Presentation
Abdominal pain.
Patient Data
2 x 2.5 cm oval ileocolic mass. No other suspicious findings.
Ultrasound biopsy images showing the oval mass, Doppler to check for vessels, and first biopsy pass.
Case Discussion
Castleman disease is a non-neoplastic, non-clonal lymph node hyperplasia which can be idiopathic or associated with HIV, lymphoma, POEMS and other disorders. It commonly presents as avidly-enhancing adenopathy. Most cases (90%) are hyaline vascular, which occurs in younger patients, is unicentric, asymptomatic, and follows a benign course.
On a practical note, this was biopsied using ultrasound. Many people instinctively look a mass in this location, surrounded by bowel and vessels, and assume that this cannot be biopsied safely. However, ultrasound is a fantastic modality for abdominopelvic biopsies, as overlying small bowel loops can be pushed out of the way as pressure is applied to the transducer (think of it's central mesenteric attachments), and Doppler can be used to ensure that there are no overlying vessels.
Carefully watching the needle path for peristalsis is also important to ensure that a bowel loop is not compressed between the abdominal wall and mass, although a biopsy device can safely pass through small bowel if needed (20 gauge or smaller is recommenced; note that traversing large bowel is higher risk and prep and antibiotics may be considered). Thus, ultrasound is actually much safer for this type of biopsy than CT, which would be very challenging in this case.
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