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