Answer for BIR CoW 10 Mar 2024
Castleman Disease
Findings
Well defined smoothly marginated homogenous predominantly exophytic mass noted arising from tail of pancreas, shows faint enhancement with prominent feeding vessels ,without areas of calcification /hemorrhage/necrosis within it. Main pancreatic duct not dilated. No evidence of adjacent organ infiltration.
Discussion
Castleman disease also known as angiofollicular lymph node hyperplasia, is a complex lymphoproliferative disorder divided into two forms: unicentric CD (UCD) and multicentric CD(MCD) .
UCD typically manifests as a solitary enhancing mass that is discovered incidentally or after development of compression type symptoms.
MCD encompasses 3 subtypes: Idiopathic MCD , HHV8 associated MCD and POEMS syndrome associated MCD .
CD most commonly manifests as UCD, chest is the most common site, followed by the neck , abdomen and pelvis & axilla.
Usually presents in 4th decade.Only 19 cases of CD associated with pancreas were described in the world literature.
IMAGING :
USG- Mass appears as well-defined homogeneously hypoechoic lesion.
CT-Well-defined hypodense lesion shows enhancement and prominent feeding vessels with or without discrete or coarse calcification.
MRI –T1 hypo/isointense, T2- hyper/isointense & shows homo or heterointense enhancement.
PETCT-Mild to moderately hypermetabolic .
Few cases of CD transform into FDC( Follicular dendritic cell sarcoma).Complete surgical excision is typically curative for UCD. MCD usually requires systemic therapy.Since diagnosis of CD based solely on imaging findings is often not possible, pathologic confirmation with core needle biopsy and/or surgical excision is necessary.
DIFFERENTIAL DIAGNOSIS
1.Pancreatadenocarcinoma
2.Pancreatic neuroendocrine tumour
3.Lymphoma.
Findings
Well defined smoothly marginated homogenous predominantly exophytic mass noted arising from tail of pancreas, shows faint enhancement with prominent feeding vessels ,without areas of calcification /hemorrhage/necrosis within it. Main pancreatic duct not dilated. No evidence of adjacent organ infiltration.
Discussion
Castleman disease also known as angiofollicular lymph node hyperplasia, is a complex lymphoproliferative disorder divided into two forms: unicentric CD (UCD) and multicentric CD(MCD) .
UCD typically manifests as a solitary enhancing mass that is discovered incidentally or after development of compression type symptoms.
MCD encompasses 3 subtypes: Idiopathic MCD , HHV8 associated MCD and POEMS syndrome associated MCD .
CD most commonly manifests as UCD, chest is the most common site, followed by the neck , abdomen and pelvis & axilla.
Usually presents in 4th decade.Only 19 cases of CD associated with pancreas were described in the world literature.
IMAGING :
USG- Mass appears as well-defined homogeneously hypoechoic lesion.
CT-Well-defined hypodense lesion shows enhancement and prominent feeding vessels with or without discrete or coarse calcification.
MRI –T1 hypo/isointense, T2- hyper/isointense & shows homo or heterointense enhancement.
PETCT-Mild to moderately hypermetabolic .
Few cases of CD transform into FDC( Follicular dendritic cell sarcoma).Complete surgical excision is typically curative for UCD. MCD usually requires systemic therapy.Since diagnosis of CD based solely on imaging findings is often not possible, pathologic confirmation with core needle biopsy and/or surgical excision is necessary.
DIFFERENTIAL DIAGNOSIS
1.Pancreatadenocarcinoma
2.Pancreatic neuroendocrine tumour
3.Lymphoma.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!