Schulte Klaus-Martin, Sinha Prakash, Talat Nadia, Diaz-Cano Salvador
Department of Endocrine Surgery, King's College Hospital, King's Health Partners, London, UK.
BMJ Case Rep. 2011 May 3;2011:bcr0320113938. doi: 10.1136/bcr.03.2011.3938.
A 78-year-old woman with B-symptoms was referred for a left adrenal incidentaloma of 5 cm. Imaging revealed features compatible with adrenal cancer. The authors excluded excess production of catecholamines or adrenal steroids. The tumour was removed by en bloc radical left retroperitonectomy with adrenalectomy, nephrectomy, interaortocaval lymphadenectomy and splenectomy. Histology demonstrated periadrenal hyaline vascular Castleman's disease with local infiltration and 14 positive lymph nodes. The lymphoid infiltrate spilled into the adjacent renal cortex. HHV8 was negative. The Ki67 proliferative index was 30-40% in germinal centres. There was no syn- or metachronous disease on extended imaging including fluorodeoxyglucose positron emission tomography-CT and narrow follow-up at 3 years. This is a rare case of unicentric hyaline vascular Castleman's disease with documented locoregional lymph node involvement. The case exemplifies the transition from unifocal unicentric disease into disseminated disease with involvement of multiple lymph node stations (multicentric disease). The authors demonstrate surgical cure by oncological resection.
一名78岁有B症状的女性因5厘米的左肾上腺偶发瘤前来就诊。影像学检查显示其特征符合肾上腺癌。作者排除了儿茶酚胺或肾上腺类固醇的过度分泌。通过整块根治性左腹膜后切除术，包括肾上腺切除术、肾切除术、主动脉腔静脉间淋巴结清扫术和脾切除术，切除了肿瘤。组织学显示肾上腺周围透明血管型Castleman病伴局部浸润及14个阳性淋巴结。淋巴浸润蔓延至相邻的肾皮质。HHV8呈阴性。生发中心的Ki67增殖指数为30%-40%。包括氟脱氧葡萄糖正电子发射断层扫描-CT在内的广泛影像学检查及3年的密切随访均未发现同步或异时性疾病。这是一例罕见的单中心透明血管型Castleman病，有局部区域淋巴结受累的记录。该病例例证了从单灶单中心疾病向累及多个淋巴结站的播散性疾病（多中心疾病）的转变。作者展示了通过肿瘤切除实现手术治愈。
