AB164. Adrenal area Castleman’s disease: two cases reports and review

Objective: Castleman’s disease, as known as angiofollicular lymph node hyperplasia or giant lymph node hyperplasia, is an uncommon and easily misdiagnosed, lymphoproliferative disorder that can affect any lymph nodes, usually occur in mediastinum, abdominal and pelvic cavity. This study report two cases of Adrenal Area Castleman’s disease and review literatures to improve its diagnosis, treatment and prognosis.

Methods: Retrospectively analysis of two patients histopathologically diagnosed of adrenal area Castleman’s disease admitted to our hospital from January 1^st, 2014 to April 30^th, 2015 Combined with literature review.

Results: In the two cases, one male aged 48 and one female aged 43 with an average age of 45.5. One case presented abdominal discomfort, another discovered by medical examination and had no significant or specific pre-operation routine laboratory tests. CT scan mostly show a well-defined lower density, round or oval mass that can be unevenly enhanced. Two patients received lumpectomy and diagnosed by pathology, and two patients are alive.

Conclusions: Castleman’s disease is rare and because of its lack of specific clinical symptom and imaging and laboratory manifestation, it can be easily misdiagnosed. It is difficult to be diagnosed and easily misdiagnosis because most clinicians are a lack of understanding without enough typical clinical symptom, laboratory manifestation and imaging. Adrenal area Castleman’s disease is easily misdiagnosed to adrenal tumor, such as primary aldosteronism, pheochromocytoma. Especially differentiate diagnose to occult pheochromocytoma and reduce surgery risk. Besides, adrenal area Castleman’s disease asymptomatic mostly, should distinguish to functionless adrenal tumor. To local Castleman’s disease, Surgical is the preferred treatment due to high recovery rate, survival rate and lower recurrence rate. Multicentric Castleman’s disease can only receive little effect through operation, so the major treatment of Multicentric Castleman’s disease still follow the rules of lymphoplasia disease: chemotherapy and radiotherapy, but the results are not very good, and other drugs like immune modulators, monoclonal antibodies, antiviral agents etc. Seem to have a bright future but still need a lot clinical trials.

Keywords: Castleman’s disease; diagnosis; treatment