Castleman disease in the parapharyngeal space: a case report and review of the literature

Abstract

Castleman disease is most commonly found in the mediastinum, while the head and neck is the second most common location. The disease exists in a unicentric and multicentric variety and is usually successfully treated with surgical resection alone. Early identification is important for treatment planning. Castleman disease has been reported to mimic other disease processes, however there has been only one report of the disease mimicking a nerve sheath tumor in the parapharyngeal space. Here we report the second case of Castleman disease mimicking a schwannoma in the parapharyngeal space.

Fig. 1

a–c MRI demonstrating right post styloid parapharyngeal lesion lateralizing the right internal carotid artery extending from the level of the basioccipit of the clivus to C2/C3 level

Fig. 2

a Lower magnification of the Case 1 showing atretic follicles and several hyalinized vessels with markedly enlarged lymphoid follicles with nodular growth pattern (1a, ×100). b Lymphoid follicle showing para follicular cells were markedly increased in number arranging in onion-skin appearance (1b, ×200)

Fig. 3

Immunostain for IgD showing positivity of the para follicular small lymphoid cells consistent with mantle zone origin The overall morphologic and immunophenotypic features are consistent with Castleman disease (Hyaline vascular type [A1] [A2]) (3, ×350)