Retroperitoneal Castleman's disease and ovarian torsion: A case report

Castleman's Disease (CD) is a rare lymphoproliferative disorder with diverse clinical manifestations. It is primarily characterized by painless lymph node enlargement, most commonly in the mediastinum, neck, retroperitoneum, axillary regions, and pelvis. A 12-year-old female was admitted to our hospital with persistent abdominal pain and vomiting that were not alleviated by initial treatments. Physical examination revealed tenderness in the right lower abdomen. Pelvic ultrasound revealed a mass in the pelvic region. Due to persistent pain, she underwent a laparoscopic exploration during which it was discovered that the right ovary was twisted 360°, and it was adjacent to the pelvic mass. It appeared that the mass was pushing the ovary, and this phenomenon could have been the cause of the torsion. The nature of the mass could not be conclusively determined during the intraoperative assessment, but a biopsy with a fine needle was obtained. Pathological examination was suggestive of a tumor related to the lymphatic system. She underwent a pelvic MRI that confirmed a round, soft tissue mass on the right side of the pelvis measuring approximately 63 × 50 × 56 mm. We did a subsequent laparoscopy and completely resected the mass. The patient recovered well and was discharged without complications. At 2 years of follow up she is in good health. The final pathology diagnosis of the mass was CD. CD is often asymptomatic, but symptoms can arise when the enlarged lymph nodes cause compression on surrounding organs.