Sweed Dina, Abdelhalim Heba, Fayed Yahya, Mosbeh Asmaa, Kilany Shimaa, Ehsan Nermine, El-Azab Dina, Shalan Mai, Helal Thanaa
Pathology, National Liver Institute, Menoufia University, Egypt.
Radiology, National Liver Institute, Menoufia University, Egypt.
Ann Med Surg (Lond). 2020 Aug 23;58:37-40. doi: 10.1016/j.amsu.2020.08.019. eCollection 2020 Oct.
Castleman's disease (CD) is a primary lymphoproliferative disorder of the lymph nodes with rare extra-nodal primary affection.
Here we present a case of primary hepatic CD associated with hepatocellular carcinoma (HCC).
Sixty-two years old, male received direct-acting antiviral agents (DAAs) for HCV infection. Follow up revealed sustained virologic response; however, three hepatic focal lesions were accidently discovered. Triphasic CT confirmed the HCC nature of two masses while the other mass remained undiagnosed. Surgical intervention was the treatment of choice, and pathological examination showed a fairly circumscribed mass formed of angiolymphoid hyperplasia displayed atrophic germinal center, expanded mantle zone, and variable hyalinization. The radiological evaluation of lymph nodes was unremarkable. The patient is 40 months alive after resection, with no further management advised.
The immune-modulatory effect of DAAs may induce hepatic CD development in a cirrhotic patient, necessitating further studies. A new radiologic finding was observed in the present case in the form of vessels traversing through the lesion with no attenuation or occlusion. Pathology remains the gold standard in the diagnosis of CD.
Castleman病（CD）是一种淋巴结原发性淋巴增殖性疾病，结外原发性病变罕见。
在此，我们报告一例与肝细胞癌（HCC）相关的原发性肝CD病例。
一名62岁男性因丙型肝炎病毒（HCV）感染接受了直接抗病毒药物（DAAs）治疗。随访显示病毒学持续应答；然而，意外发现了三个肝脏局灶性病变。三期CT证实其中两个肿块为HCC性质，而另一个肿块仍未确诊。手术干预是首选治疗方法，病理检查显示一个边界相当清晰的肿块，由血管淋巴样增生构成，生发中心萎缩，套区扩大，伴有不同程度的玻璃样变性。淋巴结的影像学评估无异常。患者术后存活40个月，无需进一步治疗。
DAAs的免疫调节作用可能会在肝硬化患者中诱发肝CD的发生，需要进一步研究。在本病例中观察到一种新的影像学表现，即血管穿过病变且无衰减或阻塞。病理检查仍然是CD诊断的金标准。
