Surgery Godfather
Chapter 1313 - 995: The Doctor Does Things in A Very Doctorly Way

Chapter 1313: Chapter 995: The Doctor Does Things in A Very Doctorly Way

The typical pathological manifestation is the main basis for diagnosing Castleman’s disease, and now the diagnostic criteria have become very clear, so the diagnosis has been naturally confirmed.

Castleman’s disease, discovered by Doctor Castleman in 1956 and named after him, is also known as giant lymph node hyperplasia, lying between benign and malignant tumors. It’s a rare disease characterized by different clinical presentations and histopathological features of reactive lymphoid hyperplasia, with the most prominent feature being large abdominal and thoracic lymph node masses.

The cause is still unknown, but current research suggests that the development of Castleman’s disease is related to infection with human herpesvirus 8 and human immunodeficiency virus, immune system dysfunction, and excessive secretion of interleukin 6, among other factors.

Its pathogenesis is not yet clear; it mainly presents as lymphoid tissue involvement, with the primary pathological change being chronic inflammatory cell stimulation causing reactive lymph node hyperplasia, leading to localized or systemic lymph node enlargement in patients.

It is classified into unicentric and multicentric types based on the number of affected lymph nodes; unicentric type is limited to a single lymph node or a single region of enlarged lymph nodes. As the name suggests, multicentric type involves more than one lymph node and extends beyond a single region.

The unicentric type is more common among individuals in their thirties and forties, often occurring in the head and neck area with fewer systemic symptoms. This type can be treated surgically, and the prognosis is relatively good.

The multicentric type often occurs in people in their fifties and sixties, presenting with multiple enlarged lymph nodes and multiple organ involvement, accompanied by long-term fever, weight loss, night sweats, and general metabolic symptoms such as fatigue, anemia, and hypergammaglobulinemia. This type often has complex conditions and a poor prognosis.

Diagnosis of this disease relies on pathological biopsy. If surgical resection is possible, it should be done; if complete resection is not possible by surgery, chemotherapy is the preferred treatment method.

Director Jiang personally brought the pathology report to the ward. When Fu Xiaotao heard the name of the disease he had contracted, he felt a sense of relief. Regardless of whether the disease could be cured, at least now he knew what was wrong, which was certainly better than being in the dark.

Fu Xiaotao’s parents also felt hopeful at this time. They had been distressed and regretful because their son was sick, but now that they finally understood the illness, might there be a chance for recovery? At least now they could hold onto a thought, unlike before when they didn’t even know the nature of the disease.

However, things were not as good as imagined. Fu Xiaotao had the multicentric type of Castleman’s disease, which has a very poor prognosis—reportedly, very few people live over two years. Therefore, the news Director Jiang brought was mixed.

Once the diagnosis was clear, the next step was treatment. The difficulty in internal medicine lies not in treatment, but in diagnosis, while in surgery, the diagnosis is easy but performing the surgery is challenging.

For surgeons, diagnosis is usually easy to clarify, but the same disease can have vastly varying outcomes depending on the surgeon. Internal doctors are different; they spend great energy on diagnosis, and once that is clear, there are guidelines available for treatment, so there isn’t much difference among them.

Even for rare diseases, there are treatment guidelines, but these are generally outdated. However, for safety reasons, most doctors prefer to follow guidelines, regardless of their effect, because by doing so, there is no fault in the outcome. Should they use a novel method not included in the guidelines, there is a risk of complications.

"Let’s try Rituximab first to see the effect, and if that doesn’t work, we’ll move on to chemotherapy," Director Jiang told Fu Xiaotao.

"Chemotherapy? Is this a tumor?" Fu Xiaotao’s parents immediately became alert.

Director Jiang explained, "This disease is in between benign and malignant tumors. At least we now know what it is and how to treat it, but as for the treatment outcome, no one can draw any conclusions now."

"Let’s give it a try," said Fu Xiaotao’s mother, taking it in stride. Compared to the past confusion, this was a significant improvement.

But Fu Xiaotao’s father wasn’t as optimistic. He felt the situation was worse now. Previously, not knowing the disease meant only that it was worrisome, not yet despairing. Now, knowing what it was, with a very slim chance of recovery, the feeling was one of despair.

Fu Xiaotao was different from both his parents. While undergoing tests, he saw Luo Jin’s posters in the hallway. Fu Xiaotao knew Luo Jin’s inspiring story; a role model’s spirit is infinitely powerful. Fu Xiaotao was determined to fight like Luo Jin, to strive with 200 percent effort for even the slightest hope.

"Let’s go with your treatment plan. Can I see Professor Yang again?" Fu Xiaotao asked.

Director Jiang responded, "I’ll contact him for you; he’s very busy, so the time is not certain yet."

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Wen Ruzheng’s confidence in handling Castleman’s disease is justifiable because, to date, there have only been a handful of cases reported. Although the reported cases are in single digits, the actual incidence in the population is far greater because the majority of doctors do not recognize the disease, meaning these patients have never been diagnosed correctly.

Doctor Wen, diligent in his pathological studies, would read a vast amount of literature daily and knew the histopathological features of various rare diseases, whether in text or image, like the back of his hand. Unexpectedly, Wen Ruzheng encountered such a rare disease, which was a once-in-a-lifetime opportunity. However, it was all shattered in less than a minute by Yang Ping.

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