Shams Alexandra A, Ahmed Mostafa M, Scalzitti Nicholas J, Howell Della L, Hall Jordan M, Ritter John L, Maturo Stephen C
From the Uniformed Services University of the Health Sciences, Bethesda, Maryland, and the Departments of Otolaryngology-Head and Neck Surgery, Pediatric Hematology/Oncology, Pathology, and Radiology, San Antonio Military Medical Center, San Antonio, Texas.
South Med J. 2016 Feb;109(2):78-82. doi: 10.14423/SMJ.0000000000000406.
Castleman disease (CD) is a rare lymphoproliferative disorder that occurs in adults and rarely in the pediatric population. The disease is characterized by slowly enlarging masses that can form anywhere within the lymphatic system. It is an uncommon cause of a neck mass in both children and adults that presents insidiously and nonspecifically. A 21-year-old woman was referred to the otolaryngology service because of an asymptomatic neck mass found incidentally on computed tomographic imaging 15 months earlier. On repeat imaging, the lesion was characterized as a homogenously enhancing soft tissue mass and appeared stable in size compared with previous studies. Given the nondiagnostic radiologic features, tissue sampling was pursued, first using fine-needle aspiration and ultimately excisional biopsy. The excision revealed histopathology consistent with unicentric, hyaline-vascular CD. Excision is the gold standard for treatment of this variant of CD. The patient was referred to the hematology/oncology service but was subsequently lost to follow-up. This case illustrates a rare cause of a neck mass in a young adult and exemplifies the extremely broad differential in this setting. In addition, it highlights the importance of a systematic and thorough approach to diagnosing neck masses in children and adults.
卡斯特曼病（CD）是一种罕见的淋巴增生性疾病，多见于成年人，儿童患者罕见。该病的特征是肿块缓慢增大，可在淋巴系统内任何部位形成。它是儿童和成人颈部肿块的罕见病因，起病隐匿且无特异性。一名21岁女性因15个月前计算机断层扫描成像偶然发现的无症状颈部肿块转诊至耳鼻喉科。复查成像时，该病变表现为均匀强化的软组织肿块，与之前的检查相比，大小稳定。鉴于影像学特征无法确诊，遂进行组织取样，首先采用细针穿刺抽吸，最终进行切除活检。切除标本的组织病理学检查结果符合单中心透明血管型卡斯特曼病。切除是治疗这种卡斯特曼病变体的金标准。该患者转诊至血液学/肿瘤学科室，但随后失访。本病例说明了青年成人颈部肿块的罕见病因，并举例说明了这种情况下鉴别诊断范围极广。此外，它强调了对儿童和成人颈部肿块进行系统、全面诊断方法的重要性。
