Castleman’s Disease in the Axilla: A Case Report

Abstract

INTRODUCTION: Castleman s disease is a rare benign lymphoproliferative disorder of uncertain origin which most commonly involves the mediastinum but rarely affects the axilla. REPORTING: We report a case of a 40-year-old woman, without comorbidities and no family history of cancer, that sought medical assistance for having presented a right axillary tumor during two years. Physical examination showed a mass in the right axilla approximately 4. 0 x 3. 0 cm, mobile and painless palpation. The ultrasonography of the breast demonstrated a well-defined, heterogeneous, hypoechoic, ovoid mass at the right axilla whose measurement was 5, 2 x 3, 6 x 2, 5 cm, and peripheral hypervascularity was observed at a color Doppler sonography. We conducted a percutaneous needle biopsy which showed reactive follicular hyperplasia. The patient underwent resection of the lesion and the microscopic sections of the enlarged lymph node showed numerous small follicle like structures with radially penetrating capillaries, some with hyalinization in the central portion. The final pathologic diagnosis was angiofollicular lymphoid hyperplasia, hyaline vascular type (Castleman disease). The patient is asymptomatic seven months after surgery with no change in the new ultrasound exams. DISCUSSION: Castleman s disease is an uncommon lymphoproliferative disorder. There are three histological types, hyaline vascular (the most common), plasma cell variant and mixed form. The hyaline vascular variant is typically characterized by a benign clinical course without constitutional symptoms (localized disease). It is usually managed with surgery and/or radiotherapy. They usually consider the patient free from disease after surgical resection of localized Castleman s disease, but there is a risk of developing non-Hodgkin lymphoma in the long-term. The purpose of this report is to present this rare case and to stress that Castleman s disease should be included in the differential diagnosis of axillaries’ tumors, mainly the axillary lymph node metastasis and the primary occult breast carcinoma.