Breakthrough in Castleman Disease by TMU Hospital team published in Gastroenterology, a renowned journal

Source: Taipei Medical University Hospital

Published on 2020-08-10

Do not ignore persistent constipation.

A young woman experiencing constipation for 6 months had tried home remedies without success. The right side of her stomach became distended, so she sought treatment at the Taipei Medical University Hospital.

Examination showed that the patient had a tumor in her abdominal cavity. Its compression on the gastrointestinal tract resulted in the constipation. After surgical removal, biopsy indicated that the tumor was a rare unicentric lymphoproliferative disease (aka. Castleman Disease). Doctors remind that with busy modern life, it is easy to ignore constipation and irregular bowel movements, and as a result, neglect the warning signs of tumors.

Castleman Disease is a benign tumor. It is a benign proliferative disease of lymphoid tissues. 67% of them are found in the mediastinum, and others are found in the neck, abdomen, pelvic cavity or underarms. The abovementioned patient is the first case seen by Taipei Medical University Hospital in the last decade. After surgical removal of the tumor, the patient recovered well. Outpatient follow-up showed no recurrence, indicating surgical removal as the main method of treatment. Prognosis is better with early diagnosis compared to other retroperitoneal malignant tumors. This case study was an interdisciplinary team cooperation between the Division of General Surgery (clinical) and the Division of Colorectal Surgery (research). Their paper was accepted by the renowned journal, Gastroenterology.

TMU Team. Dr. Yan-Jiun Huang (left), Division of Colorectal Surgery and Dr. Wen-Ke Wang (left), Director of Breast Surgery and Division of Gastroenterological Surgery.

This 20-year-old woman was in good health with no related medical history. Experiencing constipation for about half a year, she tried drinking more water and eating more fruits and vegetables. However, her condition failed to improve. About 3 months prior to seeking treatment, the right side of her stomach became distended. After eating, she sometimes felt bloated, which was relieved by walking. The patient did not experience symptoms associated with general gastrointestinal diseases, such as vomiting and weight loss. Lab results from the patient’s blood were normal. However, computer tomography showed a tumor in her posterior abdominal cavity. The tumor was pressing on her gastrointestinal tract, resulting in the constipation. After the tumor was surgically removed, both her constipation and abdominal distension were relieved.

 Did you know?

Many people have experienced constipation and uncomfortable bowel movements, but clinically, most seek medical treatment only when they have their fecal occult blood tested positive. Moreover, most people are worried about intestinal diseases such as colorectal cancer, and may overlook the possibility of tumor outside the intestine. As with this case example of Castleman Disease, tumors can be divided into localized type and multiple type lymphatic proliferation. The former usually shows no obvious symptoms and no obvious signs in blood tests. Clinically, a combination of detailed medical history and imaging is needed to determine the exact diagnosis. The latter may show symptoms of excessive sweating, fever, weight loss, nausea and vomiting. With surgical removal, most localized type patients can recover their health. The prognosis for the multiple type is poorer, and carries the risk of developing cancer.

Castleman Disease is often discovered in routine chest X-rays. If a posterior abdominal cavity mass is found in young patients, Castleman Disease should also be regarded as a possible diagnosis. In terms of treatment and prognosis, the localized type is a self-limiting disease and prognosis is good. Only surgical removal is needed. The systemic symptoms will disappear immediately after surgery and rarely recur. Therefore those with long-term constipation, abdominal distension or abnormal weight changes should immediately seek medical attention to rule out the risk of tumor.

Legend. Physical examination showed a palpable abdominal mass and a normal laboratory data. Abdominal computed tomography (Figure A, B, red arrows) revealed a large, encapsulated and hypervascular space-occupying lesion with cystic component in right lower quadrant of abdomen (7.6 × 5.0 cm in size).

This article is simultaneously available on QS WOWNews.

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