A diagnostic and therapeutically challenging presentation of unicentric mesenteric Castleman disease: A case report

Castleman disease (CD) is a rare lymphoproliferative disorder primarily manifesting as either Multicentric CD (MCD) or Unicentric CD (UCD), with Unicentric Mesenteric CD (UMCD) representing a less common subtype within the UCD category. The present study presented an encounter with a 29-year-old male patient afflicted by UMCD, presenting with significant morbidity attributed to a sizable mesenteric mass. The diagnostic and therapeutic management of this condition posed notable challenges. In the absence of any additional abnormalities detected in auxiliary examinations, a distinct soft tissue density lesion in the abdominal region was revealed by computed tomography (CT). Despite the patient's reluctance to pursue further diagnostic procedures such as fine needle aspiration, a surgical approach was adopted under the suspicion of malignancy to establish a definitive diagnosis and implement treatment, confirming the condition as UMCD. Subsequent adjuvant chemotherapy was performed postoperatively. Fortunately, the patient achieved complete recovery, with no tumor recurrence observed during the 5-year follow-up period post-surgery. Due to the special location of UMCD, its preoperative diagnosis posed challenges and the most effective treatment remains a topic of debate. The prevalent instances of delayed diagnosis and misdiagnosis underscore a deficiency in comprehending the etiology and features of the disease, essential for advancing novel therapeutic strategies. CT imaging and pathological examination both play a crucial role in UMCD diagnosis. The present study supported surgery as the primary treatment modality for UMCD, with chemotherapy and immunotherapy offering additional benefits for appropriately selected patients.