Abstract
A 32-year-old man had been found to have elevated levels of C reactive protein (CRP) at a medical examination severed years previously. Blood examination in our hospital also showed elevation of CRP (7.95mg/dl) and hypergammaglobulinemia (2,200mg/dl). Abdominal CT scan demonstrated a well circumscribed tumor measuring 3.7 × 3.4 cm located in the hepato-duodenal ligament. The tumor showed a relatively hypointense signal similar to that of muscle on T1-weighted MR image, and enhanced to the same extent as the liver. Endoscopic ultrasonography (EUS) suggested that the tumor originated in the duodenal proper muscle and had grown to the extra-duodenal lumen. From these findings, duodenal gastro-intestinal stromal tumor (GIST) was suspected and laparotomy was performed. An isolated, elastic soft tumor measuring 5.5 × 4.5 × 3.0 cm was revealed in the hepato-duodenal ligament. Because intraoperative rapid pathological examination suggested malignant lymphoma, only the tumor was excised. The histopathological diagnosis was hyaline vascular type Castleman's disease. The patient shows no signs of recurrence as of 1 year 3 months postoperatively. We report here the first case of Castleman's disease arising in the hepato-duodenal ligament.
