Clinical features and management of head and neck castleman disease: a single-center retrospective analysis

Background Castleman disease, a rare lymphoproliferative disorder with diverse features, is often misdiagnosed due to rarity and similarity to malignancies.Aims The study analyzed the clinicopathological characteristics, diagnostic challenges, and outcomes of head and neck Castleman disease (HNCD) to improve diagnostic accuracy and optimize management strategies.Material and Methods Retrospective study of 21 HNCD patients treated at Beijing Tongren Hospital (2007-2024). Demographics, presentation, imaging, histopathology, treatment, and outcomes were analyzed using t-tests, Mann–Whitney U, and Fisher’s exact tests.Results Mean age 36.1; 52.4% female. Mainly painless cervical masses (95.2%). Histology: 85.7% hyaline vascular, 14.3% plasma cell. Imaging showing non-specific hypoechoic nodules (ultrasound) and homogeneous enhancement (CT/MRI). Surgical excision (85.7%) achieved 76.2% complete remission (mean follow-up: 85.2 months). Tumor size (34.6 ± 15.3 mm) didn’t correlate with outcome (p = 0.756). One plasma cell patient (4.8%) died of unrelated causes. No recurrences or malignant transformations were observed.Conclusions and Significance HNCDs are predominantly unicentric and can be cured with complete surgical resection. Due to the lack of specificity of imaging and laboratory findings, diagnosis relies on histopathology. Collaborations among multiple centers and molecular studies are essential to advancing the precision treatment of HNCD.