骨盤内Castleman diseaseの1例

Abstract

36歳男性.患者は発熱が続き近医でCRP高値を指摘されたがNSAID投与で軽快したため放置していた.しかし今回, 38℃以上の不明熱の持続で著者らの施設へ受診となった.所見では, 左下腹部に表面平滑, 弾性硬, 可動性ある腫瘤を触知し, CTでは小骨盤左壁腹側に66×42mmの境界明瞭, 辺縁平滑な腫瘤を認めた.また, 造影CTでは均一な軽度の造影効果を認め, MRIでは内部はT1強調像で筋肉と等信号, T2強調像で高信号を呈し, 腫瘤の周囲に1～2cmのリンパ節の多発を認めた.更にMRアンギオグラフィーでは栄養動脈は左内腸骨動脈であり, 動脈相から濃染する充実性腫瘤と考えられ, 骨盤内腫瘍摘除術を施行することとなった.その結果, 病理所見で摘除組織は腫大したリンパ節で, 内部に大小不規則なリンパ濾胞の過形成と, 濾胞間に形質細胞の著明な浸潤を認め, Castleman diseaseのplasma cell typeと診断した.術後1年経過現在, 再発は認められていない

Although Castleman disease may occur in any lymph node of the body, it is the most commonly found in the thoracic cavity. Castleman disease rarely occurs in the pelvic cavity and only 8 such cases have been reported previously in Japan. In this report, we describe a case of Castleman disease in the pelvic cavity. A 36-year-old man complained of fever. Both serum c-reactive protein (CRP) and serum interleukin-6 (IL-6) were elevated. Computed tomography and magnetic resonance imaging showed a solid mass with calcification in the pelvic cavity. The pelvic mass was surgically excised. The removed mass was solid and 75 x 45 x 30 mm in size. The histological diagnosis was the plasma cell type of Castleman disease. Fever subsided and both serum CRP and serum IL-6 were normalized after the operation. No evidence of disease was detected one year post operation.