以颈部淋巴结肿大为首发症状的局灶型Castleman病诊治体会

Diagnosis and treatment of cervical Castleman disease presenting as a neck mass

目的总结颈部Castleman病的临床特征与诊治体会。方法回顾性分析2000年5月至2008年10月期间8例以颈部淋巴结肿大为首发症状的Castleman病患者临床资料。肿物位于颈部Ⅰ区1例，Ⅱ区3例，Ⅲ区3例，Ⅳ区1例。8例病例均行常规CT检查表现为类圆形软组织肿块影，其中4例增强扫描后周围可见环性增强区。8例血常规检查大致正常，其中6例患者轻度贫血。结果本组病例均为局灶型Castleman病，手术完整切除肿大淋巴结，肿大淋巴结呈椭圆形，大小约（2cm×2cm×3cm）～（4cm×3cm×2cm），界限清楚，与周围组织无明显粘连。病理类型为透明血管型。术后随访7～30个月未见复发。结论局灶型Castleman病表现为单一部位的淋巴结肿大，CT等影像检查可以提示诊断，手术切除疗效好。

Objective To investigate the clinical and pathological features, diagnosis and treatment of Castleman disease （CD）. Methods Clinical features and related information on diagnosis and treatment of eight cases of CD were retrospectively analyzed. The size of involved lymph nodes ranged from （2 cmx 2 crux3 em）--（4 cm x3 cm x2 cm）. The lymph nodes were found in level I （1 case） , level 1] （3 cases） ,level III （3 cases） and level IV （1 case）. CT examination in eight patients showed the lesions manifested as ellipse soft masses. Dynamic contrast CT scan in four patients showed ring-enhanced area around the masses. Blood routine examination in eight patients were generally normal, with six patients had mild anemia. Results Based on the clinical classification, all lesions in this group were localized CD. Histopathology indicated that all lesions were of hyaline-vascular type. After surgery, there was no recurrence during the follow-up period. Conclusions Patients with localized CD mainly have lymphadenectasis in a single location. The CT scan can give some evidence. Surgery should be given first priority.