Castleman’s Disease Arising from the Hepatoduodenal Ligament Mimicking a Duodenal Gastrointestinal Stromal Tumor

Abstract

Castleman’s disease (CD) arising from the hepatoduodenal ligament is extremely rare. A 32-year-old man was referred to a clinic with nausea. He was found to have an abdominal mass by ultrasonography and consulted our hospital for further examination. Computed tomography revealed an equally enhancing mass, 5.2 cm in diameter, adjacent to the duodenum. On magnetic resonance imaging, the mass revealed a slightly iso-intensity signal equal to smooth muscle on T1-weighted imaging, a slightly high-intensity signal on T2-weighted imaging, and a high-intensity signal on diffusion-weighted imaging. Endoscopic ultrasonography showed a well-demarcated hypoechoic mass adjacent to the duodenum. The Doppler echo pattern indicated abundant blood flow. The preoperative diagnosis was a duodenal gastrointestinal stromal tumor. The patient underwent laparotomy and tumor excision. The finding of the intraoperative frozen section was CD. Histologically, the lymph follicles were markedly increased in number throughout the cortex and medulla with vascular proliferation and hyalinization in the intra- or extra-follicles. The germinal centers were atrophic and surrounded by concentrically arranged layers of small lymphocytes. The histological findings were the hyaline vascular variant of CD. If a hypervascular solid mass is detected in the abdomen, CD should be considered in the differential diagnosis.

Keywords

• castleman’s disease
• duodenal gastrointestinal stromal tumor
• hepatoduodenal ligament