Localized early mesenteric Castleman's disease presenting as recurrent intestinal obstruction: a case report

Primary neoplasms of the mesentery are very rare. They are usually of mesenchymal origin and include desmoid tumor, lipoma, liposarcoma, and fibrosarcoma. Metastatic carcinomas and lymphoma are more common. We report a rare case of localized mesenteric Castleman's disease, presenting as intestinal obstruction. Clinical and radiological findings were suspicious for lymphoma. Localized mesenteric Castleman's disease, though rare, has to be considered in the differential diagnosis of mesenteric tumors, particularly in the young and in the absence of history for other tumor, an abnormal blood picture, or splenomegaly.A thirty-three year old female presented with recurrent symptoms of small intestinal obstruction of chronic onset and progressive course. The patient's medical history was non contributory. Her blood picture was unremarkable. CT scan showed intussusception associated with multiple mesenteric lymphadenopathies, measuring 1.8 cm in maximum dimension. Mediastinal lymphadenopathy and organomegaly were absent. The clinical impression was suspicious for lymphoma.Laporotomy was performed which showed increased caliber and thickening of the small intestinal loops, particularly at the ileum over an area of about 90-100 cm. In addition, several enlarged mesenteric lymph nodes were present. An excisional biopsy from the nodes and a full thickness wedge excision from the abnormal area in the ileum were performed.A piece of adipose tissue containing two lymph nodes measuring 2.1 × 1.5 × 1 cm and 1 × 1 × 1 cm and a small intestinal wedge measuring 4.5 cm long are received fresh. The lymph nodes are submitted according to the lymphoma protocol in our institute. Two touch preparations are prepared from the cut surface. The larger node is trisected and the smaller is bisected, with one section of each is submitted for flow cytometry assay. A tiny piece from the larger node is sent to microbiology. The rest of the tissue is submitted for formalin fixation. The intestinal wed