CASTLEMAN LYMPHADENOPATHY MIXED HYALINE VASCULAR

AND PLASMA CELL VARIANT OF MESENTERIUM

Indah Yati, Aspitriani, Krisna Murti

1
Department of Anatomical Pathology Faculty of Medicine, Sriwijaya University,
Palembang, Indonesia

Abstract

Background: Castleman’s disease (CD) is a rare lymphoproliferative disorder that now

bears his name, also known as angiofollicular or giant lymph node hyperplasia. It usually
appears in young adult and rarely occurs in chillhood and even rarer in infants and toodler. The
disease can be localized or generalized, lymphoproliferative disorder with a frequent
mediastinal location, but possible in any lymph node or extra nodal site.
Case description : A 10 year old female patient, admitted to RSMH Palembang presented
with a mesenterium mass lymph node. Macroscopic appearance reveal smooth to rough two
masses measuring 2,5x1x1 cm and 1x1x0,5 cm. Cut section shows a solid, white and
encapsulated nodules. Microscopic examination demonstrates lymp nodes with thick
fibrocollagen capsule, many lymphoid follicles are atrophy and spread throughout the cortex
and medula. Sclerotic blood vessels penetrate the germinal centers forming hyaline vascular
lesions similar to “lollipop lesion”. Some foci of residual germinal center contain pink
cytoplasmic material, also present in larger germinal center. Some of the follicles are
surrounded by a broad mantle zone composed of concentric rings of small lymphocytes like
“onion skin”. Interfolicular stroma areas are infiltrated by numerous plasma cells.
Immunohistochemical staining using CD 138 highlights plasma cells and BCl2 demarcates the
mantle zones.
Discussion and conclusion: This case shows accumulated immunoglobulin like pink material,
but staining for immunoglobulin was not performed. Based on histopathologic features and
immunohistochemical staining, we diagnosed this case as castleman lymphadenopathy myxed
hyaline vascular and plasma cell variant type with possible immunoglobulin related disease.

Keywords: castleman lymphadenopathy, mesenterium, immunoglobulin,

immunohistochemistry