局灶型Castleman病临床分析

Clinical Analysis of Localized Castlemanfs Disease

【目的】探讨局灶型Castleman病的诊断和治疗要点。【方法】对1999年1月至2009年7月中国医科大学附属第一医院收治的53例局灶型Castleman病的临床表现、诊疗方法及预后进行了分析。【结果】局灶型Castleman病无特征性临床表现，影像学检查亦无特异性。53例病例中，透明血管型50例，浆细胞型1例，混合型2例。有随访结果的47例中，1例因心肌梗死死亡；46例存活，41例手术完全切除者均无复发，1例部分切除及4例活检病例无症状存活。【结论】局灶型Castleman病确诊主要依靠病理。活检时注意选取不同部位表现典型的淋巴结，必要时多次送检；手术时应与恶性肿瘤鉴别，要做术中冰冻病理检查，避免不必要的扩大性切除。局灶型Castleman病手术切除后可长期生存。

[Objective] To investigate the diagnostic and therapeutic essentials of localized Castleman＇s disease. [Methods]Fifty three cases of localized Castleman＇s disease were collected from the patients admitted in the First Hospital of China Medical University from January 1999 to July 2009. The clinical manifestations, the course of diagnosis and treatment, and the outcome of the clinicopathologic entity were analyzed. [Results]The clinical presentations of localized Castleman＇s disease were nonspecific with no characteristic features, as well as radiologic findings. Of the 53 cases, 50 cases were hyaline-vascular type, 1 was plasma cell type and 2 were mixed subtype. Among the 47 cases with available followed-up outcome, 1 died of acute myocardial infarction, while other 46 cases were alive up present, of whom, 41 cases following complete surgical resection remained symptom free without any evidence of recurrence, 1 case following partial resection and 4 cases under observation by biopsy remained asymptomatic. [Conclusion]The definite diagnosis of localized Castlemans disease mainly depends on pathology. In biopsy, it is necessary to select different sites of typical lymph nodes, try again even again if necessary. As for surgical excision, in order to avoid unnecessarily extensive resection, peroperative histopathological diagnosis by open biopsy is required, which would help to distinguish this benign disorder from resembled malignant tumors. Complete surgical resection for localized Castleman＇s disease can obtain long-term survival.