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Weekly Chest CasesArchive of Old Cases

Case No : 957 Date 2016-02-29

  • Courtesy of Kyung Min Shin, Chun Geun Lim / Kyungpook National University Medical Center
  • Age/Sex 49 / F
  • Chief ComplaintIncidental abnormality on chest radiograph
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7

Diagnosis With Brief Discussion

Diagnosis
Castleman disease, multicentric, hyaline vascular type
Radiologic Findings
Figs 1-1. Chest PA shows right hilar enlargement and widening of the right paratracheal stripe, measuring about 3.5cm.
Fig 2-1,2,3,4,5. Axial and coronal reformatted images of MDCT demonstrate the homogenously enhancing lymphadenopathy in the right hilum, mediastinum and the right supraclavicular area. The mean pre- and postcontrast attenuation values were 40 and 140HU.
Excisional biopsy of the right supraclavicular lymph node demonstrated Castleman disease, hyaline vascular type.
Brief Review
Castleman disease is a non-clonal lymphoproliferative disorder. It is one of the more common causes of non-neoplastic lymphadenopathy. Two classification systems exist for Castleman disease: the older morphologic classification and the more recent histopathogenetic classification.
The morphologic classification distinguishes between unicentric and multicentric Castleman disease on the basis of the extent of local lymph node involvement. The histopathogenetic classification distinguishes hyaline vascular type, plasma cell type, human herpesvirus 8 (HHV-8)–associated Castleman disease, and multicentric Castleman disease not otherwise specified.
The classic CT appearance of hyaline vascular Castleman disease is a solitary enlarged lymph node or localized nodal masses that demonstrates homogeneous intense enhancement after contrast material administration. Three patterns of involvement have been described, including a solitary noninvasive mass (50% of cases), a dominant infiltrative mass with associated lymphadenopathy (40% of cases), and matted lymphadenopathy without a dominant mass (10% of cases).
The multicentric, hyaline vascular variant of Castleman disease has rarely been reported in the literature. Multicentric Castleman disease runs a more aggressive course and can progress to non-Hodgkin’s lymphoma.
Please refer to
Case 56, Case 253, Case 387, Case 742, Case 937,
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. Mehmet Ali Erkurt, Ismet Aydogdu, Irfan Kuku, et al. A multicentric, hyaline vascular variant of Castleman’s disease associated with B cell lymphoma: a case report, Cases Journal 2009, 2:8183
Keywords
Mediastinum, Lymphproliferative disorder,

No. of Applicants : 112

▶ Correct Answer : 66/112,  58.9%
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Union hospital,Wuhan , China Nan Diao
  • - radiologist, aditya imaging centre , India vivek patel
  • - Asan Medical Center , Korea (South) Soyeoun Lim
  • - Juntendo University Hospital , Japan Akifumi Hagiwara
  • - King Abdulaziz University Hospital , Saudi Arabia Amr Ajlan
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Khoo Teck Phuat Hospital Singapore , Singapore ashish chawla
  • - NIMS, HYDERABAD , India bhaskar kakarla
  • - Nihon University Itabashi Hospital , Japan Yusuke Watanabe
  • - Policlinico Umberto I , Italy Paolo Baldassari
  • - PNUH , Korea (South) Seungbaek Hong
  • - Nasaret Hospital , Korea (South) Hee Seok Choi
  • - NEUROCITI DIAGNOSTICS , India Justin Moses
  • - Asan Medical Center , Korea (South) Hyung Jung Koo
  • - pamukkale university hospital , Turkey ergin karaman
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - chonnam national university hospital , Korea (South) Kim eun
  • - The Jikei university , Japan Taku Gomi
  • - university of montreal , Canada Andrei Gorgos I
  • - Kyungpook national university hospital , Korea (South) Nari Jung
  • - MUHC , Canada Hani AlSalam
  • - Department of Radiology, Seoul National University Bundang Hospital , Korea (South) Sung Hyun Yoon
  • - Saint Malo , France jean-baptiste Noel
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Chonnam National University Hospital , Korea (South) So yeon Ki
  • - Medicheck health care , Korea (South) Chae Lim
  • - Kyung Hee University Hospital at Gangdong , Korea (South) Han Na Lee
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - Okayama University Hospital , Japan Toshiyuki Komaki
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - University of Toronto , Canada Micheal McInnis
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Pusan national university hospital , Korea (South) Minkyu Kwak
  • - Kyungpook national university hospital, Korea , Korea (South) SUNGJUN MOON
  • - Avrasya Hospital , Turkey Murat Ulusoy
  • - Les cedres St malo , France nicolas gautier
  • - Maimonides Medical Center , United States naomi twersky
  • - Seoul national university , Korea (South) Kumju Chae
  • - Chonnam National University Hospital, Radiology department , Korea (South) Park byung jin
  • - CHRU Lille , France Paul Lebert
  • - CHU Poitiers , France CHAN paul
  • - Pusan national university hospital , Korea (South) Park Bin
  • - Daya general Hospital , India Raishad Khan
  • - Centre Imagerie de Fribourg , Switzerland Benoit RIZK
  • - MBAL BURGAS , Bulgaria VLADISLAV RUSINOV
  • - Maternity & child hospital , Saudi Arabia Sania ALBlushi
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - SAMSUGN MEDICAL CENTER , Korea (South) HAN SOLBEE
  • - National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
  • - Seoul National University Hospital , Korea (South) Sunkyung Jeon
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - University of Tsukuba , Japan Toshitaka Ishiguro
  • - SMG-SNU Boramae Medical Center , Korea (South) hyoun cho
  • - Private sector , Greece Vasilios Tzilas
  • - The University of Tokyo Hospital , Japan Takeyuki Watadani
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia Yuranga Weerakkody
  • - Pusan national university hospital , Korea (South) Jin Joo Kim
  • - Kyoto University , Japan Akihiko Sakata
  • - Pusan national university hospital , Korea (South) So Park
  • - Asan medical center , Korea (South) Cherry Kim
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
▶ Correct Answer as Differential Diagnosis : 27/112,  24.1%
  • - Saitama-Sekishinkai Hosptal , Japan Mihoko Yamazaki
  • - okayama university , Japan numa shingo
  • - Osaka Rosai Hospital , Japan Hiromitsu Sumikawa
  • - Kinki University Faculty of Medicine, , Japan Mitsuru Matsuki
  • - Niigata University , Japan Atsushi Uehara
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - , Korea (South)
  • - IRSA LA ROCHELLE , France, Metropolitan BIGOT
  • - the First Affiliated Hospital of NanJing Medical University , China Aiping Chen
  • - Chonnam national university hospital , Korea (South) INSOO JANG
  • - Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
  • - �stanbul , Turkey Ayhan Yilmaz
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - HHS , Canada S Lee
  • - Pusan national university hospital , Korea (South) hie bum suh
  • - University of Tsukuba, Dept of Radiologt , Japan Manabu Minami
  • - Himeji Red Cross Hospital , Japan Mayu Uka
  • - Teikyo University Mizonokuchi Hospital , Japan Noriko Kobayashi
  • - GHICL , France manuel toledano
  • - Shinmatsudo Central General Hospital , Japan Taku Tajima
  • - Daejin Medical Center Bundang Jesaeng General Hospital , Korea (South) Donghwan Kim
  • - NASA SCANS , India RAKESH BHATIA
  • - Ajou University Hospital , Korea (South) Seulgi You
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - University of Tsukuba Hospital , Japan Sodai Hoshiai
  • - Ajou University Hospital , Korea (South) Youngjin Yoo
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