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• W2016083967 abstract "Question: A 61-year-old woman was referred for acid reflux, recurrent distention, and pain in the upper abdomen. She had a past history of cholecystolithiasis and laparoscopic cholecystectomy 3 years ago. Physical examination revealed no palpable superficial lymph node. Her abdomen was soft and nontender without abnormal mass. Gastroduodenoscopy demonstrated a subepithelial mass with intact overlying mucosa in the gastric fundus (Figure A). Endoscopic ultrasonography revealed a 14-mm, homogenous, and hypoechoic oval lesion in the muscular layer (Figure B). The mass was resected completely by endoscopic full-thickness resection, and the defect was securely clamped (Figure C). The tumor tissue was processed for pathologic examination, and histology is displayed in Figure D–F. What is your diagnosis of this gastric submucosal tumor? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Histology of the tumor revealed features of Castleman's disease (CD). Some lymphoid follicles showed features of hyaline vascular variant (HV) CD, presenting a ring-like accumulation of small lymphocytes that surround a regressive germinal center (Figure E), with vascularization (Figure G) and concentric follicular dendritic cell processes (Figure H). Infiltration of plasma cells were also noted in the interfollicular region (Figure F, I), indicating plasma cell variant (PV) CD. Therefore, the patient was diagnosed as mixed variant (MV) CD of the stomach. She recovered well postoperatively. Computed tomography of the chest and abdomen confirmed no lymph node enlargement. She was discharged without systemic chemotherapy. CD is a rare, non-neoplastic, lymphoproliferative disorder that exhibits as HV, PV, or MV histologically.1Cronin D.M. Warnke R.A. Castleman disease: an update on classification and the spectrum of associated lesions.Adv Anat Pathol. 2009; 16: 236-246Crossref PubMed Scopus (236) Google Scholar HV is usually unicentric, curable, and asymptomatic with a favorable prognosis. PV is more commonly multicentric, unresectable, and requires systemic therapy to reduce the risk of malignant progression.2Dispenzieri A. Armitage J.O. Loe M.J. et al.The clinical spectrum of Castleman's disease.Am J Hematol. 2012; 87: 997-1002Crossref PubMed Scopus (160) Google Scholar MV is considered to be a transitional type between HV and PV. MV could be unicentric or multicentric. Therapy for MV may differ according to the clinical manifestations.3Madan R. Chen J.H. Trotman-Dickenson B. et al.The spectrum of Castleman's disease: mimics, radiologic pathologic correlation and role of imaging in patient management.Eur J Radiol. 2012; 81: 123-131Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar This case is noteworthy because MV of the gastrointestinal tract is extremely rare. Only 8 cases of gastrointestinal CD have been reported: 5 in the stomach, 2 in the duodenum, and 1 in the colon. To our knowledge, all of the stomach CD cases are HV, but the present case is the first documented gastric MV. This case highlights that CD should be considered in differential diagnosis of submucosal tumors of the stomach. Bin Wang and Jun Wang contributed equally to this work. Pathology review and images provided by Prof Hualiang Xiao, MD, PhD, Director, Department of Pathology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China." @default.
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• W2016083967 date "2013-04-01" @default.
• W2016083967 modified "2023-10-16" @default.
• W2016083967 title "A Rare Submucosal Tumor of the Stomach" @default.
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• W2016083967 doi "https://doi.org/10.1053/j.gastro.2012.11.028" @default.
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