Overview: Retroperitoneal giant lymph node hyperplasia
Retroperitoneal giant lymph node hyperplasia is a tumor-like hyperplasia-like lesion of lymph nodes that occurs in the retroperitoneum and is a benign lesion. Giant lymph node hyperplasia is also known as Castleman’s disease, vascular follicular lymphoid hyperplasia, giant lymphadenopathy, hemangiomatous lymphoid malformation, etc., which is relatively rare clinically. It can occur at any age, mostly in youth and middle age, with no significant difference in male and female ratio, and can be clinically classified into unicentric and multicentric types.
Etiology
The cause of the disease is not clear, but may be related to human immunodeficiency virus and human herpesvirus-8 infection.
Symptoms
1. Symptoms
Some patients may have compression symptoms caused by enlarged lymph nodes, such as nausea and vomiting caused by compression of the gastrointestinal tract; compression of the renal pelvis and ureter may cause pyelonephrosis and renal impairment; and compression of the common bile duct may cause jaundice. Systemic symptoms are rare, such as fever, night sweats, fatigue, loss of appetite, weight loss, etc., but they are not specific.
2. Signs and symptoms
The signs of this disease are rare, without abdominal pressure and rebound pain, only when the organs are compressed, the corresponding signs appear.
Examination
1. Laboratory examination
Blood sedimentation is accelerated, serum cold agglutinin test is positive.
2. Imaging examination
(1) Ultrasound: show the lesion is uniform low echo.
(2) CT: shows round and lobulated soft tissue mass with clear and smooth border and uniform density.
(3) MRI: shows that the lesion has low signal in T1-weighted imaging and high signal in T2-weighted imaging.
3. Pathologic examination
Most of them are unicentric type with significant proliferation of capillaries between the peritoneum and lymphoid follicles, many blood vessels in the follicles, hyaline changes, and some of them have blood abnormalities; a few of them are multicentric type with a large number of plasma cells between the follicles, and no obvious vascular proliferation.
Diagnosis
Unicentric type is not obvious in clinical symptoms, and laboratory tests are not specific, mainly through imaging and pathological examination for localization and qualitative diagnosis; if there is a retroperitoneal mass, systemic symptoms and blood abnormalities, it is considered as multicentric type. Abdominal CT has the highest localization value, which can understand the nature and location of the tumor and its adjacency to the surrounding organs, thus guiding the surgery, and the confirmation of the diagnosis mainly relies on the results of histopathological examination.
Treatment
1. Single-center type
Surgical resection is the mainstay, and the prognosis is good. If the tumor is closely adhered to important blood vessels or organs, accompanied by poor systemic condition, radiation therapy can be considered.
2. Multicenter type
The main treatment is systemic comprehensive treatment, if there is no clinical symptom, it can continue to observe, if there is symptom, the first chemotherapy, usually using CVP (cyclophosphamide, vincristine, prednisone) or CHOP (cyclophosphamide, adriamycin, vincristine, prednisone) chemotherapy regimen, hormone therapy can also be used.