대한흉부영상의학회 Weekly Chest Cases

Case No : 937 Date 2015-10-12

Courtesy of Sangik Park, Han Na Lee, Sang Young Oh, Sang Min Lee, Kyung-Hyun Do / Asan medical center
Age/Sex 32 / F
Chief ComplaintIncidentally detected abnormality on chest radiograph

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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: 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,

No. of Applicants : 73

▶ Correct Answer : 30/73, 41.1%

- University of Tsukuba , Japan Hiroaki Takahashi
- University of British Columbia , Canada Amr Ajlan
- Ajou University Hospital , Korea (South) Seulgi You
- Daejin Medical Center Bundang Jesaeng General Hospital , Korea (South) Donghwan Kim
- the first affiliatited hospital of nanjing medical univercity , China Hai Xu
- Santosh hospital,Bengaluru , India Pravin Mahadevappa
- AJOU University Medical Center , Korea (South) Cho JaeYong
- privato , Italy genchi enzo
- , Korea (South)
- Asan Medical Center , Korea (South) Soyeoun Lim
- Kyoto University , Japan Akihiko Sakata
- Asan , Korea (South) Sania ALBlushi
- Niigata City General Hospital , Japan Takao Kiguchi
- Kyungpook national university , Korea (South) Chungeun Lim
- The University of Tokyo Hospital , Japan Takeyuki Watadani
- The University of Tokyo Hospital , Japan Toshihiro Furuta
- Asan Medical Center , Korea (South) , Korea (South) Han Na Lee
- chungbuk university hospital , Korea (South) Hyeonmi Ryu
- Okinawa Kyodo Hospital , Japan Shoko Iraha
- IRSA La Rochelle , France Denis Chabassiere
- Gifu Central Hospital , Japan Haruo Watanabe
- Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
- Niigata University , Japan Atsushi Uehara
- Fortis hospital , Mohali , India Shaleen Rana
- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- NASA SCANS , India RAKESH BHATIA
- Shiga University of Medical Science , Japan Akitoshi Inoue
- National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
- Tashkent Medical Academy , Uzbekistan Rustam Fayzullaev
- Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani

▶ Correct Answer as Differential Diagnosis : 12/73, 16.4%

- Juntendo University Hospital , Japan Akifumi Hagiwara
- Armed Forces Seoul Hospital , Korea (South) Eui Jin Hwang
- DAYA General Hospital,Thrissur,Kerala , India Raveendran TK
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- chungbuk national university hospital , Korea (South) soojung lee
- chungbuk national university hospital , Korea (South) lee jung hwan
- McGill University Health Center , Canada Alexandre Semionov
- CHU Poitiers , France CHAN paul
- CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
- jaslok hospital & research centre mumbai , India JAINENDRA JAIN
- ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
- Kizawa Memorial Hospital , Japan Shoji Okuda

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 937 Date 2015-10-12

Discussion

No. of Applicants : 73