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Rare Case of Castleman Disease Mimicking the Spread of Renal Cell Carcinoma

By: Joseph Fanelli
Posted: Monday, February 1, 2021

The rare, clinicopathologic entity Castleman disease may be included in the differential diagnosis of renal cell carcinoma with regional lymphatic dissemination after simulating the presence of clinically active tumoral lymph nodes, according to the findings of a case report presented in Urology Case Reports. The symptoms of Castleman disease are similar to those of paraneoplastic syndromes linked to renal cell carcinoma, concluded Eurico Cleto Ribeiro de Campos, PhD, of the Sao Paolo Group, Brazil, and colleagues.

“The fundamental prognostic factors that are recognized as key determinants of the treatment, clinical evolution, and overall survival of the patients are clinicopathological staging, histological grade, and performance status,” the authors noted.

A 60-year-old man was admitted to the hospital because of anemia, night sweats, and weight loss. A CT scan uncovered splenomegaly, a renal mass on the left kidney, and retroperitoneal lymph adenomegaly. A physical examination revealed splenomegaly without evidence of a palpable renal mass. The patient then underwent left-sided radical nephrectomy, with resection extended to the spleen, and retroperitoneal lymphadenectomy. A histopathologic diagnosis of the mass revealed clear cell carcinoma.

The authors reported the tumor was 10.8 cm with a high-grade neoplasm and a large portion of tumoral necrosis and renal invasion at the renal pelvis. Of the 21 retroperitoneal lymph nodes removed, all have demonstrated negative lymph node status for malignancy, although they contained a lymphoplasmacytic infiltrate. Posterior analysis of the lymph nodes using immunohistochemistry testing confirmed the absence of neoplastic entities at these lymph nodes. At this point, the authors detected angiofollicular lymph node hyperplasia with polyclonal plasmacytosis, which confirmed the diagnosis of retroperitoneal Castleman disease.

Disclosure: The authors reported no conflicts of interest.

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