Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Multicentric Castleman disease (plasma cell type)
- Radiologic Findings
- CT scans show multiple small lymph nodes in both supraclavicular, both axillae, and the mediastinum with hot uptake on PET scan. Lung window images show bronchovascular bundle thickening, nodular thickening of the fissure and interlobular septal thickening, which are compatible with pulmonary involvement of Castleman
- Brief Review
- Castleman disease is a rare cause of massive lymph node enlargement in the chest. There are two major histopathologic variants of Castleman disease: hyaline-vascular and plasma cell.
Multifocal Castleman disease usually manifests on chest radiographs with diffuse mediastinal widening. On CT, multifocal lymph node enlargement is noted.
Because of its highly vascular nature, hyaline-vascular Castleman disease usually enhances intensely following administration of intravenous contrast material. Plasma cell Castleman disease is less vascular, and typically shows less enhancement after contrast administration. On FDG-PET scans, the lesions are usually quite metabolically active, whether uni- or multifocal in nature.
Reported manifestations of lung involvement include a pulmonary mass, centrilobular nodules, septal thickening, and thin-walled cysts. Most patients with diffuse lung involvement have multifocal disease and the lung findings are usually due to associated lymphoid interstitial pneumonitis.
- References
- 1. Dham A, Peterson BA: Castleman disease. Curr Opin Hematol 2007; 14:354-359.
2. Dispenzieri A: Castleman disease. Cancer Treat Res 2008; 142:293-330.
3. Dispenzieri A, Gertz MA: Treatment of Castleman's disease. Curr Treat Options Oncol 2005; 6:255-266.
- Please refer to
- Case 745 Case 742 Case 724 Case 624
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- Keywords
- Mediastinum, Lung, Lymphproliferative disorder, LIP,