Unicentric Castleman disease; the laparoscopic en bloc resection of a hypervascular giant lymph node in the aortacaval zone

Abstract

Unicentric Castleman disease (UCD) is a rare disease of the lymph nodes with unknown etiology, most commonly presenting as localized asymptomatic adenopathy incidentally discovered on radiographic imaging. The retroperitoneum is a rare site for UCD, where it can mimic malignant tumors. Complete surgical resection with disease-free margins is considered both diagnostic and curative. However, this may be challenging due to the high vascularity and close proximity of UCD to major vessels. A 42-year-old patient with a 46x44x26 mm mass in the aortocaval area at the level of the renal pelvis underwent surgery with the suspicion of metastatic lymphadenopathy. Laparoscopic excision of the mass was carried out and the histopathological examination revealed the presence of UCD. This video article aimed to demonstrate the surgical steps and techniques used to minimize hemorrhage during dissection of UCD. Laparoscopy is safe and effective in the diagnosis and treatment of UCD, provided the operating surgeons have a thorough knowledge of abdominal anatomy and are aware of the functions and limitations of surgical devices used during laparoscopy.