2017, Number 5
Rev Mex Urol 2017; 77 (5)
Gómez-Sánchez J, Herrera-Muñoz J, Preciado-Estrella DA, Trujillo-Ortiz L, Sedano-Basilio J, Viana-Álvarez G
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ABSTRACTBackground: Castleman’s disease describes a group of lymphoproliferative disorders caused by excessive proinflammatory cytokine production, mainly of interleukin-6. Patients present with heterogeneous clinical features, with histopathologic lymph node changes, and often with multiple organ failure.
Clinical case: A 70-year-old man had a past medical history of type 2 diabetes mellitus and high blood pressure. A left Bosniak I renal cyst and a 36-mm mass occupying the ipsilateral pelvic region were incidentally diagnosed. Kidney scintigram revealed a glomerular filtration rate of 22.5 mL/min in the right kidney and of 39.3 mL/min in the left kidney. Complementary urinary cytology study was negative. Laboratory test results were: hemoglobin 14.6 mg/dL, hematocrit 38%, leukocytes 7240, platelets 226000, PT 15.2, PTT 32 sec, glucose 158 mg/dL, creatinine 0.7, and nonpathologic urinalysis. Radical nephrectomy was performed with no early or intermediate complications, metabolic control and hemodynamic control were adequate, and the patient was released. The histopathologic result was lymphoplasmacytic tumor in the adipose tissue of the renal hilum (3.5 cm) consistent with Castleman’s disease.
Conclusions: Castleman’s disease is difficult to diagnose. Histopathologic study is essential, and given the low frequency of the disease, ideal management has not been established. However, surgical excision is the only curative option in its unicentric variants.