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Weekly Chest CasesArchive of Old Cases

Case No : 1008 Date 2017-02-20

  • Courtesy of Chan Ho Park, Sang Young Oh, En Jin Chae, Kyung Hyun Do, Jae Woo Song / Asan Medical Center
  • Age/Sex 54 / M
  • Chief ComplaintIncidental abnormal finding, anemia
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Diagnosis With Brief Discussion

Diagnosis
Multicentric castleman disease (plasma cell type)
Radiologic Findings
Chest PA view shows bilateral hilar enlargement and multiple nodular opacities in both lung fields. CT scan shows multiple enlarged lymph nodes in the mediastinum, bilateral hila and axillae. There is poorly defined ground-glass opacities in centrilobular distribution and suspicious interstitial thickening in both lungs.
Brief Review
Castleman disease is a non-clonal lymphoproliferative disorder and one of the more common causes of nonneoplastic lymphadenopathy. There are two major histopathologic classification of Castleman disease: Hyaline vascular type & Plasma cell type.
Plasma cell type much more common multicentric form occurs in an older age group, with a median age in the 6th decade. Plasma cell type of Castleman disease is frequently associated with (a) systemic manifestations such as fever, night sweats, and malaise; (b) hematologic and immunologic abnormalities such as anemia, thrombocytopenia, and hyperglobulinemia;
and (c) splenomegaly (5)
Plasma cell type of Castleman disease typically demonstrates less avid enhancement after contrast material administration as compared to the hyaline vascular type. Calcification is uncommon. Plasma cell Castleman disease occurs more frequently as multicentric Castleman disease, with diffuse lymphadenopathy that involves multiple anatomic regions, including hilar and mediastinum, abdominal, pelvic, or cervical lymphadenopathy. Diffuse centrilobular pulmonary parenchymal nodular opacities in cases of plasma cell Castleman disease are often associated with lymphocytic interstitial pneumonitis.
References
1. Bonekamp D, Horton KM, HrubanRH, et al. Castleman disease the greast mimic. Radiographics 2011 ;31 :1793-1807.
2. Ko SF, Hsieh MJ, Ng SH, et al. Imaging spectrum of Castleman’s disease. AJR 2004 ;182 :769-775.
Keywords
Lung, Lymph node,

No. of Applicants : 100

▶ Correct Answer : 23/100,  23.0%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Otsu Municipal Hospital , Japan NORIATSU ICHIBA
  • - Yokohama-asahi-chuo-general hospital , Japan KYOKO NAGAI
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Kizawa Memorial Hospital , Japan Tomohiro Ando
  • - Apollo hospital , India SAMSON K
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Yonsei University, Wonju Severance Christian Hospital , Korea (South) JUYEON LEE
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Kanto Rosai Hospital , Japan TAKU TAJIMA
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - The University of Tokyo Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - University of Tsukuba , Japan Toshitaka Ishiguro
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - Korea University Ansan Hospital , Korea (South) CHERRY KIM
▶ Correct Answer as Differential Diagnosis : 12/100,  12.0%
  • - Hyogo Prefectural Amagasaki General Medical Center , Japan TOMOAKI OTANI
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONG SU KANG
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Samsung Medical Center , Korea (South) KYOWON GU
  • - Dong-a University Medical Center , Korea (South) WON JIN CHOI
  • - Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
  • - Other , Korea (South) HAYEON LEE
  • - , Australia RASHID HASHMI
  • - Aerospace medical group, Air Force Education and Training Command , Korea (South) Donghwan Kim
  • - Korea University Guro Hospital , Korea (South) HWANSEOK YONG
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