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Weekly Chest CasesArchive of Old Cases

Case No : 724 Date 2011-09-12

  • Courtesy of In Kim, Jae-Kwang Lim, Duk Sik Kang / Kyungpook National University Hospital
  • Age/Sex 36 / F
  • Chief ComplaintDry cough for 1 year, weight loss
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Figure 1

Diagnosis With Brief Discussion

Diagnosis
Multicentric Castleman's Disease with Lung Involvement (Lymphocytic Interstitial Pneumonitis)
Radiologic Findings
Chest radiograph shows diffuse coarse reticulonodular opacities in both lung fields. Chest CT shows multiple enlarged lymph nodes in the mediastinum, both axillary areas, and upper abdomen, which was associated with splenomegaly. And also there are poorly defined centrilobular nodules, ground-glass opacities and diffuse interstitial thickening in both lungs.
The histopathological diagnosis of Castleman's disease (plasma cell type) and lymphocytic interstitial pneumonia were made by mediastinal lymph node biopsy and wedge resection of the right middle and lower lobes.
Brief Review
Castleman’s disease(CD) is an uncommon benign lymphoproliferative disorder characterized by hyperplasia of lymphoid follicles. Two histological types are described: hyaline-vascular type and plasma cell type. From a clinical stand point, CD is also classified as localized or multicentric.
The hyaline-vascular type of CD occurs in up to 90% of cases. Patients with the hyaline-vascular type are usually children or young adults and up to 70% of them have an asymptomatic, localized mediastinal mass. On the other hand, the plasma cell variety often presents as a multicentric process, associated with generalized lymphadenopathy and hepatosplenomegaly. It often results in a systemic illness, associated with fever, anemia, infections, and malignancies such as lymphoma or Kaposi’s sarcoma.
On contrast-enhanced CT, localized CD typically shows dense contrast enhancement; any mediastinal compartment can be involved. Central, dense, or flocculent lymph node calcifications are occasionally seen. Patients with multicentric CD have shown early, dense, uniform enhancement of enlarged mediastinal lymph nodes. Axillary, abdominal, and other lymph node groups may also be involved.
Histologic findings obtained from lung biopsy in patients who had multicentric CD have been shown lymphocytic interstitial pneumonitis(LIP). CT findings of LIP include ground-glass attenuation, air-space consolidation, ill-defined nodules, extensive thickening of bronchovascular bundles and interlobular septa, and cysts. Multicentric CD had a much worse prognosis than localized CD and currently regarded as a potentially malignant lymphoproliferative disorder.
References
1. Thoracic Imaging: Pulmonary and Cardiovascular Radiology, North American Edition. W. Richard Webb, Charles B. Higgins. Lippincott Williams & Wilkins, 2010 : 255
2. Takeshi J, Nestor LM, Kazuya I et al. Intrathoracic multicentric Castleman disease: CT Findings in 12 patients. Radiology 1998;209:477-481
Keywords
lung, lymphoproliferative disease,

No. of Applicants : 98

▶ Correct Answer : 15/98,  15.3%
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Okayama University , Japan Akihiro Tada
  • - Fr Mullers Medical College , India Deepu Thomas
  • - Humber River Hospital , Canada Sean Carr
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - HSC , Brazil Diogo Pinheiro
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - UWO , Canada S Lee
  • - Asan medical center , Korea (South) sang young oh
  • - All India Institute of medical sciences , India Justin Moses
  • - China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Asan Medical Center , Korea (South) Jae-Woo Song
  • - Az Osp Santa Maria Terni , Italy angelo carloni
  • - Azienda Ospedaliera San Gerardo , Italy Gabriele DAndrea
  • - KUMC ansan , Korea (South) kihwan kim
▶ Correct Answer as Differential Diagnosis : 19/98,  19.4%
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - National Jewish Health , United States Jonathan Chung
  • - Onomichi municipal hospital , Japan Ryotaro Kishi
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Seoul St Mary Hospital , Korea (South) Chae Lim
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - NASA SCANS , India RAKESH BHATIA
  • - Okayama university , Japan Mayu Uka
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - Emory University Department of Radiology , United States Travis Henry
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
▶ Semi-Correct Answer : 33/98,  33.7%
  • - HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
  • - Radnet Teleradiology Istanbul , Turkey Armagan Sarac
  • - Goa Medical College , India Paresh Desai
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - Radnet Teleradiology , Turkey Murat Ulusoy
  • - Asan Medical Center , Korea (South) Sanghyun Choi
  • - Armed Force Capital Hospital , Korea (South) Dae Kun Oh
  • - Seoul National University Hospital , Korea (South) YongSub Song
  • - Brabois - CHU Nancy , France Alban Gervaise
  • - Chuncheon Sacred Heart Hospital , Korea (South) Pak Su-young
  • - Saga University , Japan Tetsuya Kondo
  • - CHA Bundang hospital , Korea (South) Hyerin Kim
  • - Severance hospital , Korea (South) Beomseok Sohn
  • - Yonsei University College of Medicine, Shinchon Severance hospital , Korea (South) Young Joo Suh
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - CHRU lille , France manuel toledano
  • - Montreal , Canada D J
  • - Shree Diagnostics , India amol jagdale
  • - DongA University hospital , Korea (South) Jiyoung Kang
  • - chp st martin , France Mariotte benoit
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - NDMVP Nashik , India Imran Jindani
  • - Seoul National University Gangnam Center , Korea (South) Hua Sun Kim
  • - PRINCESS MARGARET HOSPITAL , Bahamas SHUJAUDDIN RAHIMI
  • - Hotel-Dieu Montreal , Canada nicolas gautier
  • - chungbuk uni. hospital , Korea (South) JY Ahn
  • - Asan Medical Center , Korea (South) Eun Kim
  • - IRSA , France jean-luc BIGOT
  • - A.P.Chest hospital ,hyderabad , India bhaskar kakarla
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - Bupyong Serim Hospital , Korea (South) Hee Seok Choi
  • - Severance hospital , Korea (South) Saerom Hong
  • - Vikram hospital , India Pravin Mahadevappa
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