Presentation
Bilateral groin swelling.
Patient Data
Multiple enlarged variable-size lymph nodes were seen in both inguinal regions more on the right side with homogenous enhancement in the post-contrast study. Another enlarged similar lymph nods was seen in the right external iliac groups and on the right paracaval region.
No suspicious enlarged lymph nodes were seen. Normally the size of the spleen, adrenal, and liver has no focal lesion. In comparison with a previous study done 5 months ago, there is reduction in the size and number of lymph nodes.
Case Discussion
Castleman disease is usually diagnosed by exclusion and histopathology, our patient has no history of HIV infection and shows multiple enlarged inguinal and intrabdominal lymph nodes with homogenous enhancement in the post-contrast study, no arborising calcification, the differential diagnosis includes infective, reactive causes, and neoplastic including lymphoma and others.
The patient went on to have an excisional biopsy.
Histopathology and Immunohistochemistry
After excisional biopsy of lymph nodes histopathology and immunohistochemistry shows infiltration of lymph nods by diffuse sheets of atypical small and medium size lymphoid cells having hyperchromatic nuclei and positive CD20, CD3, CD30 & LCA and increase proliferation index in the germinal center (K167) and negative EMA.
CT follow-up after 5 months of medical treatment (chemotherapy) shows significant improvement as a reduction in size and number of enlarged lymph nodes.
Acknowledgment to Dr Reema AL-Joniaid (pathology specialist ) and Dr Abdulatif Magram (radiology specialist) contributes to the diagnosis of the case.
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