Mesenteric Vessel-Preserving Laparoscopic Surgery for Pediatric Unicentric Castleman Disease in the Transverse Mesocolon.

INTRODUCTION: Castleman's disease is a rare lymphoproliferative disorder. Unicentric Castleman disease (UCD) is usually benign and can be treated by complete resection. We herein report a pediatric case of UCD that occurred in the transverse mesocolon and was successfully treated with a laparoscopic approach.

CASE PRESENTATION: The patient was a 10-year-old girl at the time of the surgery. She was referred to our hospital with a persistent fever of unknown origin and high C-reactive protein levels. Abdominal enhanced MRI showed a 38 × 25-mm enhanced mass in the left transverse mesocolon, and fluorodeoxyglucose PET-CT showed an abnormal accumulation in the same lesion. UCD was the most suspected diagnosis, and laparoscopic tumor resection was planned and performed. The tumor was adjacent to the inferior mesenteric vein and the left branch of the middle colic artery. There was no evidence of vascular invasion into these vessels. The feeding arteries and drainage veins were securely clipped and cut using an ultrasonic harmonic scalpel. Further dissection revealed swollen bead-like lymph nodes connected to the tumor. After all swollen lymph nodes and the tumor were isolated, they were completely resected en bloc. Colectomy was unnecessary because the main mesenteric vessels were preserved. The histopathological diagnosis was hyaline vascular-type Castleman disease. Her symptoms, such as the fever, disappeared soon after surgery. The patient was discharged on day 9 without any complications. The C-reactive protein level dropped within the normal range 2 weeks after surgery. There was no evidence of recurrence or symptoms 3 years after surgery.

CONCLUSIONS: We encountered a rare case of pediatric UCD. Although only limited cases of the laparoscopic approach for pediatric UCD have been reported, we believe that the laparoscopic approach is useful for UCD in children.