Correct!
3. Castleman disease
The left pelvic mass shows intense enhancement, reflecting hypervascularity, which is typical of Castleman disease (also known as angiofollicular hyperplasia). The presence of the enhancement excludes a cyst, including hemorrhagic cyst- such lesions should not show such profound diffuse enhancement. Lymphoma is a consideration, but such intense enhancement is atypical, and no other enlarged lymph nodes are seen. Sarcoma is always a consideration for an isolated pelvic mass, but such intense enhancement is atypical. Furthermore, sarcomas can be aggressive, but this lesion has not spread either locally or distantly in 2 years, apparently only recurring in the same location following surgical resection. Solitary fibrous tumor is also a remote consideration, given the rarity of this lesion (particularly outside the thorax), but again, intense contrast enhancement is atypical. Additional differential diagnostic considerations, not provided as answer options, should include neuroendocrine malignancy and metastatic disease from hypervascular tumors such as melanoma and renal cell carcinoma.
The outside surgical resection records showed the left pelvic mass to represent the hyaline vascular variant Castleman disease, unicentric.
Based on the information thus far, which of the following represents the most appropriate next step for the patient’s management? (click on the correct answer to be directed to the seventh of twelve pages)