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Presented by Fred Askin, M.D. and prepared by Kara Judson, M.D.
Case 1: Twenty-nine year old woman who underwent exploratory surgery because of a radiographically demonstrated kidney mass.
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Question 1 of 1
1. Question
Week 233: Case 1
Twenty-nine year old woman who underwent exploratory surgery because of a radiographically demonstrated kidney mass. At the time of the operation, an incidental mesenteric mass was discovered.
Correct
Answer: Castleman’s disease, Hyaline-Vascular type
Histology: none provided
Discussion: Castleman’s Disease is an unusual and morphologically distinct form of lymphoid hyperplasia. Based on microscopy, two major forms have been described. The first, and that seen here, is the hyaline-vascular type which shows large follicles scattered in a mass of lymphoid tissue. The follicles have a broad mantle zone with an “onion-skin pattern” that surrounds relatively small germinal centers. These germinal centers contain hyalinized vessels which may produce a characteristic “lollipop” appearance. The second morphologic category of Castleman’s Disease is the plasma cell type, and is characterized by diffuse plasma cell proliferation in interfollicular tissue. Hyaline-vascular changes in the follicles in the plasma cell variant are inconspicuous but there is often a deposition of amorphous pink material in the center of the follicles. The rare multicentric or systemic form of Castleman’s Disease is nearly always the plasma-cell type.
Incorrect
Answer: Castleman’s disease, Hyaline-Vascular type
Histology: none provided
Discussion: Castleman’s Disease is an unusual and morphologically distinct form of lymphoid hyperplasia. Based on microscopy, two major forms have been described. The first, and that seen here, is the hyaline-vascular type which shows large follicles scattered in a mass of lymphoid tissue. The follicles have a broad mantle zone with an “onion-skin pattern” that surrounds relatively small germinal centers. These germinal centers contain hyalinized vessels which may produce a characteristic “lollipop” appearance. The second morphologic category of Castleman’s Disease is the plasma cell type, and is characterized by diffuse plasma cell proliferation in interfollicular tissue. Hyaline-vascular changes in the follicles in the plasma cell variant are inconspicuous but there is often a deposition of amorphous pink material in the center of the follicles. The rare multicentric or systemic form of Castleman’s Disease is nearly always the plasma-cell type.
