Weekly Chest CasesArchive of Old Cases

Case No : 278 Date 2003-02-22

  • Courtesy of Yeong Cheol Yoon, M.D. / Kangdong Sacred Heart Hospital, Hallym University, Seoul, Korea
  • Age/Sex 21 / M
  • Chief ComplaintIncidental detected mass at left hilum
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Castleman Disease
Radiologic Findings
Initial chest radiograph shows mass shadow at left hilum, which has increased on follow up radiograph obtained 4 years later. CT scan shows mass at left left hilum with marked enhancement after contrast injection.
On operation, the mass was broad based on the left major fissure and hypervascular. Pathologic study of the excised mass revealed typical findings of Castleman disease.
Brief Review
Castleman disease is a relatively rare disorder of lymphoid tissue, and it is also known as angiofollicular hyperplasia or giant lymph node hyperplasia. The disease may occur anywhere along the lymphatic chain but most commonly is found as a solitary mass in the mediastinum. Two distinct histologic patterns have been described, the hyaline-vascular type, which accounts for 90% of cases, and the plasma cell type accounting for the remainder.
On contrast-enhanced CT, Castleman disease localized to the mediastinum typically shows dense contrast enhancement; any mediastinal compartment can be involved, as can abdominal lymph nodes. Central dense, or flocculent lymph node calcifications can occasionally be seen.
References
1. Moon WK, Im J-G, Kim JS, et al. Mediastinal Castleman disease: CT findings. J Comput Assist Tomogr 1994; 18:43-46
2. McAdams HP, Rosado-de-Christenson M, Fishback NF, Templeton PA. Castleman disease of the thorax: radiologic features with clinical and histopathologic correlation. Radiology 1998; 209:221-228
Keywords
Mediastinum, Lymphproliferative disorder,

No. of Applicants : 26

▶ Correct Answer : 5/26,  19.2%
  • - Chungju Hospital Konkuk University, Korea Chang Hee Lee
  • - Dept of IM, Seoul National University Hospital, Korea Hee-Seok Lee
  • - Ospedale di Jesi, Italy Giancarlo Passarini
  • - Sarang Hospital, Incheon, Korea Jung Hee Kim
  • - SUN Hospital, Korea Ki Taek Hong
▶ Semi-Correct Answer : 17/26,  65.4%
  • - CHU Grenoble, France Gilbert Ferretti
  • - CHU Nancy-Brabois, France Denis Regent
  • - Chung Li Ten-Chen Hospital,Taiwan Gui-Lin Zheng
  • - Dept of IM, Seoul National University Hospital, Korea Jae-Joon Yim
  • - Dr.Park's Clinic, Korea Jong Wook Park
  • - Ewha Womans' University Hospital, Korea Sung Shine Shim
  • - Ewha Womans' University, Mokdong Hospital, Korea Yookyung Kim
  • - Gwangmoung Seongae Hospital, Korea Jiyong Rhee
  • - Hangang Sacred Heart Hospital, Korea Eil Seong Lee
  • - Hanyang University Hospital, Korea Seunghun Lee
  • - Maimonides Medical Center, New York, USA Jack Twersky
  • - MH, Agra, India Rajiv Kapur
  • - Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
  • - Social Security Hospital, Ankara, Turkey Meric Tuzun
  • - Soroka University Medical Center, Bear Sheva, Israel Pavel Crystal
  • - Teleradiology Solutions, Bangalore, India Sharad Bidari
  • - Tokyo Kouseinenkin Hospital , Japan Noriatsu Ichiba
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