Complete anemia reversal after surgical excision of mesenteric hyaline-vascular unicentric Castleman disease.

An asymptomatic 29-year-old woman, with a long-term history of mild anemia, was referred to our hospital for evaluation. She was pale and asthenic. Except for anemia, her past medical and surgical history was unremarkable. There was no history of spoliation, and we noted no coagulopathy, type-B symptoms or systemic disease. Results of a complete physical examination were normal. The abdomen was soft with no palpable mass. Laboratory test results showed a decrease in hemoglobin (86 g/L) and mean corpuscular volume (69.9 fL) with thrombocytosis (716 × 109/L). We might have diagnosed iron-deficiency anemia as the patient’s blood iron (2.5 μmol/L) and serum transferrin saturation percentage (0.04) had also decreased, but total iron binding capacity (66.5 μmol/L) and ferritin levels (49 pmol/L) were normal. The erythrocyte sedimentation rate was elevated (116 mm/h), as was C-reactive protein (775.2 nmol/L), accompanied by a mild hypoalbulinemia (34 mmol/L), suggesting a possible inflammatory anemia. Renal and hepatic functions were normal. Abdominopelvic ultrasound followed by a computed tomography (CT) scan (Fig. 1) revealed a unique mesenteric, noncalcified contrast-enhancing mass near the jejunum with peripheral vascularity and 3 mesenteric lymph nodes varying from 8 to 12 mm. The mass was capsulated, nonmobile and directly adjacent to mesenteric vessels. We performed surgical excision by laparotomy. Macroscopic examination revealed a 4.7 × 4.0 × 2.7 cm tumour weighing 27.5 g. The tumour showed lymphoid follicular hyperplasia, fibrotic areas and numerous plasmocytes. Some follicules were surrounded by a lymphocyte crown with a concentric onion-skin appearance, and there was a lymphoplasmocytic infiltrate with hyaline material between lymphoid nodules (Fig. 2). Immunochemistry analysis showed κ and λ light chains in normal ratios with germinal centres positive for CD20, CD21, CD23, Bcl6 and Ki-67, and negative for Bcl2. The interfollicular spaces were reactive in particular to CD3, CD5, CD20 and Bcl2. These results were compatible with a diagnosis of angiofollicular hyperplasia or unicentric Castleman disease. The patient was discharged on the fifth postoperative day after an uncomplicated postsurgical recovery. Her symptoms of inflammatory anemia Jimmy Bejjani* Bernard Lemieux, MD† Gilles Gariepy, MD‡ Rami Younan, MD*