Unicentric Castleman disease was misdiagnosed as pancreatic mass:A case report

BACKGROUND Castleman’s disease(CD)is a lymphatic proliferative disorder of unknown cause and is rarely seen clinically.It has been divided into unicentric and multicentric types.Unicentric CD(UCD)occurs as a solitary enlarged mass and mediastinal lymph nodes are the most common site.Surgical excision has proven to be curative for UCD.Multicentric CD(MCD)appears as a systemic disease with peripheral lymphadenopathy.MCD had a poor response to surgery and monoclonal antibodies with rituximab have become a research hotspot.CASE SUMMARY A 44-year-old woman presented with a pancreatic mass during routine physical examination.She had no obvious symptoms,such as fever,abdominal pain,abdominal distension,or jaundice.Ultrasound examination indicated a hypoechoic mass between the body of the pancreas,left lobe of the liver and stomach.It had a clear boundary,irregular shape,uneven echo,and no obvious blood flow signals.To clarify the diagnosis,contrast-enhanced ultrasound examination was performed,which showed a benign pancreatic lesion.Neuroendocrine or solid pseudopapillary tumor was a possible diagnosis.The patient underwent further contrast-enhanced computed tomography and contrastenhanced magnetic resonance imaging,which were suggestive of solid pseudopapillary tumor or neuroendocrine tumor.All the examinations failed to give a definitive diagnosis,and the patient underwent surgery.The final pathological and immunohistochemical results showed that the mass was CD.CONCLUSION This case highlights when lymphadenopathy is encountered clinically,CD should be considered and a biopsy should be performed.

Role of imaging in management of hepatocellular carcinoma: surveillance, diagnosis, and treatment response

Imaging plays a notable role in hepatocellular carcinoma(HCC)surveillance,diagnosis,and treatment response assessment.Whereas HCC surveillance among at-risk patients,including those with cirrhosis,has traditionally been ultrasound-based,there are increasing data showing that this strategy is operator-dependent and has insufficient sensitivity when used alone.Several novel blood-based and imaging modalities are currently being evaluated to increase sensitivity for early HCC detection.Multi-phase computed tomography(CT)or contrast-enhanced magnetic resonance imaging(MRI)should be performed in patients with positive surveillance tests to confirm a diagnosis of HCC and perform cancer staging,as needed.HCC is a unique cancer in that most cases can be diagnosed radiographically without histological confirmation when demonstrating characteristic features such as arterial phase hyperenhancement and delayed phase washout.The Liver Imaging Reporting and Data System offers a standardized nomenclature for reporting CT or MRI liver findings among at-risk patients.Finally,cross-sectional imaging plays a critical role for assessing response to any HCC therapy as well as monitoring for HCC recurrence in those who achieve complete response.