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Weekly Chest CasesArchive of Old Cases

Case No : 742 Date 2012-01-16

  • Courtesy of Ki-Yeol Lee / Korea University Ansan Hospital
  • Age/Sex 19 / M
  • Chief ComplaintIncidentally found abnormality
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Figure 1.

Diagnosis With Brief Discussion

Diagnosis
Castleman disease
Radiologic Findings
Chest CT scan demonstrates a well-defined, homogenously enhanced mass that abuts to adjacent vertebral body without invasion to the structures. There is no calcification, cystic change or necrosis within the mass. On MRI, the mass show iso-signal intensity compared to skeletal muscle on T1-weighted images, high signal intensity on T2-weighted images, and intense enhancement on contrast- enhanced T1-weighted images. Mass excision operation was performed. About 5cm sized, oval shaped mass was noted at the right posterior mediastinum, and pathologically confirmed as a Castleman disease, hyaline-vascular type.
Brief Review
Castleman disease is a rare cause of massive lymph node enlargement. Although intrathoracic lymph nodes are most commonly affected, nodes at any location can be involved. The hyaline vascular type is the most common (90%) and show a follicular structure with tumor nodules composed predominantly with small lymphocytes and a large number of blood vessels in the interfollicular space. The plasma cell type (10%) shows sheets of interfollicular cells and fewer blood vessels. Castleman disease of either type may occur at any age, but it most frequently affects young adults.
On noncontrast-enhanced CT, the mass is usually homogeneous and of soft tissue attenuation. Calcification is uncommon (5-10%) and, when it occurs, calcification is typically coarse central in location. Imaging studies one of three morphologic pattern: (1) solitary mass (50%); (2) dominant infiltrative mass with associated lymphadenopathy (40%); and (3) diffuse lymphadenopathy confined to a single mediastinal compartment (10%). Hyaline vascular Castleman disease usually enhances intensely following administration of contrast material, but plasma cell Castleman disease shows a less enhancement. The lesions are typically heterogeneous and have increased signal intensity compared to skeletal muscle on T1-weighted images. They become hyperintense on T2-weighted images, and low signal septa are occasionally visible within the lesion. Because the lesions are hypervascular, diffuse enhancement following administration of contrast media is common.
References
1. Kim YJ, Choi BW, Seo JS, Choe KO. Mediastinal Castleman disease: heterogeneous enhancement with filling-in pattern on dynamic CT and MRI. Eur J Radiol Extra 52 2004;103-105
2. McAdams HP, Rosado-de-Christenson M, Fishback NF, Templeton PA. Castleman disease of the thorax: radiologic features with clinical and histopathologic correlation. Radiology 1998;209:221
Keywords
mediastinum, lymphoproliferative disease,

No. of Applicants : 115

▶ Correct Answer : 10/115,  8.7%
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - shanghai zhoupu hospital , China wei wang
  • - Kohka Public Hospital , Japan Akitoshi Inoue
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - korea university , Korea (South) Hyelarn Lee
  • - Emory University Department of Radiology , United States Travis Henry
  • - KUMC ansan , Korea (South) kihwan kim
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - All India Institute of medical sciences , India Justin Moses
▶ Correct Answer as Differential Diagnosis : 21/115,  18.3%
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Sunchun university hospital, Bucheon , Korea (South) So Young Bae
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Samsung medical center , Korea (South) Hyun Su Kim
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - XiangYa hospital , China Xia Yu
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Radnet Teleradiology Istanbul , Turkey Armagan Sarac
  • - China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - CSSS St Hyacinthe , Canada olivier krief
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Sejong general hospital , Korea (South) Dong Jae Shim
  • - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
  • - Asan Medical Center , Korea (South) Sang Min Lee
  • - IRSA , France, Metropolitan BIGOT
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Soon Chun Hyang Seoul , Korea (South) Hayoun Kim
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