Oral Lichen Planus-Like Lesions With Castleman Disease

A 22-year-old male patient presented with "whitening and ulceration of the buccal and tongue mucosa accompanied by pain for over one month." Since conventional medication (particularly glucocorticoids) showed limited efficacy, further histopathological examination and CT scans were performed, revealing an occult tumor. A biopsy was performed on the right buccal mucosa. Histopathological examination combined with clinical presentation, were consistent with a diagnosis of oral lichen planus. Chest CT revealed a vertically oriented soft tissue mass measuring approximately 56mm × 30mm × 89mm. The paravertebral mass was resected, with histopathology confirming mixed-type Castleman disease. Following six months of systemic medication and topical therapy, the oral erosions completely healed. No new lesions were observed during one year of post-treatment follow-up. 1.Multidisciplinary Collaboration to Identify Underlying Etiology For patients presenting with extensive oral erosions and white striae unresponsive to conventional therapy, thoracoabdominopelvic CT should be performed to screen for occult neoplasms. 2.Timely Treatment Adjustment & Elimination of Triggering Factors After definitive diagnosis, primary tumor resection (if present) should be prioritized, supplemented with topical oral medications. If oral lesions persist post-tumor resection, systemic pharmacotherapy (e.g., immunomodulators) should be initiated. The occurrence of oral mucosal diseases is closely linked to systemic health conditions. As oral medicine specialists managing mucosal disorders, we play a critical role in the early detection, diagnosis, and treatment of such systemic diseases. Enhancing clinical awareness and diagnostic expertise will ultimately improve patient outcomes.