Castleman’s Disease Masquerading as a Large Paraganglioma

Abstract

Objective: 1) To describe a case of Castleman’s disease with unusual clinical and radiographic presentation as a somatostatin-positive mass in the poststyloid parapharyngeal space (PPS). 2) To review the literature, which does not report Castleman’s disease of the PPS, somatostatin-positive disease, or disease resulting in cranial neuropathy. Method: The clinical presentation, imaging features, surgical findings, and pathology slides were reviewed in the case of an adult patient with a parapharyngeal space mass. The literature on Castleman’s disease was reviewed as was that on somatostatin-positive parapharyngeal space lesions. Permission was obtained from the patient to publish the findings. Results: A 51-year-old male with 3 months of otalgia, hearing loss, and tinnitus underwent audiogram, revealing asymmetric hearing loss. Laryngoscopy showed a paretic true vocal cord. Magnetic resonance imaging (MRI) showed a 4.5-cm poststyloid PPS mass displacing the carotid artery anterolaterally. Octreoscan scan showed a significant uptake. Angiogram showed prominent vascular blush and feeders from the occipital artery. The patient underwent preoperative embolization of arterial feeders to the mass. A transcervical approach was used to access and remove the mass. Final histopathology is consistent with Castleman’s disease. Our review of the literature did not identify previously reported cases of octreotide-positive lymphoproliferative diseases. Conclusion: This case demonstrates that poststyloid parapharyngeal masses in the medial portion of the parapharyngeal space may actually be lateral retropharyngeal nodes. Paragangliomas may also grow medially and present atypically and may be associated with vocal cord paralysis. This case is particularly unusual in that octreotide-positive Castleman’s has never been reported.