Abstract

Castleman disease is a rare, benign lymphoproliferative disorder that often poses a diagnostic dilemma due to its clinical and radiological resemblance to lymphoma. We report a case of unicentric Castleman disease of the cervical lymph node in a young patient, emphasizing the importance of histopathological examination and immunohistochemistry in establishing a definitive diagnosis. The patient presented with a long-standing, painless cervical lymphadenopathy without constitutional symptoms. Radiological evaluation revealed an isolated enlarged lymph node, raising suspicion of a neoplastic lymphoid disorder. Fine needle aspiration cytology showed a polymorphous lymphoid population but was inconclusive. Excision biopsy demonstrated partial effacement of nodal architecture with numerous small regressed germinal centers surrounded by concentric layers of mantle zone lymphocytes, imparting an “onion-skin” appearance. Prominent hyalinized blood vessels penetrating the follicles were noted, forming characteristic “lollipop” lesions. Interfollicular areas showed increased vascularity without sheets of plasma cells. On immunohistochemistry, lymphoid follicles were highlighted by CD20, interfollicular T cells were CD3 positive, BCL2 showed positivity in mantle zone lymphocytes, CD5 showed focal interfollicular positivity, and Cyclin D1 was negative, effectively excluding mantle cell lymphoma. A final diagnosis of unicentric Castleman disease, hyaline vascular type, was rendered. The patient underwent complete surgical excision with no recurrence on follow-up. This case underscores the importance of considering Castleman disease in the differential diagnosis of isolated cervical lymphadenopathy and highlights the pivotal role of histomorphology and immunohistochemistry in avoiding misdiagnosis and overtreatment.

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