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Pancreatic Castleman disease treated with laparoscopic distal pancreatectomy
Filip Cecka1, Alexander Ferko, Bohumil Jon
1Department of Surgery, Faculty of Medicine and University Hospital Hradec Kralove, Sokolska 581, 500 05 Hradec Kralove, Czech Republic. filip.cecka@seznam.cz
Background:
Castleman disease is an uncommon lymphoproliferative disorder most frequently occurring in the mediastinum. Abdominal forms are less frequent, with pancreatic localization of the disease in particular being extremely rare. Only seventeen cases have been described in the world literature.
Method:
This report describes an interesting and unusual case of pancreatic Castleman disease treated with laparoscopic resection.
Results:
A 48-year-old woman presented with epigastric pain. CT scan showed a well-encapsulated mass on the ventral border of the pancreas. Endosonography with fine needle aspiration biopsy was performed. Biopsy showed lymphoid elements and structures of a normal lymph node. The patient was treated with laparoscopic distal pancreatectomy. The pancreas was transected with a Ligasure device and the pancreatic stump was secured with a manual suture. One year after surgery the patient was complaint-free and showed no signs of recurrence of the disease.
Conclusions:
Laparoscopic distal pancreatectomy is a feasible and safe method for the treatment of lesions in the body and tail of the pancreas. Transection of the pancreas with a Ligasure device offers the advantages of low bleeding and low risk of pancreatic fistula.
Insights
Castleman disease is a rare lymphoproliferative disorder. This case highlights laparoscopic distal pancreatectomy as a safe and effective treatment for rare pancreatic Castleman disease.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Pathology
Background:
- Castleman disease is a rare lymphoproliferative disorder, typically affecting the mediastinum.
- Pancreatic localization of Castleman disease is exceptionally rare, with only seventeen cases documented globally.
- Abdominal presentations of Castleman disease are less common than mediastinal forms.
Observation:
- A 48-year-old woman presented with epigastric pain and a pancreatic mass identified via CT scan.
- Endosonography with fine needle aspiration biopsy revealed lymphoid elements consistent with a normal lymph node.
- The pancreatic mass was surgically resected using a laparoscopic approach.
Findings:
- The patient underwent a laparoscopic distal pancreatectomy for the rare pancreatic Castleman disease.
- The pancreas was transected using a Ligasure device and secured with a manual suture.
- Post-operative follow-up at one year showed the patient to be symptom-free with no signs of recurrence.
Implications:
- Laparoscopic distal pancreatectomy is a viable and safe surgical option for pancreatic body and tail lesions.
- Utilizing a Ligasure device for pancreatic transection minimizes bleeding and reduces the risk of pancreatic fistula.
- This case contributes to the limited literature on managing extremely rare pancreatic Castleman disease.
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