Published online May 27, 2022. doi: 10.4240/wjgs.v14.i5.514
Peer-review started: January 8, 2022
First decision: March 13, 2022
Revised: April 1, 2022
Accepted: May 7, 2022
Article in press: May 7, 2022
Published online: May 27, 2022
Processing time: 136 Days and 21.2 Hours
Castleman disease is an uncommon nonclonal lymphoproliferative disorder, which frequently mimics both benign and malignant abnormalities in several regions. Depending on the number of lymph nodes or regions involved, Castleman disease (CD) varies in diagnosis, treatment and prognosis. It rarely occurs in the pancreas alone without any distinct clinical feature and tends to be confused with pancreatic paraganglioma (PGL), neuroendocrine tumors (NETs), and primary tumors, thus impeding proper diagnosis and treatment.
A 28-year-old woman presented with a lesion on the neck of the pancreas, detected by ultrasound during a health examination. Physical examination and laboratory findings were normal. The mass showed hypervascularity on enhanced computed tomography (CT), significantly increased 18F-fluorodeoxyglucose uptake on positron emission tomography (PET)/CT, and slightly increased somatostatin receptor (SSTR) expression on 68Ga-DOTATATE PET/CT, suggesting no distant metastases and subdiagnoses such as pancreatic PGL, NET, or primary tumor. Intraoperative pathology suggested lymphatic hyperplasia, and only simple tumor resection was performed. The patient was diagnosed with the hyaline vascular variant of CD, which was confirmed by postoperative immunohistochemistry. The patient was discharged successfully, and no recurrence was observed on regular review.
High glucose uptake and slightly elevated SSTR expression are potentially new diagnostic features of CD of the pancreas.
Core tip: Some rare tumors with high blood supply to the pancreas, such as Castleman disease (CD), paraganglioma, and neuroendocrine tumors are difficult for clinicians to differentially diagnose based on conventional imaging and clinical presentation. In our case, CD of the pancreas had no obvious clinical features as previously reported but showed higher glucose uptake and mildly increased somatostatin receptor expression on positron emission tomography/computed tomography, which might help in the diagnosis.