Loic Tchokouani, MD, Michael Fastiggi, MD, Edward Chin, MD. Mount Sinai Medical Center
This is a 34-year old woman with no past medical or surgical history who presented with chronic right upper quadrant pain. A right upper quadrant ultrasound was initially obtained revealing a 5-cm mass in the left upper quadrant. Subsequent CT scan and MRI were obtained to further characterize the mass. It measured 5.1 x 3.5 x 4.2 cm in the left retroperitoneum, anterior to the psoas muscle and medial to the lower pole of the left kidney not originating from bowel, adrenal gland, pancreas, or kidney. The case was presented at a multi-disciplinary tumor board who agreed with resection of the mass with a differential of sarcoma, paraganglioma, and lymphoma. Resection of the mass was approached laparoscopically in left lateral decubitus position. The tumor was penetrating through the colonic mesentery and had multiple feeding vessels from the gonadal, renal, and retroperitoneal vessels. Dissection began by mobilizing the left colon and splenic flexure. The spleen and kidney were fully exposed to delineate the attachments of the tumor. The ureter was displaced by the tumor and dissection was very meticulous. The mass was able to be safely resected with preservation of all major structures. Pathology revealed, after further evaluation by the National Institutes of Health, the diagnosis of Castleman Disease.
This disease involves lymphovascular proliferation of lymph nodes. There are three main classes: unicentric, multicentric +HHV8, and multicentric –HHV8.
Unicentric, the type our patient was found to have, involves one or more enlarged lymph node(s) in a single region of the body that demonstrates Castleman Disease histopathologic features (hyaline vascular histology to plasma cell histology). The etiology of this subtype is not well documented and approximately 6,000 cases are diagnosed in the US yearly. This disease is closely associated with Hodgkin’s and Non-Hodgkin’s lymphoma. Treatment for Unicentric Castleman Disease involves resection of the tumor with PET CT used as a surveillance tool annually for 5 years.
This experience shows that large retroperitoneal tumors can be resected laparoscopically as long as a sound operative plan is in place.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94563
Program Number: V083
Presentation Session: Exhibit Hall Theater Video Session III
Presentation Type: EHVideo
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