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Weekly Chest CasesArchive of Old Cases

Case No : 808 Date 2013-04-22

  • Courtesy of Cheol Min Lee, Yo Won Choi / Hanyang Univertiy Seoul Hospital
  • Age/Sex 43 / M
  • Chief Complaintweight loss, fever, and night sweat for several weeks
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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
Keywords
Mediastinum, Lung, Lymphproliferative disorder, LIP,

No. of Applicants : 92

▶ Correct Answer : 16/92,  17.4%
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - SKG radiology , Australia Yuranga Weerakkody
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Kyoto University , Japan Akihiko Sakata
  • - Kyung Hee University Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - Dongnam Institute of Radiological and Medical Sciences , Korea (South) Dae-Wook Yeh
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Asan medical center , Korea (South) yoonyoung choi
  • - SNUH , Korea (South) Euijin Hwang
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
  • - Okayama university , Japan Mayu Uka
▶ Correct Answer as Differential Diagnosis : 9/92,  9.8%
  • - Korea university , Korea (South) Kun Woo Kang
  • - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
  • - Asan medical center , Korea (South) Sang Young Oh
  • - NDMVP Nashik , India Imran Jindani
  • - Fukuyama city hospital , Japan Ryotaro Kishi
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
▶ Semi-Correct Answer : 13/92,  14.1%
  • - UWO , Canada S Lee
  • - Saint Malo , France jean-baptiste Noel
  • - CNUH , Korea (South) Kim Soo Hyun
  • - , Korea (South) Chan Park
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Eren T캇p Merkezi Istanbul , Turkey Armagan Sarac
  • - Dae-jeon Bohun Veterans Hospital , Korea (South) KI-TAE HAN
  • - Chungbuk University Hospital , Korea (South) Yunhee Jang
  • - chungbuk national university hospital , Korea (South) soojung lee
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Private sector , Greece Vasilios Tzilas
  • - Medicheck health care , Korea (South) Chae Lim
  • - Chonnam National University Hospital , Korea (South) So yeon Ki
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