گزارش یک مورد نادر از بیماری کاستلمن با تظاهر توده گردنی

ﻣﻘﺪﻣﻪ: ﻫﺎﯾﭙﺮﭘﻼزی آﻧﮋﯾﻮﻓﻮﻟﯿﮑﻮﻻر ﻟﻨﻒ ﻧﻮد (alnh) ﯾﺎ ﺑﯿﻤﺎری ﮐﺎﺳﺘﻠﻤﻦ (cd) ﯾﮏ ﺑﯿﻤﺎری ﻟﻨﻔﻮﭘﺮوﻟﯿﻔﺮاﺗﯿﻮ ﻏﯿﺮ ﻧﺌﻮﭘﻼﺳﺘﯿﮏ ﺧﻮش ﺧﯿﻢ ﻧﺎﺷﺎﯾﻊ اﺳﺖ. اﯾﻦ ﺑﯿﻤﺎری ﻣﯽﺗﻮاﻧﺪ در ﻏﺎﻟﺐ ﯾﮏ ﺗﻮده ﻟﻮﮐﺎﻟﯿﺰه ﺗﻈﺎﻫﺮ ﮐﻨﺪ. در اﯾﻦ ﻣﻘﺎﻟﻪ ﻣﻮرد ﻧﺎدری از ﺑﯿﻤﺎری ﮐﺎﺳﺘﻠﻤﻦ در ﯾﮏ ﺧﺎﻧﻢ 34 ﺳﺎﻟﻪ ﮐﻪ ﺑﺎ ﯾﮏ ﺗﻮده ﮔﺮدﻧﯽ ﻣﺮاﺟﻌﻪ ﮐﺮده اﺳﺖ ﻣﻌﺮﻓﯽ ﺷﺪه اﺳﺖ. ﮔﺰارش ﻣﻮرد: ﺧﺎﻧﻢ 34 ﺳﺎﻟﻪ در ﺗﯿﺮ ﻣﺎه ﺳﺎل 1397 ﺑﺎ ﺷﮑﺎﯾﺖ ﺗﻮده ﮔﺮدن ﮐﻪ از ﻫﻔﺖ ﺳﺎل ﻗﺒﻞ اﯾﺠﺎد ﺷﺪه ﺑﻮد و از ﺣﺪود ده روز ﻗﺒﻞ از ﻣﺮاﺟﻌﻪ دﭼﺎر درد ﺷﺪه ﺑﻮد ﺑﻪ درﻣﺎﻧﮕﺎه درد ﻣﺮاﺟﻌﻪ ﮐﺮد. ﺳﭙﺲ ﺑﻪ درﻣﺎﻧﮕﺎه ﺟﺮاﺣﯽ ﻋﻤﻮﻣﯽ ارﺟﺎع ﺷﺪ. ارزﯾﺎﺑﯽﻫﺎی ﭘﺎراﮐﻠﯿﻨﯿﮏ اوﻟﯿﻪ ﺷﺎﻣﻞ ﺳﻮﻧﻮﮔﺮاﻓﯽ و ct اﺳﮑﻦ ﮔﺮدن ﻧﺸﺎن دادﻧﺪ ﮐﻪ ﺗﻮده ﺑﺪﺧﯿﻢ ﻧﯿﺴﺖ. ﺑﻪ ﻋﻠﺖ ﻣﺤﻞ آﻧﺎﺗﻮﻣﯿﮏ ﺧﻄﺮﻧﺎک ﺗﻮده، ﺟﺮاﺣﯽ اﻧﺠﺎم ﻧﺸﺪ. ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﯾﻨﮑﻪ در ﻃﻮل ﯾﮑﺴﺎل اﺧﯿﺮ، ﺳﺎﯾﺰ ﺗﻮده اﻓﺰاﯾﺶ ﭘﯿﺪا ﮐﺮده و در ﻟﻤﺲ دردﻧﺎک ﺑﻮد، ﺑﯿﻤﺎر رﺿﺎﯾﺖ ﺑﻪ ﺟﺮاﺣﯽ داد. ﺑﯿﻤﺎر ﺷﺮح ﺣﺎﻟﯽ ﻣﺒﻨﯽ ﺑﺮ ﻋﻼﯾﻤﯽ ﺳﺮﺷﺘﯽ ﻃﯽ ﻫﻔﺖ ﺳﺎل ﮔﺬﺷﺘﻪ ﻧﻤﯽداد. در ﻣﻌﺎﯾﻨﻪ ﻓﯿﺰﯾﮑﯽ ﯾﮏ ﺗﻮده 2,5 ﺳﺎﻧﺘﯽ ﻣﺘﺮ ﺣﺴﺎس و ﻣﺘﻮرم ﮐﻪ ﺑﻪ ﻋﻀﻠﻪ اﺳﺘﺮﻧﻮﮐﻠﻮﯾﯿﺪوﻣﺎﺳﺘﻮﺋﯿﺪ ﭼﭗ ﭼﺴﺒﻨﺪﮔﯽ داﺷﺖ ﻟﻤﺲ ﻣﯽﺷﺪ. آزﻣﺎﯾﺸﺎت اوﻟﯿﻪ ﺷﺎﻣﻞ ﺷﻤﺎرش ﺳﻠﻮلﻫﺎی ﺧﻮﻧﯽ ﻧﺮﻣﺎل ﺑﻮدﻧﺪ. ﺑﺮای ﺑﯿﻤﺎر ﻣﺠﺪداً ct اﺳﮑﻦ و ﺳﻮﻧﻮﮔﺮاﻓﯽ درﺧﻮاﺳﺖ ﺷﺪ. در ﺳﻮﻧﻮﮔﺮاﻓﯽ ﺗﻮده ﻫﻤﻮژن ﻫﯿﭙﻮاﮐﻮ ﺑﻪ اﺑﻌﺎد 60*27*40 ﻣﯿﻠﯽ ﻣﺘﺮ در ﻣﺜﻠﺚ ﺧﻠﻔﯽ ﭼﭗ ﮔﺮدن ﮔﺰارش ﺷﺪ. ﯾﺎﻓﺘﻪ ct اﺳﮑﻦ ﺷﺎﻣﻞ ﯾﮏ ﺗﻮده ﻫﻤﻮژن ﺑﯿﻀﯽ ﺷﮑﻞ و اﯾﺰودﻧﺲ ﺑﺎ ﻋﻀﻠﻪ اﺳﺘﺮﻧﻮﮐﻠﻮﯾﯿﺪوﻣﺎﺳﺘﻮﺋﯿﺪ ﭼﭗ ﺑﺎ ﺣﺎﺷﯿﻪ ﻣﺸﺨﺺ ﺑﻪ اﺑﻌﺎد 60*30*42 ﻣﯿﻠﯽ ﻣﺘﺮ ﺑﻮد. ﺗﺸﺨﯿﺺ اﻓﺘﺮاﻗﯽﻫﺎی اوﻟﯿﻪ ﺷﺎﻣﻞ ﺷﻮاﻧﻮم، ﻟﻨﻔﻮم و ﻟﻨﻔﺎدﻧﻮﭘﺎﺗﯽ واﮐﻨﺸﯽ ﺑﻮد. ﺑﯿﻤﺎر ﺑﺎ ﻣﻮﻓﻘﯿﺖ ﺗﺤﺖ ﻋﻤﻞ ﺟﺮاﺣﯽ ﻗﺮار ﮔﺮﻓﺖ.ﻧﺘﯿﺠﻪﮔﯿﺮی: ﺑﯿﻤﺎری ﮐﺎﺳﺘﻠﻤﻦ ﯾﮑﯽ از ﺗﺸﺨﯿﺺ اﻓﺘﺮاﻗﯽﻫﺎی ﻣﻬﻢ ﺗﻮده ﮔﺮدﻧﯽ اﺳﺖ. ﯾﺎﻓﺘﻪﻫﺎی ﻫﯿﺴﺘﻮﭘﺎﺗﻮﻟﻮژﯾﮏ ﺟﻬﺖ رﺳﯿﺪن ﺑﻪ ﺗﺸﺨﯿﺺ ﻗﻄﻌﯽ ﻧﯿﺎز اﺳﺖ. ﺑﺮﺧﯽ از اﻧﻮاع اﯾﻦ ﺑﯿﻤﺎری ﺑﺎ ﺑﺪﺧﯿﻤﯽﻫﺎﯾﯽ ﻧﻈﯿﺮ ﻟﻨﻔﻮم ﻧﺎن ﻫﻮﭼﮑﯿﻦ و ﺳﺎرﮐﻮم ﮐﺎﭘﻮﺳﯽ ﻣﺮﺗﺒﻂ ﻫﺴﺘﻨﺪ.

A Rare Case of Pheochromocytoma Presenting as Cervical Mass

Introduction: Angiofollicular lymph node hyperplasia (ALNH) or Castleman rsquo;s disease (CD) is an unusual benign nonneoplastic lymphoproliferative disease. CD can present as a localised mass. In this paper a rare case of Castleman rsquo;s disease in a 34 years old woman with a cervical mass is presented. Case Presentation: A 34 yearsold woman presented in July 2018 with a painful mass neck that was appeared in 2010 referred to pain clinic because of painful cervical mass. She presented to a general surgeon. Primary par clinic assessments such as ultrasound and CT scan revealed that the mass is not cancerous and surgery is dangerous because the sites of the mass. During the last year size of the mass increased rapidly and, patient decided to get rid of the mass because of pain and bad view in her neck. She had no associated symptoms with the mass such as weight loss, fever, excessive sweating during 7 years ago. On physical examination we found a 2/5 cm tendered bulged mass which was stacked to left sternocleidomastoid muscle. The routine laboratory tests was normal. Patient underwent ultrasound and CT scan again. Ultrasound demonstrated a 60mm*27mm*40 mm well defined homogenous hypo echoic mass in left posterior cervical triangle. The CTScan demonstrated a 60mm*30mm *42 mm well defined homogenous oval mass isodense to sternocleidomastoid muscle in left posterior cervical triangle. Differential diagnosis was posterior cervical schwanoma, carotid body tumor, lymphoma and reactive lymphadenopathy. Patient underwent surgery successfully. The pathology report demonstrated the diagnosis is Castleman rsquo;s disease. Conclusions: Castleman rsquo; disease is one of the differential diagnoses of masses in the neck. Histopathlogically findings is needed to achieving a definitive diagnosis. Some types of CD are associated with malignancies such as nonhodgkin lymphoma, Kaposi rsquo;s sarcoma, follicular dendritic cell sarcoma, or carcinoma.