Castleman disease (CD) is a lymphoproliferative disorder of unknown etiology that was first described in 1954 by Benjamin Castleman . Head and neck involvement is rare in pediatric populations, and there have only been a few reports of parotid involvement in pediatric or adult populations . There are two different classification systems in use: an older clinically based system that is subdivided into unicentric and multicentric disease based on the extent of lymph node involvement, as well as a newer histopathological system that is subdivided into hyaline vascular CD, plasma cell CD, HHV-8 +, and a mixed type . Patients with unicentric disease are often asymptomatic and receive curative treatment with surgical excision . On the other hand, patients with multicentric disease often present with systemic manifestations and require extensive therapy with steroids, chemotherapy, anti-virals, and immunotherapy .
A 14-year-old male was referred to our clinic with a 1-year history of a mass located at the angle of the mandible. His medical, surgical, and family histories were noncontributory. On physical examination a non-tender 3.5 × 2 × 1-cm well-circumscribed rubbery mass was found at the angle of the mandible in the area of the parotid tail. The facial nerve appeared to be grossly intact with no facial asymmetry or weakness noted. The rest of the head and neck exam was unremarkable. A fine needle aspiration was performed; however, the results were inconclusive. A CT scan revealed a 1.9 × 2.1 × 3.3-cm homogeneous mass located in the tail of the superficial lobe of the parotid ( Fig. 1 ). A presumptive diagnosis of pleomorphic adenoma was made and the patient was taken to the operating room for a superficial parotidectomy. Histopathologic analysis revealed involuted and hyalinized germinal centers with expanded mantle zones and prominent interfollicular vascular proliferation ( Fig. 2 ), which established the diagnosis of hyaline vascular castleman disease. After the diagnosis was made, a CT of the chest/abdomen/pelvis was ordered to exclude the multicentric form; however, the patient was lost to follow-up, and it was not completed.