Scrotal Hernia or Castleman Disease? A Diagnostic Pitfall in an Unusual Presentation of a Rare Entity

Abstract

Castleman disease (CD) is a rare, non-neoplastic lymphoproliferative disorder with varied clinical presentations and uncertain etiology. It is classified into unicentric (UCD) and multicentric (MCD) forms, and histologically into hyaline vascular, plasma cell, or mixed subtypes. While CD typically affects the mediastinum or neck, scrotal involvement is exceedingly rare and can mimic more common conditions. We report a case of a 65-year-old man with a painless, enlarging scrotal mass initially diagnosed as a reducible hernia. Imaging and histopathology revealed a large lymphoid mass, diagnosed as UCD with mixed hyaline vascular and plasma cell subtypes. This case highlights the importance of including CD in the differential diagnosis of scrotal masses and underscores the critical role of histopathological examination in diagnosis and treatment planning. The patient had a favorable outcome after surgical excision, reinforcing that early recognition and proper management of UCD typically result in an excellent prognosis.