumscribed and encapsulated mass. Additionally, the mass showed calcifications of variable shapes. Since the mass was adherent to the pancreatic neck, it seemed to arise from the pancreas. The mass enhanced intensely in the arterial phase with moderate washout in the venous phase. Besides the mass, the CT scan did not reveal any other abnormalities or enlarged lymph nodes.
During the exploratory laparotomy, the surgeons identified an encapsulated mass adjacent to the pancreatic neck. The mass measured 6 × 7 cm. The surgeons successfully and completely excised the tumour.
Histopathological evaluation of the mass revealed Castleman lymphadenopathy of hyaline-vascular type, which is also known as giant lymph node hyperplasia. The hyaline-vascular type is its histopathological classification. The cause still remains unknown, however, genetic factors, immune dysregulation, and infections play their part in the pathogenesis.
Since the patient was improving and had no post-operative complication, the doctors discharged the patient 7 days later.
At 2-year follow-up after surgery, the patient was doing well.
Liu L, Wang Z, Cao D (2016) Parapancreatic Castleman Disease. Clin Med Img Lib 2:029. doi.org/10.23937/2474-3682/1510029