Tsai M H, Pai H H, Yen P T, Huang T S
Department of Otolaryngology, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China.
Ear Nose Throat J. 1997 Oct;76(10):731-5, 739.
We describe the first case of isolated nasopharyngeal Castleman's disease mimicking juvenile angiofibroma. Castleman's disease may appear as a local or generalized tumor-like condition, usually in the chest or abdomen, and may involve both the lymph nodes and non-nodal tissues. Since the nasopharyngeal roof is the residence of the pharyngeal tonsils (adenoids) which are rich in lymphoid tissues, such an appearance is predictable. It is emphasized that careful interpretation of radiographs may help to distinguish Castleman's disease from other tumor conditions, such as lymphoma, neurogenic tumor, or even angiofibroma, etc. But the exact diagnosis must be made on the basis of histologic confirmation. In addition to histologic classifications, clinical distinction between the localized and multicentric forms is important in selecting appropriate management. Surgical excision is the first choice and is curative in cases of localized Castleman's disease, but provides little benefit for cases of the multicentric form because of systemic manifestations and rapid deterioration. Thus, antineoplastic agents and steroids may offer an alternative form of therapy for patients with the multicentric form.
我们报告首例酷似青少年血管纤维瘤的孤立性鼻咽部Castleman病。Castleman病可能表现为局部或全身性肿瘤样病变，通常位于胸部或腹部，可累及淋巴结和非淋巴结组织。由于鼻咽顶部是富含淋巴组织的咽扁桃体（腺样体）所在部位，出现这种表现是可以预见的。需要强调的是，仔细解读X线片有助于将Castleman病与其他肿瘤性疾病区分开来，如淋巴瘤、神经源性肿瘤，甚至血管纤维瘤等。但确切诊断必须基于组织学证实。除了组织学分类外，局部型和多中心型的临床鉴别对于选择合适的治疗方法很重要。手术切除是首选，对于局限性Castleman病病例可治愈，但对于多中心型病例益处不大，因为存在全身表现且病情迅速恶化。因此，抗肿瘤药物和类固醇可能为多中心型患者提供另一种治疗方式。
