Abstract
A 39-year-old man was referred to our department because of gastric submucosal tumor during a health screening. Abdominal enhanced computed tomography revealed two well-defined and hyper-vascular tumors dorsal to the duodenal bulb, and they did not have the continuity to the stomach and the duodenum. Magnetic resonance imaging confirmed both tumors were isointense to spleen on the T1-weighted image, and were slightly hyperintense to the spleen on the T2-weighted image. We suspected Castlemanʼs disease, gastrointestinal stromal tumor, neuroendocrine tumor, or malignant lymphoma. Since we could not rule out the possibility of malignancies, laparoscopic surgery was performed to obtain a definite diagnosis and perform adequate treatment. These tumors were located in the gastrocolic ligament near the duodenal bulb, and were resected safely with ultrasonically activated coagulating shears. The histopathological diagnosis was unicentric Castleman’s disease of hyaline vascular type. Castleman’s disease is difficult to differentiate accurately from other solid tumors, because it does not have specific clinical signs and imaging findings. In the intra-abdominal tumor which does not exhibit an obvious malignancy like this disease, laparoscopic surgery is useful for diagnostic treatment because of its minimal invasiveness.
