Diagnosis and Surgical Management of Lymphoproliferative Unicentric Castleman Disease

Castleman Disease (CD) describes a group of complex lymphoproliferative disorders that share common histopathological features. Classification largely centers around the number of affected lymph nodes and the presence or absence of Human Herpesvirus 8 (HHV-8). Unicentric CD (UCD) is estimated to make up 40% of all CD cases with the remaining 60% being multicentric CD (MCD), involving several regions of the body and increasing concern for HHV-8 involvement. While UCD is often discovered through incidental imaging or routine examination, swift confirmation via pathological diagnostics can often lead to a cure through simple resection. Presented here is the case of a 69-year-old asymptomatic male with a known thoracic aortic aneurysm. The patient underwent a routine one-year follow-up computed tomography (CT) scan to evaluate aneurysmal growth which unexpectedly revealed a single incidental enlarged lymph node in the right axilla. A high suspicion for malignancy warranted excision and pathological evaluation yielded a diagnosis of hyaline vascular UCD. As this diagnosis is frequently asymptomatic at the time of diagnosis, UCD should be suspected in any patient with a persistently enlarged lymph node or nodes in a single region.