Chen Yongjin, Fu Chang, Chen Junhong, Pan Weicong, Fu Yu, Liu Kai
Department of Hepatopancreatobiliary Surgery, The First Hospital of Jilin University, Changchun, China.
Front Surg. 2022 Mar 2;9:800050. doi: 10.3389/fsurg.2022.800050. eCollection 2022.
Castleman disease (CD) rarely presents with obstructive jaundice, which poses a diagnostic and therapeutic challenge to the management of the disease. A 40-year-old man was referred to our hospital for emergent management of upper abdominal pain. An abdominal mass was removed, and the postoperative pathology showed retroperitoneum CD, which was subsequently managed by adjuvant therapy of combination chemotherapy and steroids. One month later, a biliary metal stent was placed due to the presentation of obstructive jaundice. After ~3 months, the patient experienced another episode of obstructive jaundice, and SpyGlass DS cholangioscopy was performed the biliary tract for biopsy, which pathologically showed biliary malignancies. Radiofrequency ablation was performed with a probe, and another uncovered metal stent was placed within the existing metal stent. No stent occlusion occurred during a 6-month follow-up period. In conclusion, CD rarely presents with obstructive jaundice, and a combination of radiofrequency ablation with metal stent implantation under cholangioscopy can prolong the stent patency time and the survival time of patients.
卡斯特曼病（CD）很少表现为梗阻性黄疸，这给该疾病的管理带来了诊断和治疗挑战。一名40岁男性因上腹部疼痛紧急转诊至我院。切除了一个腹部肿块，术后病理显示为腹膜后CD，随后通过联合化疗和类固醇的辅助治疗进行管理。1个月后，由于出现梗阻性黄疸放置了胆道金属支架。约3个月后，患者再次出现梗阻性黄疸，遂进行SpyGlass DS胆管镜检查以对胆道进行活检，病理显示为胆道恶性肿瘤。用探头进行了射频消融，并在现有金属支架内放置了另一个未覆盖的金属支架。在6个月的随访期内未发生支架闭塞。总之，CD很少表现为梗阻性黄疸，在胆管镜下射频消融与金属支架植入相结合可延长支架通畅时间和患者生存时间。
