内容紹介
Summary
We report a patient who had Castleman's disease with lymphadenopathy during the treatment of gastric cancer. In May 2017, a 63-year-old man underwent gastrointestinal endoscopy, which revealed a tumor on the posterior wall of the lower part of the stomach. Based on a biopsy, he was diagnosed with suspected adenocarcinoma, Group 4. In June 2017, he visited our hospital, and endoscopic submucosal dissection(ESD)was performed. The pathological diagnosis of the resected specimens was L, Less, 20×10 mm, Type 0-Ⅱc, tub1, pT1a(M), UL(-), ly(-), v(-), pHM0, pVM0, pStageⅠA. He was referred to our department for the treatment of abdominal lymphadenopathy. His lymphadenopathy was localized in the gastric lesser curvature as an enlarged lymph node 15 mm in size, based on the findings of contrast-enhanced CT. On FDG-PET/CT, we found a slight accumulation of SUVmax 2.4 in the early phase in the same lymph node. We could not confirm a diagnosis, and we performed laparoscopic dissection of the lymph node for diagnosis and treatment. The size of the specimen was 14×14 mm, surface was smooth, and lymph node was elastic and soft. We found lymphoid follicles with atrophic germinal center using HE staining. We also found increased hyperplastic blood vessels around the germinal center, and he was diagnosed with hypervascular Castleman's disease.
要旨
症例は63歳,男性。2017年5月に検診の上部消化管内視鏡検査にて胃体下部後壁に0-Ⅱa型病変を指摘され,生検でadenocarcinoma suspected(Group 4)と診断された。同年6月に当院消化器内科を紹介受診し,内視鏡的粘膜下層剝離術(endoscopic submucosal dissection: ESD)が施行された。切除標本の病理診断はL,Less,20×10 mm,Type 0-Ⅱc,tub1,pT1a(M),UL(-),ly(-),v(-),pHM0,pVM0,pStageⅠAであり,治癒切除と判断した。ESD施行後にCTで指摘された腹部リンパ節腫大の精査加療目的にて当科に紹介となった。病巣は造影CTで胃小弯側に15 mm大の腫大リンパ節として局在した。FDG-PET/CTで同部位に早期相でSUVmax 2.4の淡い集積を認めた。当科にて腹腔鏡下リンパ節摘出術を施行した。摘出標本は14×14 mmの表面平滑で弾性・軟の腫大リンパ節であり,HE染色にて萎縮性の胚中心を有する二次リンパ濾胞を多数認めた。また,胚中心周囲に硝子化血管の増生を認めており,硝子血管型Castleman病と診断した。今回われわれは,腹部リンパ節腫大を契機に診断されたCastleman病の1例を経験したので報告する。
目次
We report a patient who had Castleman's disease with lymphadenopathy during the treatment of gastric cancer. In May 2017, a 63-year-old man underwent gastrointestinal endoscopy, which revealed a tumor on the posterior wall of the lower part of the stomach. Based on a biopsy, he was diagnosed with suspected adenocarcinoma, Group 4. In June 2017, he visited our hospital, and endoscopic submucosal dissection(ESD)was performed. The pathological diagnosis of the resected specimens was L, Less, 20×10 mm, Type 0-Ⅱc, tub1, pT1a(M), UL(-), ly(-), v(-), pHM0, pVM0, pStageⅠA. He was referred to our department for the treatment of abdominal lymphadenopathy. His lymphadenopathy was localized in the gastric lesser curvature as an enlarged lymph node 15 mm in size, based on the findings of contrast-enhanced CT. On FDG-PET/CT, we found a slight accumulation of SUVmax 2.4 in the early phase in the same lymph node. We could not confirm a diagnosis, and we performed laparoscopic dissection of the lymph node for diagnosis and treatment. The size of the specimen was 14×14 mm, surface was smooth, and lymph node was elastic and soft. We found lymphoid follicles with atrophic germinal center using HE staining. We also found increased hyperplastic blood vessels around the germinal center, and he was diagnosed with hypervascular Castleman's disease.
要旨
症例は63歳,男性。2017年5月に検診の上部消化管内視鏡検査にて胃体下部後壁に0-Ⅱa型病変を指摘され,生検でadenocarcinoma suspected(Group 4)と診断された。同年6月に当院消化器内科を紹介受診し,内視鏡的粘膜下層剝離術(endoscopic submucosal dissection: ESD)が施行された。切除標本の病理診断はL,Less,20×10 mm,Type 0-Ⅱc,tub1,pT1a(M),UL(-),ly(-),v(-),pHM0,pVM0,pStageⅠAであり,治癒切除と判断した。ESD施行後にCTで指摘された腹部リンパ節腫大の精査加療目的にて当科に紹介となった。病巣は造影CTで胃小弯側に15 mm大の腫大リンパ節として局在した。FDG-PET/CTで同部位に早期相でSUVmax 2.4の淡い集積を認めた。当科にて腹腔鏡下リンパ節摘出術を施行した。摘出標本は14×14 mmの表面平滑で弾性・軟の腫大リンパ節であり,HE染色にて萎縮性の胚中心を有する二次リンパ濾胞を多数認めた。また,胚中心周囲に硝子化血管の増生を認めており,硝子血管型Castleman病と診断した。今回われわれは,腹部リンパ節腫大を契機に診断されたCastleman病の1例を経験したので報告する。