Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Castleman disease, hyaline vascular type
- Radiologic Findings
- Posteroanterior chest radiograph shows a large, round-shaped mass in the posterior mediastinum, measuring approximately 12-cm in the maximal diameter. The tracheal carina is widened due to compression by the mass. In addition, there is bulging of the right paratracheal stripe, suggesting possibility for lymph node enlargement.
Computed tomography of the chest obtained with contrast enhancement shows multiple enlarged lymph nodes with homogeneous attenuation in the right supraclavicular, right upper and right lower paratracheal areas. And there is a large, well-defined, lobulated mass in the posterior mediastinum. It has homogeneous, relatively high (> 130 HU) attenuation with central stippled calcifications. It is in broad contact with the left atrium without evidence of invasion. Bilateral main bronchi are laterally displaced by the mass.
Considering homogeneous attenuated mediastinal mass with central calcifications and multiple lymphadenopathy, Castleman disease was suspected. Mediastinal mass excision was performed. The specimen showed well-demarcated yellowish solid mass (10.6 x 9.2 x 4.2cm), and this mass was pathologically confirmed as a Castleman disease, hyaline vascular type.
- Brief Review
- Castleman disease is a nonclonal lymphoproliferative disorder and one of the more common causes of non-neoplastic lymphadenopathy. There are two major histopathologic variants of Castleman disease : hyaline-vascular and plasma cell.
Hyaline vascular Castleman disease comprises 90% of the cases and occurs mostly in young adults, with a median age at diagnosis in the 3rd or 4th decade. This type is unicentric in 90% of the cases and usually manifests as an asymptomatic mass lesion.
The characteristic CT features of hyaline vascular Castleman disease is a solitary enlarged lymph node or localized nodal masses with homogeneous, intense enhancement after contrast administration. Three patterns have been recognized, including a solitary noninvasive mass (most common: 50% of cases), a dominant infiltrative mass with lymphadenopathy (40% of cases), and matted lymphadenopathy without a dominant mass (10% of cases). In this case, Castleman disease manifested as a dominant mass with multiple lymphadenopathy. Internal calcifications are noted in approximately 10% of the cases, and generally show coarse appearance with central location, like this case. Central low attenuation in nodal masses is unusual but can be seen.
- Please refer to
Case 56, Case 253, Case 387, Case 742, -
KSTR Imaging conference 2009 Summer Case 14
,
KSTR Imaging Conference 2003 Summer Case 3,
- References
- 1. Bonekamp D, Horton KM, Hruban RH, et al. Castleman Disease: The Great Mimic. RadioGraphics 2011; 31:1793–1807.
2. Ko SF, Hsieh MJ, Ng SH, et al. Imaging Spectrum of Castleman’s Disease: Pictorial Essay. AJR 2004;182:769–775.
- Keywords
- Mediastinum, Lymphproliferative disorder,