Castleman's disease. A case report

Angiofollicular lymph node hyperplasia or Castleman's Disease (CD) is a rare lymphoproliferative disorder that manifests itself as a local or generalized tumor-like condition affecting both lymph nodes and non-nodal tissues, usually in the chest and abdomen. Hyaline vascular and plasma cell types have been identified histologically. A new clinical form of CD with multisystemic involvement has been defined as multicentric Castleman's disease. It is very rare in childhood. In this paper we present an eight-year-old boy with multicentric Castleman's disease.     

Fahr's disease and hypocalcemic syndromes. Presentation of a clinical case]

A clinical case of a man with calcification of basal ganglions (CBG) is presented. The first manifestations of this syndrome were loss of consciousness and convulsions. The potential causes of his hypocalcemia, Fahr's syndrome, myocardiopathy of hypoparathyroidism and hypocalcemia are reviewed and a study oriented to autoimmune polyendocrinopathy is performed.     

Retroperitoneal ganglioneuroma. Report of a case

OBJECTIVE: To report an additional case of retroperitoneal ganglioneuroma. METHODS/RESULTS: A case of retroperitoneal ganglioneuroma that had been incidentally discovered in a 27-year-old male during abdominal US evaluation is described. The diagnosis was based on the histopathological findings after US-guided biopsy. The clinical features and the findings of the complementary tests, which included radiological assessment, intravenous urography, CT and cavography are presented, as well as the pathology findings. Treatment was by complete surgical excision of the tumor. CONCLUSION: Treatment of ganglioneuroma is by surgery, since the diagnosis is generally based on the histopathological analysis of the surgical specimen. For those cases with a preoperative diagnosis, some authors advocate surgery for patients with clinical evidence of neuroblastoma or another pathology arising from this disease. Although infrequent, ganglioneuroma coexisting with neuroblastoma can occur. For this reason, complete excision of the tumor is preferred.     

Sinus aspergillosis after an endodontic treatment. Presentation of a clinical case

Aspergillosis is an opportunistic deep mycosis that occurs in immunocompromised patients, often in the paranasal sinuses. However, it sometimes occurs in healthy subjects, producing symptoms similar to those of a chronic sinusitis that is unresponsive to conventional treatment. A possible entry point for Aspergillus is the oroantral communication originated by perforation of the dental root cavity during root canal of a molar with penetration of material. We report the clinical case of a patient with symptoms of chronic sinusitis who was diagnosed as sinus aspergillosis after radiological and histological study. The origin may have been a third upper molar in which a root canal was performed.     

Rendu-Osler-Weber disease. Report of a clinical case

Rendu-Osler-Weber disease is an hereditary disorder characterized by cutaneo-mucous telangiectasis and vascular abnormalities in several organs. Bleeding, especially epistaxis, represents the most important clinical feature. Pulmonary arteriovenous fistulae can cause hypoxaemia, haemoptysis, polycythaemia and clubbing. Diagnosis is based on family and personal history, teleangiectasis, laboratory (haemochrome, fibrinogen, PT, PTT) and instrumental findings (endoscopy and/or roentgen). Therapy depends on symptoms. Embolization of pulmonary arteriovenous fistulae and laser treatment of intestinal vascular abnormalities have been successful. Danazol treatment yielded controversial results. We report the case of a patient admitted for arterial hypertension and recurrent epistaxis. Rendu-Osler-Weber disease diagnosis was made based on positivity at family and personal history, clinical examination, laboratory and instrumental findings. In conclusion we underline the pivotal role of anamnesis and clinical examination in the differential diagnosis of hereditary bleeding disorders and emphasize the importance of early diagnosis for the correct therapeutic approach.     

Nasopharyngeal Castleman's disease

A 19-year-old male was admitted to our clinic because of nasal obstruction and intermittent postnasal drip of 3 to 4 years' duration. Physical examination revealed a wide-based, smooth-surfaced nasopharyngeal tumor which was suspected to be a nasopharyngeal angiofibroma after examination of computed tomographic scans and an angiogram. However, after the tumor was removed by surgical excision via a transpalatal approach, the pathologic examination revealed Castleman's disease of the hyaline-vascular type. There was neither evidence of recurrence nor nasal problems at 4 years' follow-up. To our knowledge, Castleman's disease, or angiofollicular lymph node hyperplasia, may present as a local or generalized tumor-like condition, usually in the chest or abdomen, and may involve both the lymph nodes and non-nodal tissues. A review of previous articles reveals that there has not been any report of Castleman's disease found in the nasopharynx. This rare disorder is presented and discussed.     

Retroperitoneal schwannoma: report of a clinical case and review of the literature

The retroperitoneal localization of a schwannoma or neurilemmoma undoubtedly represents an unusual occurrence (0.5-0.7% of all sites); this data, together with the absence of a typical clinical picture and the lack of peculiar instrumental signs, make a preoperative diagnosis of this lesion really hard to ascertain. In this paper, on the basis of a case report successfully treated, the Authors review the literature analysing current diagnostic and therapeutic work up, mainly emphasizing controversies in determining a proper preoperative diagnosis among all retroperitoneal tumours.     

HIV infection and isosporiasis. Presentation of a case

Tear lactoferrin concentration was measured by ELISA technique and followed in 30 patients undergoing cataract surgery. On the first day following surgery, there was a significant decrease in tear lactoferrin concentration followed by a gradual return to the initial values during the postoperative observation period of 7 days. There was an inverse linear relationship between tear lactoferrin concentration and the tear secretion rate measured by a modified Schirmer I test (1 min) suggesting a constant lactoferrin secretion by the tear glands. Since lactoferrin has known antibacterial and anti-inflammatory effects, the results may contribute to further understanding of the microbial vulnerability or resistance of the eye following surgical procedures.     

Retroperitoneal malignant teratoma. A case report

Retroperitoneal teratomas are rare in adults. These tumours may be benign or malignant and are composed of multiple tissues foreign to the part in which they arise. We report a malignant teratoma of retroperitoneal space. In searching the literature, we have been able to find 39 cases reported since 1937. Of the forty cases reported (including this case), only ten (25%) were malignant.     

Rare origin of a retroperitoneal mass: Castleman's disease

Castleman's disease (angiofollicular hyperplasia of the lymphatic nodes) can exceptionally appear as a retroperitoneal mass of difficult differential diagnosis relative to other malignant retroperitoneal masses. Because of its rarity, one case report of a retroperitoneal mass with histologic study corresponding to Castleman's disease is contributed. A revision of the different histologic varieties of Castleman's disease, specific treatment and prognosis is included.     

Fibrillary glomerulonephritis in Castleman's disease

Castleman's disease is an uncommon lymph node disorder which can be associated with renal disease. In this report we describe a patient with fever, weight loss, anorexia, increase in inflammatory proteins, anemia and nephrotic syndrome. Castleman's disease, plasma cell type, was diagnosed by histologic analysis after surgical excision of a pelvic lymph node. The disease was considered localized, since further investigations did not show any other pathologic mass. After resection of the pelvic lymphoid mass, clinical remission of systemic symptoms and laboratory abnormalities was observed, with the exception of the nephrotic syndrome. Renal biopsy was performed and showed a pattern compatible with fibrillary glomerulonephritis. Progressive decline in renal function was observed, despite immunosuppressive therapy.     

Retroperitoneal abscess from odontogenic infection. Clinical case

The authors present a patient with a retroperitoneal abscess arising by hematogenous bacterial odontogenic spread. We describe the clinical approach and the surgical therapy.