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Weekly Chest CasesArchive of Old Cases

Case No : 970 Date 2016-05-30

  • Courtesy of Chul Hwan Park, Tae Hoon Kim / Gangnam Severance Hospital
  • Age/Sex 40 / M
  • Chief ComplaintAbnormality on routine check up
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Castlemen disease, Hyaline vascular type
Radiologic Findings
Chest radiograph shows mediastinal widening. On CT, multiple variable sized lymphadenopathy noted in left anterior mediastinum, associated with surrounding fat infiltration. Biopsy was performed, and the pathologic diagnosis was Castleman disease, hyaline vascular type (CD3 and CD20: reactive pattern, CK (AE1/3): negative).
Brief Review
Castleman disease is an uncommon nonclonal lymphoproliferative disease with benign lymph node hyperplasia. Pathologically there are two types: Hyaline vascular (90%) and plasma cell type. Based on the biological behavior, Castleman disease can be subdivided into unicentric form and multicentric form.
Unicentric form Multicentric form
Pathology Hyaline vascular type
Occasionally plasma cell type Plasma cell type
Occasionally hyaline vascular type
Age 3rd or 4th decade 6th decade
Clinical course Benign Aggressive
Progression to lymphoma Rare Common
Treatment Surgery Systemic therapy

Castleman disease is most common in thorax (70%), followed by abdomen /retroperitoneum/pelvis (10-15%) and neck (10-15%).
Radiologic manifestations of thoracic Castleman disease can mimic thymoma, lymphoma or neurogenic tumor. Common CT findings of unicentric Casteman disease include 1) solitary, non-invasive mass, 2) dominant mass with involvement of contiguous structures, and 3) matted lymphadenopathy confined to single mediastinal compartment. In contrast, typical CT finding of multicentric Castleman disease is diffuse lymphadenopathy involving multiple anatomic regions.
Please refer to
Case 56, Case 253, Case 319, Case 387, Case 519, Case 611, Case 621, Case 937,
KSTR Imaging conference 2009 Summer  Case 14 ,
KSTR Imaging Conference 2003 Summer  Case 3,
References
1. Bonekamp D, Horton KM, Hruban RH, Fishman EK. Castleman disease: the great mimic. Radiographics 2011;31:1793-1807
2. Soumerai JD, Sohani AR, Abramson JS. Diagnosis and management of Castleman disease. Cancer Control 2014;21:266-278

Keywords
Mediastinum, Lymphproliferative disorder,

No. of Applicants : 103

▶ Correct Answer : 46/103,  44.7%
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Chonnam National University Hospital , Korea (South) So yeon Ki
  • - Daejin Medical Center Bundang Jesaeng General Hospital , Korea (South) Donghwan Kim
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Seoul national university , Korea (South) Boram Kim
  • - Seoul national university hospital , Korea (South) Kumju Chae
  • - King Abdulaziz University Hospital , Saudi Arabia Amr Ajlan
  • - Military service , Korea (South) Dong Jang
  • - �stanbul , Turkey Ayhan Yilmaz
  • - University of Tsukuba, Dept of Radiology , Japan Manabu Minami
  • - privato , Italy genchi enzo
  • - The University of Tokyo Hospital , Japan Kaoru Sumida
  • - Okayama University Hospital , Japan Toshiyuki Komaki
  • - Narayana Multispeciality Hospital Jaipur Raj , India JAINENDRA JAIN
  • - Shanghai Jiao Tong University Affiliated Sixth People萸 , China Jiayin Zhang
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - HSC , Brazil Diogo Pinheiro
  • - the first affiliatited hospital of nanjing medical univercity , China Hai Xu
  • - The University of Tokyo Hospital , Japan Yusuke Watanabe
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - the First Affiliated Hospital of NanJing Medical University , China Aiping Chen
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia Yuranga Weerakkody
  • - Asan Medical Center , Korea (South) Hyung Jung Koo
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - CNUH , Korea (South) 源€
  • - Asan medical center , Korea (South) Cherry Kim
  • - CHU Poitiers , France CHAN paul
  • - Niigata University , Japan Atsushi Uehara
  • - Kyungpook national university hospital , Korea (South) Nari Jung
  • - Pusan national university hospital , Korea (South) Jin Joo Kim
  • - Namwon Medical Center , Korea (South) Chan Park
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Chungbuk national university hospital , Korea (South) Miran Yeon
  • - The first affiliated Hospital of Xiamen University , China Qing Qiang Guo
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - chungbuk university hospital , Korea (South) Hyeonmi Ryu
  • - chungbuk national university hospital , Korea (South) soojung lee
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - Kanto Rosai Hospital , Japan Taku Tajima
  • - , Korea (South)
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
  • - Department of Radiology, Seoul National University Bundang Hospital , Korea (South) Sung Hyun Yoon
  • - okayama university , Japan numa shingo
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - Hyogo Prefectural Amagasaki General Medical Center , Japan Tomoaki Otani
  • - Pusan national university hospital , Korea (South) Minkyu Kwak
▶ Correct Answer as Differential Diagnosis : 26/103,  25.2%
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Pusan national university hospital , Korea (South) So Park
  • - Samsung Medical Center , Korea (South) Boda Nam
  • - Red Cross Society Himeji Hospital , Japan Soichiro Okamoto
  • - University of Tsukuba Hospital , Japan Hiroaki Takahashi
  • - Les cedres St malo , France nicolas gautier
  • - PRINCE ALI KHAN HOSPITAL , India FAHAD LODHIA
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Saitama-Sekishinkai Hosptal , Japan Mihoko Yamazaki
  • - Eren Hastanesi Istanbul , Turkey Armagan Sarac
  • - Pusan national university hospital , Korea (South) hie bum suh
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - Chungbuk national university , Korea (South) Yong Kim
  • - NASA SCANS , India RAKESH BHATIA
  • - IRSA LA ROCHELLE , France, Metropolitan BIGOT
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Maternity & child hospital , Saudi Arabia Sania ALBlushi
  • - Kyung Hee University Hospital at Gangdong , Korea (South) Han Na Lee
  • - Private sector , Greece Vasilios Tzilas
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Pusan national university hospital , Korea (South) MIRI JEONG
  • - Pusan National University Yangsan Hospital , Korea (South) SEUNG MIN LEE
  • - pusan national university hospital , Korea (South) nam soo won
  • - PNUH , Korea (South) Seungbaek Hong
  • - Nasaret Hospital , Korea (South) Hee Seok Choi
  • - Pusan national university hospital , Korea (South) SeungHyun Lee
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