Imaging Spectrum of Castleman's Disease
Sheung-Fat Ko1,
Ming-Jeng Hsieh2,
Shu-Hang Ng3,4,
Jui-Wei Lin5,
Yung-Liang Wan3,4,
Tze-Yu Lee1,
Wei-Jen Chen5 and
Min-Chi Chen6
1 Department of Radiology, Chang Gung Memorial Hospital at Kaohsiung, Chang Gung
University, 123 Ta-Pei Rd., Niao-Sung Hsiang, Kaohsiung Hsien 833,
Taiwan.
2 Department of Cardiovascular and Thoracic Surgery, Chang Gung Memorial
Hospital at Kaohsiung, Chang Gung University, Kaohsiung Hsien, Taiwan.
3 Department of Radiology, Chang Gung Memorial Hospital at Keelung, Chang Gung
University, Keelung Hsien, Taiwan.
4 Department of Radiology, Chang Gung Memorial Hospital at Linkou, Chang Gung
University, Taoyuen Hsien, Taiwan.
5 Department of Pathology, Chang Gung Memorial Hospital at Kaohsiung, Chang Gung
University, Kaohsiung Hsien, Taiwan.
6 Department of Public Health and Biostatistics, Chang Gung Memorial Hospital at
Kaohsiung, Chang Gung University, Kaohsiung Hsien, Taiwan.
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Fig. 1A. —25-year-old asymptomatic man with right posterior mediastinal
hyaline-vascular Castleman's disease. Digital chest radiograph shows right
lower posterior mediastinal mass (open arrows) mimicking neurogenic
tumor. Note intratumoral calcifications (solid arrows) with somewhat
branchlike appearance.
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Fig. 1B. —25-year-old asymptomatic man with right posterior mediastinal
hyaline-vascular Castleman's disease. Unenhanced CT scan using bone window
setting reveals posterior mediastinal mass (arrow) with typical
"arborizing" pattern of intralesional calcifications.
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Fig. 1C. —25-year-old asymptomatic man with right posterior mediastinal
hyaline-vascular Castleman's disease. Contrast-enhanced chest CT scan shows
intense enhancement of mass (arrow).
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Fig. 1D. —25-year-old asymptomatic man with right posterior mediastinal
hyaline-vascular Castleman's disease. Photomicrograph of histopathologic
section shows typical features of hyaline-vascular Castleman's disease with
hyalinized vessels within germinal follicle (arrows) formed by
onionlike sheets of lymphocytes and intervening prominent vascular stromata.
(H and E, x100)
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Fig. 2A. —60-year-old woman with thoracic plasma cell Castleman's
disease who presented with chest tightness. Posteroanterior chest radiograph
shows widening of upper mediastinum, aortopulmonary and azygos adenopathy, and
enlargement of hila (arrows) with extension of lesion below right
hilum.
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Fig. 2B. —60-year-old woman with thoracic plasma cell Castleman's
disease who presented with chest tightness. Coronal (B) and axial
(C) T1-weighted images show aortopulmonary, paratracheal, azygos,
bilateral hilar, and subcarinal adenopathy, as well as encasement of bronchi
and pulmonary vessels.
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Fig. 2C. —60-year-old woman with thoracic plasma cell Castleman's
disease who presented with chest tightness. Coronal (B) and axial
(C) T1-weighted images show aortopulmonary, paratracheal, azygos,
bilateral hilar, and subcarinal adenopathy, as well as encasement of bronchi
and pulmonary vessels.
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Fig. 2D. —60-year-old woman with thoracic plasma cell Castleman's
disease who presented with chest tightness. Photomicrograph of histopathologic
section shows typical features of plasma cell Castleman's disease with
germinal follicle (arrows) and interfollicular infiltrations of dense
plasma cells. (H and E, x200)
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Fig. 3A. —32-year-old man with anterior mediastinal hyaline-vascular
Castleman's disease who presented with anterior chest pain. Posteroanterior
chest radiograph shows widened anterior mediastinum (arrows)
mimicking thymoma or lymphoma.
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Fig. 3B. —32-year-old man with anterior mediastinal hyaline-vascular
Castleman's disease who presented with anterior chest pain. Contrast-enhanced
chest CT scan shows matted lymphadenopathy (arrows) formed by
confluence of inhomogeneously enhancing enlarged lymph nodes confined to
anterior mediastinum.
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Fig. 4A. —26-year-old asymptomatic woman with hyaline-vascular
Castleman's disease in right major fissure incidentally found on chest
radiographs; interlobar pleural mass with prominent vessels on lesion surface
and marked adhesion to adjacent lung tissues were noted during surgery.
Posteroanterior chest radiograph shows incomplete upper border of mass
(arrows) over right lower lung field suggestive of pleural lesion
abutting fissure.
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Fig. 4B. —26-year-old asymptomatic woman with hyaline-vascular
Castleman's disease in right major fissure incidentally found on chest
radiographs; interlobar pleural mass with prominent vessels on lesion surface
and marked adhesion to adjacent lung tissues were noted during surgery.
Lateral chest radiograph shows well-defined interlobar mass
(arrows).
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Fig. 4C. —26-year-old asymptomatic woman with hyaline-vascular
Castleman's disease in right major fissure incidentally found on chest
radiographs; interlobar pleural mass with prominent vessels on lesion surface
and marked adhesion to adjacent lung tissues were noted during surgery.
Contrast-enhanced chest CT scan using lung window setting shows well-defined
nodule (arrows) along right major fissure.
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Fig. 5A. —32-year-old asymptomatic woman with pericardial
hyaline-vascular Castleman's disease incidentally found on chest radiographs;
ovoid mass embedded within proliferated pericardial fat adjacent to right
atrium was confirmed during surgery. Posteroanterior (A) and lateral
(B) chest radiographs show focal bulge (arrow) of right
posterior heart border simulating pericardial cyst.
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Fig. 5B. —32-year-old asymptomatic woman with pericardial
hyaline-vascular Castleman's disease incidentally found on chest radiographs;
ovoid mass embedded within proliferated pericardial fat adjacent to right
atrium was confirmed during surgery. Posteroanterior (A) and lateral
(B) chest radiographs show focal bulge (arrow) of right
posterior heart border simulating pericardial cyst.
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Fig. 5C. —32-year-old asymptomatic woman with pericardial
hyaline-vascular Castleman's disease incidentally found on chest radiographs;
ovoid mass embedded within proliferated pericardial fat adjacent to right
atrium was confirmed during surgery. Contrast-enhanced chest CT scan shows
proliferation of right pericardial fat (solid arrows) adjacent to
right atrium and homogeneous, well-enhanced intrapericardial nodule (open
arrow) with central calcification.
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Fig. 6. —28-year-old man presented with obesity and hypertension with
lung mass found incidentally on chest radiograph; right upper lobectomy
confirmed presence of intrapulmonary hyaline-vascular Castleman's disease.
Posteroanterior chest radiograph reveals solitary lung mass (solid
arrows) in right upper lobe with inferior border contacting right minor
fissure (open arrow).
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Fig. 7. —7-year-old girl with hyaline-vascular Castleman's disease who
presented with cough. Contrast-enhanced chest CT scan shows well-defined left
anterior mediastinal mass with homogeneous enhancement and prominent tumor
vessels (arrows) at its periphery.
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Fig. 8. —38-year-old man with hyaline-vascular Castleman's disease who
presented with intermittent fever and cough. Contrast-enhanced chest CT scan
shows right posterior mediastinal mass (open arrow) with extension to
azygoesophageal recess, mild erosion of adjacent vertebral body (black
arrow), and partial bronchial encasement (solid white
arrows).
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Fig. 9A. —35-year-old asymptomatic man with right paratracheal
hyaline-vascular Castleman's disease treated by thoracoscopic excision.
Contrast-enhanced chest CT scan shows well-defined right paratracheal nodule
with enhanced rim (arrows) and central hypodensity.
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Fig. 9B. —35-year-old asymptomatic man with right paratracheal
hyaline-vascular Castleman's disease treated by thoracoscopic excision.
Photomicrograph of histopathologic section shows mildly distorted germinal
follicle (arrows) and marked central fibrotic and degenerative
changes (triangles). (H and E, x100)
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Fig. 10A. —58-year-old woman presented with aggravating dyspnea for 3
months; anemia and hyperalbuminemia were also noted. Histopathologic
examination of thoracoscopic biopsied specimen of left basal lung revealed
infiltrations of lymphocytes and plasma cells around bronchiole. Diagnosis of
multicentric plasma cell Castleman's disease was confirmed by biopsies of
enlarged neck and retroperitoneal lymph nodes. Posteroanterior chest
radiograph shows interstitial opacities in lower lobes and focal opacity
(arrow) in left lower lobe.
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Fig. 10B. —58-year-old woman presented with aggravating dyspnea for 3
months; anemia and hyperalbuminemia were also noted. Histopathologic
examination of thoracoscopic biopsied specimen of left basal lung revealed
infiltrations of lymphocytes and plasma cells around bronchiole. Diagnosis of
multicentric plasma cell Castleman's disease was confirmed by biopsies of
enlarged neck and retroperitoneal lymph nodes. High-resolution CT scan of lung
shows poorly defined centrilobular nodules (white arrows), minimal
interlobular septal thickening, mild bronchiectasis, small subpleural
thin-walled cysts (black arrow), and subpleural nodules.
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Fig. 10C. —58-year-old woman presented with aggravating dyspnea for 3
months; anemia and hyperalbuminemia were also noted. Histopathologic
examination of thoracoscopic biopsied specimen of left basal lung revealed
infiltrations of lymphocytes and plasma cells around bronchiole. Diagnosis of
multicentric plasma cell Castleman's disease was confirmed by biopsies of
enlarged neck and retroperitoneal lymph nodes. Contrast-enhanced abdominal CT
scan shows hepatosplenomegaly and enlarged retroperitoneal lymph nodes
(arrows).
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Fig. 11A. —38-year-old woman admitted for preoperative evaluation of
cervical cancer; coexistent left retroperitoneal hyaline-vascular Castleman's
disease was incidentally found. Abdominal radiograph shows retroperitoneal
mass with typical "arborizing" calcifications
(arrows).
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Fig. 11B. —38-year-old woman admitted for preoperative evaluation of
cervical cancer; coexistent left retroperitoneal hyaline-vascular Castleman's
disease was incidentally found. Abdominal CT scan at level of lower pole of
left kidney (white open arrow) shows heterogeneously enhanced
retroperitoneal mass (black open arrow) with multiple hypodense areas
and peripherally located calcifications (solid arrows).
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Fig. 12. —36-year-old woman with hyaline-vascular Castleman's disease
who presented with vague left abdominal pain. Enhanced abdominal CT scan shows
well-defined mesenteric mass (arrows) with homogeneously intense
enhancement.
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Fig. 13. —46-year-old man with hyaline-vascular Castleman's disease who
presented with lower leg numbness. Contrast-enhanced pelvic CT scan shows
well-defined pelvic mass with areas of focal necrosis (arrows) and
erosion of left sacral bone.
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Fig. 14A. —42-year-old man with hyaline-vascular Castleman's disease who
presented with neck pain and mass in right lower neck that was slowly
enlarging for several years. Axial T1-weighted image reveals slightly
hyperintense mass (arrow) in right supraclavicular fossa with
prominent tumor vessels with flow void.
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Fig. 14B. —42-year-old man with hyaline-vascular Castleman's disease who
presented with neck pain and mass in right lower neck that was slowly
enlarging for several years. Doppler sonogram of neck shows slightly
hypoechoic mass with prominent peripheral vascularity (open arrows)
and feeding artery (solid arrow) penetrating mass.
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