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Pickhardt PJ, Wong VK, Mellnick V, Sugi M, Aswani Y. Abdominal CT findings characteristic of Castleman disease: multi-centre review of 76 adult cases with abdominopelvic nodal involvement. Br J Radiol 2024; 97:1431-1436. [PMID: 38830085 PMCID: PMC11256932 DOI: 10.1093/bjr/tqae111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/29/2024] [Accepted: 05/24/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE Characterize the CT findings of abdominopelvic Castleman disease, including a new observation involving the perinodal fat. METHODS Multi-centre search at 5 institutions yielded 76 adults (mean age, 42.1 ± 14.3 years; 38 women/38 men) meeting inclusion criteria of histopathologically proven Castleman disease with nodal involvement at abdominopelvic CT. Retrospective review of the dominant nodal mass was assessed for size, attenuation, and presence of calcification, and for prominence and soft-tissue infiltration of the perinodal fat. Hypervascular nodal enhancement was based on both subjective and objective comparison with aortic blood pool attenuation. RESULTS Abdominal involvement was unicentric in 48.7% (37/76) and multicentric in 51.3% (39/76), including 31 cases with extra-abdominal involvement. Histopathologic subtypes included hyaline vascular variant (HVV), plasma cell variant (PCV), mixed HVV/PCV, and HHV-8 variant in 39, 25, 3 and 9 cases, respectively. The dominant nodal mass measured 4.4 ± 1.9 cm and 3.2 ± 1.7 cm in mean long- and short-axis, respectively, and appeared hypervascular in 58.6% (41/70 with IV contrast). Internal calcification was seen in 22.4% (17/76). Infiltration of the perinodal fat, with or without hypertrophy, was present in 56.6% (43/76), more frequent with hypervascular vs non-hypervascular nodal masses (80.5% vs 20.7%; P < .001). Among HVV cases, 76.9% were unicentric, 71.1% appeared hypervascular, and 69.2% demonstrated perinodal fat infiltration. CONCLUSION Hypervascular nodal masses demonstrating prominence and infiltration of perinodal fat at CT can suggest the specific diagnosis of Castleman disease, especially the HVV. ADVANCES IN KNOWLEDGE Abdominopelvic nodal masses that demonstrate hypervascular enhancement and prominent infiltration of the perinodal fat at CT can suggest the diagnosis of Castleman disease, but nonetheless requires tissue sampling.
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Affiliation(s)
- Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792-3252, United States
| | - Vincenzo K Wong
- Department of Abdominal Imaging, MD Anderson Cancer Center, Houston, TX 77030-4009, United States
| | - Vincent Mellnick
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO 63110, United States
| | - Mark Sugi
- Department of Radiology, University of California-San Francisco, San Francisco, CA 94143, United States
| | - Yashant Aswani
- Department of Radiology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, Iowa 52242, United States
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Yaynishet YA, Abera MT, Reta BK, Dojamo DD, Abrar FN, Legesse TK, Dessie TA. Castleman disease of the renal hilum: A rare case report. Radiol Case Rep 2024; 19:3130-3135. [PMID: 38774652 PMCID: PMC11107099 DOI: 10.1016/j.radcr.2024.04.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 05/24/2024] Open
Abstract
Castleman's disease is a rare benign lymphangioproliferative disorder. The hyaline vascular subtype has a better outcome and is curable after surgical resection. Typically, Castleman disease manifests in the thorax, with rare reports of a renal hilum location. We present a 42-year-old male patient who had an incidentally detected right hilar hyaline vascular type of Castleman's disease, which we managed with surgical excision. Cross-sectional imaging modalities help in suggesting the diagnosis based on enhancement patterns and, more importantly, define the extent of the tumor pre-operatively. Although the renal hilum is a rare location for Castleman disease, it needs to be considered when imaging features suggest it.
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Affiliation(s)
- Yodit Abraham Yaynishet
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia
| | | | - Birhanu Kassie Reta
- Addis Ababa University, College of Health Sciences, Department of Pathology, Addis Ababa, Ethiopia
| | - Demelash Darota Dojamo
- Addis Ababa University, College of Health Sciences, Department of Pathology, Addis Ababa, Ethiopia
| | - Fadil Nuredin Abrar
- Addis Ababa University, College of Health Sciences, Department of Pathology, Addis Ababa, Ethiopia
| | - Tesfaye Kebede Legesse
- Addis Ababa University, College of Health Sciences, Department of Radiology, Addis Ababa, Ethiopia
| | - Tesfahun Amsal Dessie
- Addis Ababa University, College of Health Sciences, Department of Urology, Addis Ababa, Ethiopia
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Sun X, Du Y, Zhang Y, Wang R, Hou D. Unicentric Castleman disease: multidetector computed tomography classification with surgical and pathologic correlation. Quant Imaging Med Surg 2021; 11:3562-3568. [PMID: 34341731 DOI: 10.21037/qims-20-1033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/12/2021] [Indexed: 11/09/2022]
Abstract
Background This study aimed to correlate multidetector computed tomography (MDCT) classification of unicentric Castleman disease with the surgical and pathologic features. Methods The imaging manifestations of 63 cases of unicentric Castleman disease confirmed by pathology were retrospectively analyzed. Every patient underwent an MDCT examination. Classification based on imaging manifestations, surgical, histopathological, and imaging features were simultaneously reviewed and analyzed by two radiologists, with any disagreements resolved by consensus. Results Sixty-three patients with unicentric Castleman disease were divided into I-IV types by imaging manifestations: type I, single mass with smooth margin (n=5); type II, single mass with irregular or lobulated margin (n=33); type III, single invasive mass with blurred margin (n=20); and type IV, multiple fused masses (n=5). Thirty-eight cases of type I and type II were diagnosed as hyaline-vascular type by pathology after complete surgical resection; 20 cases were type III, in which eight cases were partially resected, 17 cases were pathologically diagnosed as hyaline-vascular type, and the remaining three cases were a mixed type. In five cases of type IV that could not be completely resected, four cases were hyaline-vascular type, and one case was plasma cell type. Conclusions MDCT is an excellent tool for the detection and diagnosis of unicentric Castleman disease. Classification by MDCT features is a reliable method for evaluating tumor infiltration and growth mode, which helps surgical optimization.
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Affiliation(s)
- Xiaoli Sun
- Department of Radiology, Beijing Shijitan Hospital, Peking University Ninth School of Clinical Medicine, Capital Medical University, Beijing, China
| | - Ye Du
- Department of Nephrology, Beijing Shijitan Hospital, Peking University Ninth School of Clinical Medicine, Capital Medical University, Beijing, China
| | - Ying Zhang
- Department of Pathology, Beijing Shijitan Hospital, Peking University Ninth School of Clinical Medicine, Capital Medical University, Beijing, China
| | - Rengui Wang
- Department of Radiology, Beijing Shijitan Hospital, Peking University Ninth School of Clinical Medicine, Capital Medical University, Beijing, China
| | - Dailun Hou
- Department of Radiology, Beijing Chest Hospital, Capital Medical University, Beijing, China
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Mindiola-Romero AE, Liu X, Dillon JL, Talarico M, Smith G, Zhang L, Linos K. Metastatic low-grade endometrial stromal sarcoma after 24 years: A case report and review of recent molecular genetics. Diagn Cytopathol 2020; 49:E99-E105. [PMID: 32910526 DOI: 10.1002/dc.24601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/09/2020] [Accepted: 08/11/2020] [Indexed: 12/12/2022]
Abstract
Low-grade endometrial stromal sarcoma (LGESS) is a rare malignant uterine tumor with the potential to metastasize years after the primary resection. There is a broad differential diagnosis for endometrial stromal sarcomas (ESS), including both benign and malignant entities. Herein, we present the case of a 64-year-old female with metastatic LGESS to the lung, diagnosed by cytology, 24 years after her initial presentation. This report discusses the cytomorphologic and histopathologic characteristics, and ancillary studies including immunohistochemical stains and recent advances in molecular diagnostics of ESS. Accurate diagnosis of spindle cell lesions in the lung can be challenging. As such, this case highlights the instrumental role of ancillary testing and molecular diagnostics to achieve a more definitive diagnosis.
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Affiliation(s)
- Andres E Mindiola-Romero
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Xiaoying Liu
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Jessica L Dillon
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Michael Talarico
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Geoffrey Smith
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Linsheng Zhang
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Konstantinos Linos
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
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Ashjaei B, Ghamari Khameneh A, Darban Hosseini Amirkhiz G. Abdominal Mass Caused Failure to Thrive in a Young Boy: Mixed-Type Localized Retroperitoneal Castleman Disease. Case Rep Oncol 2020; 13:853-856. [PMID: 32884530 PMCID: PMC7443682 DOI: 10.1159/000508531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 11/19/2022] Open
Abstract
Castleman disease is a rare cause of retroperitoneal mass in children. Clinical presentation and laboratory findings are usually nonspecific. Imaging shows features of a hypervascular or soft tissue mass. We present a 12-year-old boy who complained of frequent colds, fatigue, and failure to gain weight for the past 4 years who was referred to our hospital. Anemia and hypergammaglobulinemia were revealed in laboratory tests. Imaging showed a well-delineated retroperitoneal soft tissue mass with intense homogenous enhancement at the midline below the aortic bifurcation. The histopathological features were consistent with mixed type unicentric Castleman disease. Surgical removal was curative. Our patient's hematological abnormalities resolved, and he gained 10 kg in the next 4 weeks after the operation and reached the 25–50th percentile for his age.
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Affiliation(s)
- Bahar Ashjaei
- Department of Pediatric Surgery, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshar Ghamari Khameneh
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gisoo Darban Hosseini Amirkhiz
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, Iran
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Smedile A, Capuano F, Fraticelli S, Lucioni M, La Fianza A. Unicentric or Multicentric Castleman disease? A case report of a pelvic intraperitoneal mass in a middle aged woman. J Radiol Case Rep 2019; 13:28-36. [PMID: 31565175 DOI: 10.3941/jrcr.v13i3.3387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Castleman Disease is a lymphoid disorder characterized by the presence of an enlarged or abnormal lymph node/lymphatic tissue. The disease is classified into unicentric or multicentric variants. The unicentric form is a benign disorder that is usually asymptomatic and consists of a single lymphoid mass that is predominantly located in the mediastinum, but can also rarely develop in the neck or abdomen. The multicentric type involves more than one lymphatic station and is related to the presence of type B symptoms (fevers, night sweats and weight loss), HIV/HHV8 infection and increased serum IL-6 levels. We present the case of an unusual pelvic intraperitoneal manifestation of Castleman Disease in a 52-year-old caucasian woman who showed clinical, radiological, histological and laboratory findings common to both Unicentric and Multicentric Castleman Disease.
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Affiliation(s)
- Antonella Smedile
- Department of Diagnostic Imaging Institute of Radiology, IRCCS Foundation Policlinic San Matteo, University of Pavia, Pavia, Italy
| | - Francesca Capuano
- Department of Anatomic Pathology, IRCCS Foundation Policlinic San Matteo, University of Pavia, Pavia, Italy
| | - Sara Fraticelli
- Department of Anatomic Pathology, IRCCS Foundation Policlinic San Matteo, University of Pavia, Pavia, Italy
| | - Marco Lucioni
- Department of Anatomic Pathology, IRCCS Foundation Policlinic San Matteo, University of Pavia, Pavia, Italy
| | - Alfredo La Fianza
- Department of Diagnostic Imaging Institute of Radiology, IRCCS Foundation Policlinic San Matteo, University of Pavia, Pavia, Italy
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Ferreira Junior EG, Apolinario Costa P, Freire Golveia Silveira LM, Valois Vieira R, Lima Martins Soares HA, Menon Loureiro B, Pertile Salvioni NC, Coelho Ferreira Rocha JR. Localized pancreatic Castleman disease presenting with extrahepatic dilatation of bile ducts: A case report and review of published cases. Int J Surg Case Rep 2018; 54:28-33. [PMID: 30513495 PMCID: PMC6279997 DOI: 10.1016/j.ijscr.2018.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/27/2018] [Accepted: 11/08/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Castleman disease (CD) is a rare polyclonal lymphoproliferative disorder of unknown etiology, which usually develops in the mediastinum. It can also occur in the cervical, retroperitoneal and axillary regions. Localized pancreatic CD is quite rare [1]. PRESENTATION OF CASE The authors herein present a case of a 34 years old female that was diagnosed during a symptomatic cholelithiasis evaluation. During the evaluation, an abdominal ultrasonography revealed a tumor at the head of the pancreas, which went on to generate a dilatation of the extrahepatic bile ducts. This finding was confirmed by abdominal magnetic resonance imaging (MRI). Subsequently, the patient underwent a laparotomy, where a capsulated tumor was found at the head of the pancreas with well-defined margins. The decision was made for tumor excision. The histopathology and immunohistochemistry established CD, hyaline vascular variation. DISCUSSION The authors of the present paper also performed a literature review concerning Pancreatic CD, where there were found only 33 cases until the time of the writing of this paper, and we have subsequently carried out a retrospective analysis of all cases. In a patient with atypical images, there might be a benefit from a preoperative diagnosis of CD, by using immunohistochemistry analysis in an image guided biopsy. Thus, avoiding unnecessary procedures and surgeries. CONCLUSION Localized pancreatic CD is a very rare condition with good prognosis, but it can mimic many common diseases, such as gastrointestinal stromal tumor (GIST), pancreatic neuroendocrine tumor or pancreatic adenocarcinoma.
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Affiliation(s)
- Edson Gonçalves Ferreira Junior
- Universidade Federal do Vale do São Francisco, Av. José de Sá Maniçoba, S/N - Centro, CEP: 56304-917, Petrolina, PE, Brazil.
| | - Philippos Apolinario Costa
- Universidade Federal do Vale do São Francisco, Av. José de Sá Maniçoba, S/N - Centro, CEP: 56304-917, Petrolina, PE, Brazil.
| | | | - Rafael Valois Vieira
- Universidade Federal do Vale do São Francisco, Av. José de Sá Maniçoba, S/N - Centro, CEP: 56304-917, Petrolina, PE, Brazil.
| | - Hugo Alessi Lima Martins Soares
- Universidade Federal do Vale do São Francisco, Av. José de Sá Maniçoba, S/N - Centro, CEP: 56304-917, Petrolina, PE, Brazil.
| | - Bruna Menon Loureiro
- Universidade Federal do Vale do São Francisco, Av. José de Sá Maniçoba, S/N - Centro, CEP: 56304-917, Petrolina, PE, Brazil.
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Marko J, Wolfman DJ. Retroperitoneal Leiomyosarcoma From the Radiologic Pathology Archives. Radiographics 2018; 38:1403-1420. [PMID: 30207936 PMCID: PMC6166742 DOI: 10.1148/rg.2018180006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 04/21/2018] [Accepted: 04/26/2018] [Indexed: 12/28/2022]
Abstract
Leiomyosarcoma is a malignant neoplasm that shows smooth muscle differentiation. It is the second most common sarcoma to affect the retroperitoneum. Retroperitoneal leiomyosarcomas may grow to large sizes before detection and may be an incidental finding at imaging. When symptomatic, retroperitoneal leiomyosarcoma may cause compressive symptoms, including pain. Retroperitoneal leiomyosarcoma most commonly manifests as a large soft-tissue mass, with areas of necrosis. The most frequent pattern of growth is an entirely extravascular mass. Less commonly, leiomyosarcoma may demonstrate both extravascular and intravascular components. Rarely, retroperitoneal leiomyosarcomas are completely intravascular, typically arising from the inferior vena cava. Given its variable imaging features, a large variety of neoplastic and nonneoplastic conditions are included in the differential diagnosis of retroperitoneal leiomyosarcoma. In this review, the authors discuss retroperitoneal leiomyosarcoma, with emphasis on the pathologic basis of disease, and illustrate the multimodality imaging appearances of retroperitoneal leiomyosarcoma using cases from the Radiologic Pathology Archives of the American Institute for Radiologic Pathology. The authors review important differential considerations of retroperitoneal leiomyosarcoma, focusing on the extravascular pattern of growth, and emphasize clinical and imaging features that help radiologists differentiate leiomyosarcoma from the most frequent mimics. The information presented in this review will aid radiologists in fulfilling their key roles in the diagnosis, operative planning, and follow-up of patients with retroperitoneal leiomyosarcoma.
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Affiliation(s)
- Jamie Marko
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (J.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); and Community Radiology Division, Johns Hopkins School of Medicine, Washington, DC (D.J.W.)
| | - Darcy J. Wolfman
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (J.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); and Community Radiology Division, Johns Hopkins School of Medicine, Washington, DC (D.J.W.)
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Sundar P, Bijalwan P, Pooleri GK. Castleman's Disease: a Suprarenal Surprise! Indian J Surg Oncol 2018; 9:254-255. [PMID: 29887711 DOI: 10.1007/s13193-018-0737-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/08/2018] [Indexed: 11/26/2022] Open
Abstract
Castleman's disease is a distinct form of lymph node hyperplasia. It commonly presents as a mediastinal mass and rarely as a solitary retroperitoneal mass. We narrate a case of Castleman's disease presenting as a right suprarenal mass emphasising the usefulness of robot-assisted retroperitoneoscopy in surgical management of retroperitoneal masses in close relation to vital structures.
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Affiliation(s)
- Praveen Sundar
- 1Department of Urology, Amrita Institute of Medical Sciences (AIMS), Kochi, Kerala India
| | - Priyank Bijalwan
- 2Division of Uro-oncology, Department of Urology, Amrita Institute of Medical Sciences (AIMS), Ponekkara PO, Kochi, Kerala 682041 India
| | - Ginil Kumar Pooleri
- 2Division of Uro-oncology, Department of Urology, Amrita Institute of Medical Sciences (AIMS), Ponekkara PO, Kochi, Kerala 682041 India
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Martino G, Cariati S, Tintisona O, Veneroso S, De Villa F, Vergine M, Monti M. Atypical Lymphoproliferative Disorders: Castleman's Disease Case Report and Review of the Literature. TUMORI JOURNAL 2018; 90:352-5. [PMID: 15315321 DOI: 10.1177/030089160409000319] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Castleman's disease (CD) is a rare atypical lymphoproliferative disorder characterized by enlarged hyperplastic lymph nodes with striking vascular proliferations. CD is categorized as being either localized or disseminated and further subdivided into hyaline-vascular, plasma cell, or mixed histopathological patterns. Here we report a case of CD in a 15-year-old girl who presented with a solitary asymptomatic hyaline-vascular mass in the right supraclavicular space. In addition, we discuss the pathogenesis, clinical features and reported comorbidities of unicentric and multicentric CD and evaluate effective treatment strategies based on the results of lymph node biopsy and careful staging. Surgical excision is curative for the localized variants of CD, either hyaline-vascular or plasma cell type. If complete resection is not possible, partial resection or radiotherapy may be useful to control possible systemic manifestations. Multicentric CD, regardless of the histological subtype, is a more aggressive clinical entity, commonly with a chronic or rapidly fatal course. Patients with multicentric CD do not benefit from surgical treatment and should be candidates for systemic therapy (steroids, combination chemotherapy, novel therapies), although this is still in a fairly experimental phase.
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Affiliation(s)
- Giovanni Martino
- Department of Surgical Sciences, Section of General and Plastic Surgery, University La Sapienza, Rome, Italy.
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Yu MH, Kim YJ, Park HS, Jung SI, Jeon HJ. Imaging Patterns of Intratumoral Calcification in the Abdominopelvic Cavity. Korean J Radiol 2017; 18:323-335. [PMID: 28246512 PMCID: PMC5313520 DOI: 10.3348/kjr.2017.18.2.323] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/20/2016] [Indexed: 12/12/2022] Open
Abstract
Intratumoral calcification is one of the most noticeable of radiologic findings. It facilitates detection and provides information important for correctly diagnosing tumors. In the abdominopelvic cavity, a wide variety of tumors have calcifications with various imaging features, though the majority of such calcifications are dystrophic in nature. In this article, we classify the imaging patterns of intratumoral calcification according to number, location, and morphology. Then, we describe commonly-encountered abdominopelvic tumors containing typical calcification patterns, focusing on their differentiable characteristics using the imaging patterns of intratumoral calcification.
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Affiliation(s)
- Mi Hye Yu
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Korea
| | - Young Jun Kim
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Korea
| | - Hee Sun Park
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Korea
| | - Sung Il Jung
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Korea
| | - Hae Jeong Jeon
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Korea
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Retroperitoneal unicentric Castleman's disease: A case report. Int J Surg Case Rep 2017; 31:54-57. [PMID: 28107758 PMCID: PMC5247283 DOI: 10.1016/j.ijscr.2016.12.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 12/28/2016] [Accepted: 12/29/2016] [Indexed: 12/11/2022] Open
Abstract
Retroperitoneal Castleman’s disease in the peripancreatic region is a rare entity. Preoperative diagnosis is most often difficult and mimics malignant disease. Surgical en bloc excision is the most commonly performed treatment due to diagnostic dilemma. Preoperative biopsy in cases with strong clinical suspicion can avoid radical surgery.
Introduction Castleman’s disease (CD) is an angio-follicular lymph node hyperplasia presenting as a localized or a systemic disease masquerading malignancy. The most common sites of CD are mediastinum, neck, axilla and pelvis. Unicentric CD in the peripancreatic region is very rare. Presentation of case We report a case of the 34-year-old lady presenting with epigastric pain for 3 months. Abdominal imaging revealed a retroperitoneal mass arising from the pancreas suspected to be neuroendocrine tumor. Tumor markers were not elevated. Complete surgical excision was performed and patient had uneventful recovery. Pathologic findings demonstrated localized hyaline-vascular type of Castleman’s disease. Discussion CD is a very rare cause for development of retroperitoneal mass. It is more frequent in young adults without predilection of sex. It can occur anywhere along the lymphoid chain. Abdominal and retroperitoneal locations usually present with symptoms due to the mass effect on adjacent organs. CD appears as a homogeneously hypoechoic mass on ultrasound and non-specific enhancing homogeneous mass with micro calcifications on computed tomography. Histologically, the hyaline vascular type demonstrates a follicular and inter-follicular capillary proliferation with peri-vascular hyalinization, with expansion of the mantle zones by a mixed inflammatory infiltrate of numerous small lymphocytes and plasma cells. The standard therapy of localized form is en bloc surgical excision as performed in our case. Conclusion Unicentric CD in the peripancreatic region is difficult to differentiate from pancreatic neoplasm preoperatively. However, preoperative biopsy in cases of high clinical suspicion can help in avoiding extensive surgery for this benign disease.
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A Palpable Painless Axillary Mass as the Clinical Manifestation of Castleman's Disease in a Patient with Hepatitis C Disease. Case Rep Med 2016; 2016:1970276. [PMID: 27313621 PMCID: PMC4893446 DOI: 10.1155/2016/1970276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 04/28/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction. Castleman's disease (CD) is a rare lymphoproliferative disorder. CD is divided into two clinical subtypes: the most common unicentric and the less usual multicentric subtype. The majority of unicentric CD affects the mediastinum, while neck, abdomen, and axilla are less common locations. Case Presentation. Herein, we describe a rare case of unicentric CD in the right axilla in a 36-year-old white male with a medical history of hepatitis C virus infection admitted to our hospital due to palpation of a painless mass in the right axilla. Complete excision of the lesion was performed and, one year after the diagnosis, patient was free of the disease. Conclusions. Although infrequent, it is important to include CD in the differential diagnosis when evaluating axillary lymphadenopathy particularly in young patients with a low-grade inflammation process and chronic disease even in the absence of an abnormal blood picture or organomegaly.
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Guthrie PJ, Thomas JV, Peker D, Turkbey B, Rais-Bahrami S. Perivesical unicentric Castleman disease initially suspected to be metastatic prostate cancer. Urol Ann 2016; 8:245-8. [PMID: 27141204 PMCID: PMC4839251 DOI: 10.4103/0974-7796.177196] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/26/2015] [Indexed: 11/28/2022] Open
Abstract
Unicentric Castleman disease (UCD) is a relatively rare lymphoproliferative disease, which commonly presents as a mediastinal mass and less frequently involves abdomen, pelvis, and retroperitoneum. We report a case of a 64-year-old man with newly diagnosed low-volume, Gleason 3 + 3 = 6 prostate adenocarcinoma, who in considering active surveillance versus treatment was found to have a left perivesical and iliac chain lymphadenopathy concerning for potential metastatic involvement. He underwent magnetic resonance imaging with ferumoxytol to assist in the diagnostic evaluation to better characterize his lymphadenopathy. Subsequently, he underwent robotic-assisted laparoscopic bilateral pelvic lymph node dissection and resection of left perivesical mass exhibiting hyaline vascular variant of UCD.
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Affiliation(s)
- Patrick J. Guthrie
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John V. Thomas
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Deniz Peker
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Baris Turkbey
- Department of Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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16
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Vassos N, Raptis D, Lell M, Klein P, Perrakis A, Köhler J, Croner RS, Hohenberger W, Agaimy A. Intra-abdominal localized hyaline-vascular Castleman disease: imaging characteristics and management of a rare condition. Arch Med Sci 2016; 12:227-32. [PMID: 26925142 PMCID: PMC4754385 DOI: 10.5114/aoms.2016.57600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/25/2014] [Indexed: 11/21/2022] Open
Affiliation(s)
- Nikolaos Vassos
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Dimitrios Raptis
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Michael Lell
- Institute of Diagnostic and Interventional Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Peter Klein
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | | | - Jens Köhler
- Department of Surgery, Nuremberg Medical Center, Nuremberg, Germany
| | - Roland S. Croner
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | | | - Abbas Agaimy
- Institute of Pathology, University Hospital Erlangen, Erlangen, Germany
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17
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Ikeura T, Horitani S, Masuda M, Kasai T, Yanagawa M, Miyoshi H, Uchida K, Takaoka M, Miyasaka C, Uemura Y, Okazaki K. IgG4-related Disease Involving Multiple Organs with Elevated Serum Interleukin-6 Levels. Intern Med 2016; 55:2623-8. [PMID: 27629957 DOI: 10.2169/internalmedicine.55.6919] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 63-year-old woman presented to our hospital with elevated levels of serum IgG4, marked wall thickening of the gallbladder, hepatomegaly, and abdominal lymphadenopathy. She experienced a recurrent fever and leg edema. Her laboratory data demonstrated anemia, hypoalbuminemia, and elevated serum levels of interleukin-6 and C-reactive protein. The patient was eventually diagnosed with IgG4-related disease according to the comprehensive diagnostic criteria, although the patient exhibited common clinical manifestations of multicentric Castleman disease such as a fever, anemia, lymphadenopathy, and elevated levels of serum interleukin-6 and C-reactive protein. This case report highlights the difficulties in differentiating between these two diseases.
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Affiliation(s)
- Tsukasa Ikeura
- The Third Department of Internal Medicine, Kansai Medical University, Japan
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18
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Suh JH, Hong SH, Jeong SC, Park CB, Choi KB, Shin OR, Choi SY. Anemia resolved by thoracoscopic resection of a mediastinal mass: a case report of unicentric Castleman's disease. J Thorac Dis 2015; 7:E189-93. [PMID: 26380750 DOI: 10.3978/j.issn.2072-1439.2015.07.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 06/29/2015] [Indexed: 11/14/2022]
Abstract
Castleman's disease (CD) is an uncommon benign lymphoproliferative disorder that usually presents as a single or multiple mediastinal mass. In unicentric CD, constitutional symptoms are rare, but are curable with surgical resection. However, serious intraoperative bleeding often requires conversion to thoracotomy. We present a case of unicentric CD in a 25-year-old woman with anemia, who was successfully treated by thoracoscopic resection. We describe the clinical course from the initial presentation to diagnosis and surgical cure.
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Affiliation(s)
- Jong Hui Suh
- 1 Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, 2 Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, 3 Department of Thoracic and Cardiovascular Surgery, 4 Department of Clinical Pathology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sook Hee Hong
- 1 Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, 2 Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, 3 Department of Thoracic and Cardiovascular Surgery, 4 Department of Clinical Pathology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seong Cheol Jeong
- 1 Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, 2 Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, 3 Department of Thoracic and Cardiovascular Surgery, 4 Department of Clinical Pathology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Beom Park
- 1 Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, 2 Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, 3 Department of Thoracic and Cardiovascular Surgery, 4 Department of Clinical Pathology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kuk Bin Choi
- 1 Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, 2 Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, 3 Department of Thoracic and Cardiovascular Surgery, 4 Department of Clinical Pathology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ok Ran Shin
- 1 Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, 2 Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, 3 Department of Thoracic and Cardiovascular Surgery, 4 Department of Clinical Pathology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Si Young Choi
- 1 Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary's Hospital, 2 Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, 3 Department of Thoracic and Cardiovascular Surgery, 4 Department of Clinical Pathology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
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19
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Zhou W, Zhan W, Zhou J, Zhu Y, Yao J. Sonographic findings of localized Castleman disease of the abdomen and pelvis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:401-405. [PMID: 25346169 DOI: 10.1002/jcu.22245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 09/07/2014] [Indexed: 06/04/2023]
Abstract
PURPOSE The purpose of this study was to sonographically evaluate the diagnosis of localized Castleman disease in the abdomen and pelvis. METHODS This was a retrospective analysis of 18 cases of Castleman disease localized in the abdomen and pelvis. The following features of the lesions were assessed on sonography (US): location, size, margin, echogenicity, echotexture, intralesional cystic necrosis, intralesional calcification, posterior acoustic enhancement, and blood supply. RESULTS Of the 18 tumors, 16 were located in the abdomen and 2 were located in the pelvis close to iliac vessels. The most frequent appearance of localized Castleman disease in the abdomen and pelvis on US was of a single, well-defined, hypoechoic solid mass with no intralesional cystic necrosis. The internal echotexture was homogeneous in 4 cases and heterogeneous in 14 cases, with thin hyperechoic septa (n = 14) or calcifications (n = 3). Posterior acoustic enhancement was seen in 17 of the 18 cases (94%). Ninety-four percent of the lesions (17/18) had marked vascularity on color Doppler US. CONCLUSIONS Localized Castleman disease in the abdomen and pelvis usually appears on US as a heterogeneously hypoechoic lesion containing thin septa, and more commonly than not, demonstrates posterior acoustic enhancement and marked vascularity.
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Affiliation(s)
- Wei Zhou
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weiwei Zhan
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianqiao Zhou
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Zhu
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiejie Yao
- Department of Ultrasound, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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20
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Cao W, Liang S, Liu J, Bai J, Li H. Castleman's disease presenting in the lungs: A report of two cases. Oncol Lett 2015; 10:1041-1043. [PMID: 26622622 DOI: 10.3892/ol.2015.3354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 05/14/2015] [Indexed: 12/11/2022] Open
Abstract
Castleman's disease (CD) is a rare disease that most commonly occurs in the mediastinum. The lung is a rare site in which CD may occur. The current study reported 2 cases of CD localized in the lungs. Computed tomography imaging identified a high-density mass in the lungs of the two patients. Biopsy and pathological examinations indicated that one case presented features of two CD types (hyaline-vascular and plasma cell types), while the other case suffered from multicentric CD. The present study highlighted the typical clinical features of CD in the lungs. In addition, it is proposed that a diagnosis of CD should be considered for certain patients with masses in the lungs, and a biopsy should be performed to facilitate diagnosis and treatment.
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Affiliation(s)
- Weijun Cao
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, P.R. China
| | - Shuo Liang
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, P.R. China
| | - Jinming Liu
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, P.R. China
| | - Jiuwu Bai
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, P.R. China
| | - Huiping Li
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, P.R. China
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21
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Acar T, Harman M, Guneyli S, Gemici K, Efe D, Guler I, Yildiz M. Cross-sectional Imaging Features of Primary Retroperitoneal Tumors and Their Subsequent Treatment. J Clin Imaging Sci 2015; 5:24. [PMID: 25973288 PMCID: PMC4421890 DOI: 10.4103/2156-7514.156135] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 04/08/2015] [Indexed: 02/07/2023] Open
Abstract
Basically malignant tumors in the retroperitoneal region arise from a heterogeneous group of tissues: mesodermal, neurogenic, germ cell, and lymphoid. Although rare, benign tumors and cystic masses can be also encountered in retroperitoneal space. Developments in computed tomography (CT) and magnetic resonance imaging (MRI) have contributed to both diagnosis and staging of the retroperitoneal tumors. High spatial resolution and superiority in calcification make CT indispensable; on the other hand, MRI has a better soft-tissue contrast resolution which is essential for the assessment of vascular invasion and tissue characterization. The aim of this article is to review the CT and MRI features of retroperitoneal tumors and their subsequent management.
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Affiliation(s)
- Turker Acar
- Department of Radiology, Mevlana University School of Medicine, Konya, Turkey
| | - Mustafa Harman
- Department of Radiology, Ege University School of Medicine, Izmir, Turkey
| | - Serkan Guneyli
- Department of Radiology, Bulent Ecevit University School of Medicine, Zonguldak, Turkey
| | - Kazim Gemici
- Department of General Surgery, Mevlana University School of Medicine, Konya, Turkey
| | - Duran Efe
- Department of Radiology, Mevlana University School of Medicine, Konya, Turkey
| | - Ibrahim Guler
- Department of Radiology, Konya Education and Research Hospital, Konya, Turkey
| | - Melda Yildiz
- Department of Radiology, Mevlana University School of Medicine, Konya, Turkey
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22
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YANG LING, ZHAO SHUANG, LIU RONGBO. Unicentric mesenteric Castleman's disease with littoral cell angioma, anemia, growth retardation and amenorrhea: A case report. Oncol Lett 2015; 9:1779-1781. [PMID: 25789041 PMCID: PMC4356425 DOI: 10.3892/ol.2015.2933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 01/08/2015] [Indexed: 02/05/2023] Open
Abstract
Castleman's disease (CD) is a rare lymphoproliferative disorder of unknown origin, and littoral cell angioma (LCA) is a rare vascular tumor of the spleen with an unknown etiology. The current study reports the case of a 28-year-old female who presented with anemia, growth retardation and amenorrhea. Physical examination revealed a mass in the mesentery, splenomegaly with multiple small nodules, hepatomegaly and an infantile uterus. Histopathological analysis of the resected mass and spleen confirmed the diagnosis of hyaline-vascular CD and LCA. The patient's anemia resolved, and menstruation and breast development also commenced following surgery. To the best of our knowledge, this is the first report of CD accompanied by littoral cell angioma, anemia, growth retardation and amenorrhea.
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Affiliation(s)
- LING YANG
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610000, P.R. China
| | - SHUANG ZHAO
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610000, P.R. China
| | - RONG-BO LIU
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610000, P.R. China
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23
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Chung EM, Biko DM, Arzamendi AM, Meldrum JT, Stocker JT. Solid Tumors of the Peritoneum, Omentum, and Mesentery in Children: Radiologic-Pathologic Correlation:From the Radiologic Pathology Archives. Radiographics 2015; 35:521-46. [DOI: 10.1148/rg.352140273] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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24
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Hill AJ, Tirumani SH, Rosenthal MH, Shinagare AB, Carrasco RD, Munshi NC, Ramaiya NH, Howard SA. Multimodality imaging and clinical features in Castleman disease: single institute experience in 30 patients. Br J Radiol 2015; 88:20140670. [PMID: 25710283 DOI: 10.1259/bjr.20140670] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To analyse imaging features of subtypes of Castleman disease (CD), emphasizing differentiating features from lymphoma. METHODS Institutional review board-approved, Health Insurance Portability and Accountability Act compliant, retrospective study examined 30 patients with CD. 30 patients (females, 20; mean age, 46 years; range, 22-87 years) with histopathologically confirmed CD and pre-treatment imaging formed the analytic cohort. Imaging at presentation in all patients [CT, 30; positron emission tomography (PET)/CT, 5; MR, 4; ultrasound, 3] and subsequent imaging in three cases that developed lymphoma was reviewed by two radiologists in consensus. RESULTS Subtypes: hyaline-vascular (n = 18); multicentric not otherwise specified (NOS) (n = 6); human herpesvirus 8 associated (n = 2); mixed unicentric (n = 2); pure plasma-cell variant (n = 1); and unicentric NOS (n = 1). Distribution: unicentric (n = 17); and multicentric (n = 13). Nodal sites-unicentric: 13 thoracic, 3 abdominal and 1 cervical; multicentric: 9 abdominal, 8 thoracic, 6 cervical, 5 inguinal, 4 axillary and 4 supraclavicular. On CT, differentiating features from lymphoma were calcification (n = 8; 26.7%) and heterogeneous enhancement (n = 5; 19.2%). No association between CD subtype, degree or enhancement pattern, or calcification was noted. On PET/CT (n = 5), nodes were typically fluorine-18 fludeoxyglucose avid (n = 4). On ultrasound (n = 3), nodes were hypoechoic, homogeneous with posterior acoustic enhancement. On MR (n = 4), nodes were hypointense (n = 2) to isointense (n = 2) on T1 weighted images and isointense (n = 1) to hyperintense (n = 3) on T2 weighted images. All (n = 4) demonstrated homogeneous enhancement. Three cases developed non-Hodgkin's lymphoma, two of the three had larger spleens, and these cases had effusions/ascites. CONCLUSION CD can be unicentric or multicentric and involve nodes above and below the diaphragm. Patients with CD can develop lymphoma. ADVANCES IN KNOWLEDGE Assessing individual risk of developing lymphoma in patients with CD is difficult, although the findings of splenomegaly, pleural effusion and ascites may be suggestive.
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Affiliation(s)
- A J Hill
- 1 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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25
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Abstract
Castleman disease (CD) was first described and most commonly occurs in the form of classic hyaline-vascular-type CD with hyperenhancing localized (unicentric) nonneoplastic lymphadenopathy. CD may affect any body region including unusual locations for isolated lymph node enlargement. This makes CD a great mimicker of more common benign and malignant masses in the neck, chest, abdomen, and pelvis. CD masses commonly raise the suspicion of lymphoma, paraganglioma, neuroendocrine tumor, metastatic adenopathy, solid parenchymal tumors, and infectious or inflammatory diseases. The less common plasma cell-type CD, mixed CD, and human herpes virus-8-associated CD (HHV8-CD) are more prone to lead to generalized (multicentric) adenopathy without the typical nodal hyperenhancement and are associated with B symptoms and hematologic and immunologic manifestations. The generalized forms of CD have a worse prognosis, which can approach that of malignancies. CD has multiple known associations with neoplasms, skin diseases, blood dyscrasias, and immunodeficiency, which include certain forms of lymphoma; paraneoplastic pemphigus; polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes syndrome; and plasma cell dyscrasias. Cytokine overproduction (IL-6) is an important pathogenetic factor in the development of CD. The treatment is accordingly variable, from curative or diagnostic resection of a solitary lesion to systemic chemotherapy or anti-IL-6 therapy.
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Affiliation(s)
- David Bonekamp
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University, Baltimore, MD.
| | - Ralph H Hruban
- Department of Pathology, The Johns Hopkins University, Baltimore, MD
| | - Elliot K Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University, Baltimore, MD
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26
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Aguilar-Rodriguez R, Milea SL, Demirci I, Herold S, Flasshove M, Klosterhalfen B, Kinkel H, Janßen H. Localized retroperitoneal Castleman's disease: a case report and review of the literature. J Med Case Rep 2014; 8:93. [PMID: 24612848 PMCID: PMC3977947 DOI: 10.1186/1752-1947-8-93] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 02/11/2014] [Indexed: 12/11/2022] Open
Abstract
Introduction Castleman’s disease, also known as angiofollicular lymph node hyperplasia, is a rare disease with two known expansion types, unicentric and multicentric, which play a major role in determining therapy. We focus here on the unicentric type, which can be treated and cured by surgery. To date, approximately 1000 cases of Castleman’s disease have been reported in the literature. Case presentation A 50-year-old Caucasian woman presented to our Department of Hematology and Internal Oncology with increasing fatigue as her sole symptom. Diagnostic investigations including laboratory studies, ultrasound, computed tomography and magnetic resonance imaging were performed. These revealed an interaortocaval, retroperitoneal tumor mass in her upper abdomen as the only manifestation of the disease. No enlarged lymph nodes were detected. We conducted a laparotomy with radical extirpation of the tumor mass (10×9×5.7cm). Complete tumor resection with clear margins was achieved. A pathological analysis of the resected sample showed atypical lymphoid tissue of small to medium cells with some clearly visible nucleoli, enlarged sinusoidal vessels, pleomorphic calcifications and focally preserved germinal-center-like structures. Histological and immunohistochemical analysis confirmed the diagnosis of Castleman’s disease: staining for CD3, CD5, CD10, CD20, CD23, CD79 and Ki-67 was strongly positive in the germinal-center-like structures. Histological findings clearly showed the disease to be the hyaline vascular subtype. Staining for cyclin D1 and CD30 was negative. Expression of CD15 was positive in the enlarged sinusoidal vessels. A supplementary clonality analysis was without pathological findings. Tests for human immunodeficiency virus and human herpes virus 8 were negative and results from a bone marrow biopsy were normal. Our patient recovered well from surgery and was discharged from our hospital. To date, no recurrence of the disease has been detected. Conclusion Castleman’s disease is a rare disorder that remains a diagnostic challenge. Radical surgical resection is considered to be the gold standard for treating the unicentric variant of this disease.
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Affiliation(s)
| | | | - Ilhan Demirci
- Department of General, Visceral, Vascular and Thoracic Surgery, Hospital of Düren, Düren, Germany.
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Brennan C, Kajal D, Khalili K, Ghai S. Solid malignant retroperitoneal masses-a pictorial review. Insights Imaging 2013; 5:53-65. [PMID: 24293303 PMCID: PMC3948907 DOI: 10.1007/s13244-013-0294-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 08/31/2013] [Accepted: 10/11/2013] [Indexed: 12/25/2022] Open
Abstract
Primary retroperitoneal masses are a rare but important group of neoplasms. Cross-sectional imaging has revolutionised the investigation of patients with retroperitoneal neoplasms. Both computed tomography (CT) and magnetic resonance imaging (MRI) can contribute to tumour diagnosis, though histological confirmation is often required because of the considerable overlap of imaging features. Cross-sectional imaging is key to the pre-operative staging and planning of retroperitoneal masses, though ultrasound may also help in certain instances. Imaging also helps to select and guide the site to biopsy from these usually large and heterogeneous neoplasms. This article aims to review many of the primary retroperitoneal neoplasms that may be encountered by the radiologist.
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Affiliation(s)
- Cressida Brennan
- Division of Abdominal Imaging, Joint Department of Medical Imaging, University Health Network - Mount Sinai Hospital - Women's College Hospital, University of Toronto, Toronto, ON, Canada
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28
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Abstract
AIM The objective of this study was to evaluate the clinicoradiological findings of thoracic Castleman disease. METHODS The study included 34 patients (22 male and 12 female patients; mean age, 32 [SD, 18.1] years) with thoracic Castleman disease. Clinicoradiological findings of the 34 patients were analyzed. Regarding computed tomography findings, lesion number, location, degree of enhancement (moderate, >20 Hounsfield units than back muscle enhancement; high, >40 Hounsfield units), and associated findings were recorded. RESULTS Of 34 patients, hyaline-vascular type (HVT) was found in 27 patients (79%), plasma cell type (PCT) in 5 patients (15%), and mixed type (6%) in 2 patients. In HVTs (n = 27), lesions were found, in decreasing order, in the lower neck (n = 9, 33%), pulmonary hilum (n = 6, 22%), and the upper paratracheal area (n = 4, 15%). Ten (37%) of 27 HVT patients had symptoms, whereas all (100%) with PCT had generalized symptoms. In 26 (96%) of 27 HVT patients, disease was unicentric, whereas it was multicentric in all PCT patients. Moderate to high degree of lesion enhancement was seen in 22 (92%) of 24 HVT patients and 4 (80%) of 5 PCT patients. Feeding vessels or draining veins were identified in 12 (44%) of 27 HVT patients and 2 (40%) of 5 PCT patients. The diseases were cured with surgical removal in HVT, whereas they showed variable prognosis in PCT. CONCLUSIONS Irrespective of subtypes, Castleman disease is characterized radiologically by unicentric or multicentric enhancing lymph node enlargement; in HVT, they show good prognosis after surgical treatment, but in PCT, they show variable prognosis.
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29
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Castleman Disease: An Unexpected Cause of a Solitary Pleural Mass. Case Rep Radiol 2013; 2013:130515. [PMID: 24106632 PMCID: PMC3784231 DOI: 10.1155/2013/130515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 08/06/2013] [Indexed: 11/17/2022] Open
Abstract
Castleman disease (CD) is a rare benign lymphoproliferative disorder, the etiology of which is unclear. Clinically it may manifest as localized disease (unicentric) or disseminated disease (multicentric). CD occurs in the thorax in 70% of cases, abdomen and pelvis in 15%, and in the neck in 10–15% of cases. We present a case of a pleural mass located posteriorly in a paraspinal location, which was discovered incidentally in a 50-year-old man and was subsequently resected followed by an unexpected diagnosis of Castleman disease on histological examination. In this report, we review the clinical and histological findings in a rare presentation of Castleman disease and discuss the findings in this case as part of an overall review of the typical radiological findings seen in Castleman disease.
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30
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Jain S, Chatterjee S, Swain JR, Rakshit P, Chakraborty P, Sinha S. Unicentric Castleman's Disease Masquerading Pancreatic Neoplasm. Case Rep Oncol Med 2012; 2012:793403. [PMID: 23227386 PMCID: PMC3512256 DOI: 10.1155/2012/793403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 11/05/2012] [Indexed: 11/29/2022] Open
Abstract
Castleman's disease is a rare nonclonal proliferative disorder of the lymph nodes with an unknown etiology. Common locations of Castleman's disease are mediastinum, neck, axilla, and abdomen. Castleman's disease of a peripancreatic location masquerading as pancreatic neoplasm is an even rarer entity. On search of published data, we came across about 17 cases published on peripancreatic Castleman's disease until now. Here we are reporting a case of retropancreatic Castleman's disease masquerading as retroperitoneal neoplasm in a 46-year-old male patient.
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Affiliation(s)
- Saurabh Jain
- Department of General Surgery, Medical College Hospital, Kolkata, 88 College Street, Kolkata 700073, India
| | - Souvik Chatterjee
- Department of General Surgery, Medical College Hospital, Kolkata, 88 College Street, Kolkata 700073, India
| | - Jyoti Ranjan Swain
- Department of General Surgery, Medical College Hospital, Kolkata, 88 College Street, Kolkata 700073, India
| | - Pritha Rakshit
- Department of Plastic & Reconstructive Surgery, IPGMER, 244 Acharya Jagadish Chandra Bose Road, Kolkata 700020, India
| | - Partha Chakraborty
- Department of Pediatric Surgery, Medical College Hospital, Kolkata, 88 College Street, Kolkata 700073, India
| | - Santanu Sinha
- Department of General Surgery, Medical College Hospital, Kolkata, 88 College Street, Kolkata 700073, India
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31
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Saeed-Abdul-Rahman I, Al-Amri AM. Castleman disease. THE KOREAN JOURNAL OF HEMATOLOGY 2012; 47:163-77. [PMID: 23071471 PMCID: PMC3464333 DOI: 10.5045/kjh.2012.47.3.163] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 07/23/2012] [Accepted: 08/03/2012] [Indexed: 12/19/2022]
Abstract
Castleman and Towne described a disease presenting as a mediastinal mass resembling thymoma. It is also known as "giant lymph node hyperplasia", "lymph node hamartoma", "angiofollicular mediastinal lymph node hyperplasia", and "angiomatous lymphoid hyperplasia". The pathogenesis is unknown, but the bulk of evidence points toward faulty immune regulation, resulting in excessive B-lymphocyte and plasma-cell proliferation in lymphatic tissue. In addition to the mediastinal presentation, extrathoracic involvement in the neck, axilla, mesentery, pelvis, pancreas, adrenal gland, and retroperitoneum also have been described. There are 2 major pathologic variations of Castleman disease: (1) hyaline-vascular variant, the most frequent, characterized by small hyaline-vascular follicles and capillary proliferation; and (2) the plasma-cell variant, in which large lymphoid follicles are separated by sheets of plasma cells. The hyaline-vascular cases usually are largely asymptomatic, whereas the less common plasma-cell variant may present with fever, anemia, weight loss, and night sweats, along with polyclonal hypergamma-globulinemia. Castleman disease is a rare lymphoproliferative disorders. Few cases have been described world widely. In this article we reviewed the classification, pathogenesis, pathology, radiological features and up to date treatment with special emphasis on the role of viral stimulation, recent therapeutic modalities and the HIV-associated disease.
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Affiliation(s)
- Ibrahiem Saeed-Abdul-Rahman
- Division of Nephrology, Department of Internal Medicine, King Fahd University Hospital, Dammam University, Al-Khobar, Saudi Arabia
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Abstract
Castleman disease is a nonclonal lymphoproliferative disorder and one of the more common causes of nonneoplastic lymphadenopathy. Because of its diverse manifestations and ability to affect any body region, Castleman disease is a great mimic of both benign and malignant abnormalities in the neck, chest, abdomen, and pelvis. Castleman disease most commonly manifests as unicentric disease (unicentric Castleman disease) with a hyperenhancing lymph nodal mass and should be considered in the differential diagnosis of lymphoma, metastatic adenopathy, and infectious and/or inflammatory diseases that result in adenopathy. Castleman disease includes a spectrum of pathologic variants, including the classic hyaline vascular type, the less common plasma cell variant of Castleman disease, and the more recently described multicentric Castleman disease and Castleman disease associated with human herpesvirus 8. Castleman disease has been associated with the human immunodeficiency virus, lymphoma, POEMS (polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes) syndrome, paraneoplastic pemphigus, and plasma cell dyscrasias. Aggressive forms of Castleman disease with systemic manifestations may occur. Unicentric hyaline vascular Castleman disease is often curable with surgery; however, multicentric Castleman disease may require steroid treatment, chemotherapy, antiviral medication, or the use of antiproliferative regimens because a surgical procedure cannot be curative in this setting. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.316115502/-/DC1.
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Affiliation(s)
- David Bonekamp
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 601 N Caroline St, JHOC 3140C, Baltimore, MD 21287, USA.
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Unicentric Castleman's disease presenting with growth retardation and iron deficiency anemia. Am J Med Sci 2012; 343:426-8. [PMID: 22227514 DOI: 10.1097/maj.0b013e318242a212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 16-year-old boy presented with growth retardation and iron deficiency anemia. The disease was identified incidentally in the pararenal retroperitoneum after computed tomography and magnetic resonance imaging scans. A retroperitoneal lesion was removed in its entirety and was histologically confirmed to be a symptom of Castleman's disease of the unicentric plasma cell type. The unicentric plasma cell type appears so rarely in the retroperitoneum that a similar case has been reported only once. The patient was discharged on day 9 after surgery without significant complications and grew 18 cm within a year.
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Farruggia P, Trizzino A, Scibetta N, Cecchetto G, Guerrieri P, D'Amore ESG, D'Angelo P. Castleman's disease in childhood: report of three cases and review of the literature. Ital J Pediatr 2011; 37:50. [PMID: 22014148 PMCID: PMC3219574 DOI: 10.1186/1824-7288-37-50] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Accepted: 10/20/2011] [Indexed: 12/24/2022] Open
Abstract
Castleman's disease (CD) is a rare, localized or generalized, lymphoproliferative disorder with a frequent mediastinal location, but possible in any lymph node or extra nodal site. It usually appears in young adults whilst it rarely occurs in childhood. There are only about 100 pediatric cases published, five of them in Italy. We report 3 cases of localized Castleman's disease, investigated in our Department in a 3 years period and reviewed the literature.
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Affiliation(s)
- Piero Farruggia
- Unit of Pediatric Hematology and Oncology, "G. Di Cristina" Children's Hospital, A.R.N.A.S., Palermo, Italy
| | - Antonino Trizzino
- Unit of Pediatric Hematology and Oncology, "G. Di Cristina" Children's Hospital, A.R.N.A.S., Palermo, Italy
| | - Nunzia Scibetta
- Unit of Pathology, "Civico e Benfratelli" Hospital, A.R.N.A.S., Palermo, Italy
| | | | - Patrizia Guerrieri
- Unit of Oncological Radiotherapy, "Civico e Benfratelli" Hospital, A.R.N.A.S., Palermo, Italy
| | | | - Paolo D'Angelo
- Unit of Pediatric Hematology and Oncology, "G. Di Cristina" Children's Hospital, A.R.N.A.S., Palermo, Italy
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Poole PS, Chang EY, Santillan CS. Case 172: Retroperitoneal Castleman disease (hyaline vascular type). Radiology 2011; 260:601-5. [PMID: 21778453 DOI: 10.1148/radiol.11100185] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Patricia Sims Poole
- Department of Radiology, University of California, San Diego, 200 W Arbor Dr, San Diego, CA 92103-8756, USA.
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The value of MDCT in diagnosis of hyaline-vascular Castleman's disease. Eur J Radiol 2011; 81:2436-9. [PMID: 21664085 DOI: 10.1016/j.ejrad.2011.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Revised: 05/17/2011] [Accepted: 05/19/2011] [Indexed: 11/22/2022]
Abstract
PURPOSE Castleman's disease (CD) is an uncommon entity characterized by a massive growth of lymphoid tissue. There are two types: the hyaline-vascular (HV) type and the plasma cell (PC) type. The purpose of this study was to evaluate the clinical value of multiple detector computed tomography (MDCT) in the diagnosis and planning of treatment for hyaline-vascular CD. MATERIALS AND METHODS Fifty-two cases of confirmed hyaline-vascular CD were retrospectively reviewed. Unenhanced and contrast-enhanced MDCT scans had been performed in all patients, followed by surgery and pathological analysis of the lesion. Original MDCT transverse and reconstructed images were used for image interpretation. Features of the lesion and its adjacent structures were identified. RESULTS The lesion was present in the thorax of 24 patients and the abdomen in 28. Obvious features of hyaline-vascular CD (especially feeding vessels and draining veins) and its adjacent structures were demonstrated on 52 patients. CONCLUSION On MDCT imaging, original MDCT transverse and reconstructed images provide an excellent tool for diagnosis of hyaline-vascular CD and have high value in the determination of a treatment plan.
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Madan R, Chen JH, Trotman-Dickenson B, Jacobson F, Hunsaker A. The spectrum of Castleman's disease: mimics, radiologic pathologic correlation and role of imaging in patient management. Eur J Radiol 2010; 81:123-31. [PMID: 20643523 DOI: 10.1016/j.ejrad.2010.06.018] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Revised: 06/08/2010] [Accepted: 06/09/2010] [Indexed: 12/21/2022]
Abstract
Castleman's disease (CD) is a rare benign lymphoid disorder with variable clinical course. The two principal histologic subtypes of CD are hyaline-vascular and plasma cell variants and the major clinicoradiological entities are unicentric and multicentric CD. Management of CD is tailored to clinicoradiologic subtype. In this review, we describe the CT, MR and PET/CT findings in Castleman's disease which can help suggest a diagnosis of CD as well as emphasize role of imaging in management of patients with CD.
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Affiliation(s)
- Rachna Madan
- Thoracic Imaging, Brigham & Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
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Ryu JH, Oh JW, Kim KH, Choi JI, Ryu KH, Kim YJ, Jung TY. Castleman Disease Misdiagnosed as a Neoplasm of the Kidney. Korean J Urol 2009. [DOI: 10.4111/kju.2009.50.4.413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jae Hyun Ryu
- Department of Urology, Seoul Veterans Hospital, Seoul, Korea
| | - Jung Woo Oh
- Department of Urology, Seoul Veterans Hospital, Seoul, Korea
| | - Kwang Ho Kim
- Department of Urology, Seoul Veterans Hospital, Seoul, Korea
| | - Joon Il Choi
- Department of Urology, Seoul Veterans Hospital, Seoul, Korea
| | - Kyoung Ho Ryu
- Department of Urology, Seoul Veterans Hospital, Seoul, Korea
| | - Yoon Jung Kim
- Department of Pathology, Seoul Veterans Hospital, Seoul, Korea
| | - Tae Young Jung
- Department of Urology, Seoul Veterans Hospital, Seoul, Korea
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Zhou LP, Zhang B, Peng WJ, Yang WT, Guan YB, Zhou KR. Imaging findings of Castleman disease of the abdomen and pelvis. ACTA ACUST UNITED AC 2008; 33:482-8. [PMID: 17624567 DOI: 10.1007/s00261-007-9282-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The purpose of this study was to analyze the characteristic features of Castleman disease in the abdomen and pelvis as suggested by imaging findings in order to deepen the recognition and understanding of this rare disease. METHODS A group of ten patients with pathologically proven Castleman disease in the abdomen (n = 9) and pelvis (n = 1) were included in this study. Patients were 18 approximately 56-year-old (mean = 40); seven of them were men and three were women. Imaging findings (CT&MRI, n = 4; only CT, n = 4; only MRI, n = 2) were retrospectively reviewed and correlated with clinical and pathologic findings. RESULTS The lesions were divided into those with localized Castleman (n = 9) and disseminated Castleman (n = 1). The pathologic subtype of all nine cases of localized disease was hyaline vascular with six patients showing a solitary mass and three having a single dominant mass surrounded by small satellite nodules. On nonenhanced CT images, the lesions were manifested as homogeneous masses of soft tissue attenuation, which was isoattenuated relative to normal muscle. On MRI, the lesions were isointense or slightly hypointense compared with that of normal muscle on T1-weighted images and hyperintense on T2-weighted images. After intravenous injection of contrast media, most of the masses (7/9) showed marked enhancement and slow washout with the degree of enhancement approaching that of the large arteries. And in the interior of four cases of larger masses (>5 cm) was observed fissured and radial patterns in both low-density area on CT and low-signal area on MRI. These patterns were pathologically proved to be fibrous. The pathological subtype of a sole disseminated case was plasma-cell type, where imaging findings showed a lining of well defined, sharply enhanced soft-tissue nodules in retroperitoneal zone. CONCLUSION Imaging findings of Castleman disease in the abdomen and pelvis are closely related to pathological type diagnosed. The characteristic features of localized and hyaline vascular type of Castleman disease include a solitary mass or a dominant mass surrounded with small satellite nodules, and high enhancement and slow washout with the degree of enhancement approaches that of large arteries. The presence of central areas of fibrosis of the larger tumors is one of the characteristic features of this disease.
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Affiliation(s)
- L P Zhou
- Department of Radiology, Cancer Hospital of Fudan University, Shanghai, 270 DongAn Road, Shanghai, 200032, China
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40
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Rhee KH, Lee SS, Huh JR. Endoscopic ultrasonography-guided trucut biopsy for the preoperative diagnosis of peripancreatic castleman’s disease: A case report. World J Gastroenterol 2008; 14:2115-7. [PMID: 18395917 PMCID: PMC2701537 DOI: 10.3748/wjg.14.2115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Castleman’s disease (CD) of the pancreas/peripancreas is extremely rare. The recently introduced, endoscopic ultrasonography (EUS)-guided trucut biopsy (TCB) is a useful diagnostic modality for obtaining tissue samples from peripancreatic lesions. However, its role in diagnosing CD remains unknown. We report a case of localized, peripancreatic, hyaline-vascular CD biopsied using EUS. The pathology results were initially interpreted as an extranodal, marginal-zone B-cell lymphoma. However, polymerase chain reaction (PCR) study for the IgH gene rearrangement revealed a polyclonal pattern. We also reviewed the relevant literature. To our knowledge, this is the first illustrated report on EUS-TCB findings of CD with its pathology results of EUS-TCB mimicked a B-cell lymphoma.
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41
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Crean A, Paul N, Merchant N, Singer L, Provost Y. Diagnosis of paracardiac castleman disease by dynamic gadolinium-enhanced first pass perfusion magnetic resonance imaging. Clin Med Case Rep 2008; 1:127-31. [PMID: 24179362 PMCID: PMC3785362 DOI: 10.4137/ccrep.s732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Summary Castleman disease is an uncommon disorder affecting the lymphatic system and is characterised by atypical lymphocyte proliferation. The usual clinical presentation is of a solitary mass lesion, frequently within the thorax. A number of different imaging findings have been reported on CT and MRI. We present a case of paracardiac Castleman disease where the diagnosis was suggested by dramatic enhancement of the tumour mass during a dynamic MR perfusion sequence. To our knowledge this is the first report of the use of a first pass bolus tracking technique in the diagnosis of Castleman disease.
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Waisberg J, Satake M, Yamagushi N, Matos LLD, Waisberg DR, Artigiani Neto R, Franco MIF. Retroperitoneal unicentric Castleman's disease (giant lymph node hyperplasia): case report. SAO PAULO MED J 2007; 125:253-5. [PMID: 17992400 PMCID: PMC11020540 DOI: 10.1590/s1516-31802007000400013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2006] [Revised: 07/10/2006] [Accepted: 07/18/2006] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE Castleman's disease, or giant lymph node hyperplasia, is a rare disorder of the lymphoid tissue that causes lymph node enlargement. It is considered benign in its localized form, but aggressive in the multicentric type. The definitive diagnosis is based on postoperative pathological findings. The aim here was to describe a case of retroperitoneal unicentric Castleman's disease in the retroperitoneum. CASE REPORT A 61-year old white male with weight loss and listlessness presented with moderate arterial hypertension and leukopenia. Abdominal tomography revealed a 5 x 4 x 5 cm oval mass of low attenuation, with inner calcification and intense enhancement on intravenous contrast, located in the retroperitoneal region, between the left kidney and the aorta, at the renal hilus. Exploratory laparotomy revealed a non-pulsatile solid oval mass situated in the retroperitoneum, adjacent to the left renal hilus. The retroperitoneal lesion was removed in its entirety. Examination of frozen samples revealed benign lymph node tissue and histopathological examination of the surgical sample revealed hyaline-vascular giant lymph node hyperplasia (Castleman's disease). The patient was discharged on the 12th day without significant events. Two months after the operation, the patient was readmitted with severe cardiac insufficiency, acute renal failure and bronchopneumonia, which progressed to acute respiratory insufficiency, sepsis and death.
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Affiliation(s)
- Jaques Waisberg
- Departments of Surgery and Pathology, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil.
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Mangini M, Aiani L, Bertolotti E, Imperatori A, Rotolo N, Paddeu A, Uccella S, Carrafiello G, Fugazzola C. Parapancreatic Castleman disease: contrast-enhanced sonography and CT features. JOURNAL OF CLINICAL ULTRASOUND : JCU 2007; 35:207-11. [PMID: 17373687 DOI: 10.1002/jcu.20325] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Castleman disease is a rare lymphoproliferative disorder that can be classified into 3 types: hyaline-vascular, plasma cell, and mixed. We report a rare case of localized para-pancreatic hyaline-vascular Castleman disease that was evaluated using contrast-enhanced sonography and CT.
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Affiliation(s)
- Monica Mangini
- Department of Radiology, University of Insubria, Varese, Italy
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Demir MK, Aker FV. Hyaline-vascular type Castleman's disease of the pararenal retroperitoneum: Multidetector CT findings. ACTA ACUST UNITED AC 2007; 51:75-7. [PMID: 17217494 DOI: 10.1111/j.1440-1673.2006.01663.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We describe the case of a 40-year-old woman who presented with a pararenal hyaline-vascular type Castleman's disease that had an arterial supply from the renal artery and a draining vein as showed by multidetector CT. Identification of the renal artery relationship to the feeding vessel of the mass is critical to prevent potential surgical complications.
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Affiliation(s)
- M K Demir
- Department of Radiology, Trayka University School of Medicine, Edirne, Turkey.
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45
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Gupta NK, Torigian DA, Gefter WB, Marshall MB, Liang H, Carver JR, Miller WT. Mediastinal Castleman disease mimicking mediastinal pulmonary sequestration. J Thorac Imaging 2005; 20:229-32. [PMID: 16077341 DOI: 10.1097/01.rti.0000155045.82156.e4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We describe a 39-year-old woman who presented with anterior mediastinal Castleman disease that mimicked an anterior mediastinal pulmonary sequestration due to the presence of both prominent systemic arterial feeding vessels and a systemic draining vein as seen on computed tomography and magnetic resonance imaging.
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Affiliation(s)
- Narainder K Gupta
- Department of Radiology, University of Pennsylvania, Philadelphia, USA
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46
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Sakaguchi C, Hama Y, Kadota Y, Sugiura Y, Aida S, Kosuda S. Castleman's disease arising from the accessory spleen: ultrasonography, computed tomography, and magnetic resonance imaging findings. Clin Imaging 2005; 29:352-5. [PMID: 16153544 DOI: 10.1016/j.clinimag.2005.01.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Revised: 01/02/2005] [Accepted: 01/24/2005] [Indexed: 11/22/2022]
Abstract
Castleman's disease is a rare lymphoproliferative disorder of unknown etiology. To our knowledge, Castleman's disease arising from the accessory spleen has not been reported in the literature. We report the case of localized Castleman's disease arising from the accessory spleen in a 34-year-old woman and discuss the characteristic findings of ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging.
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Affiliation(s)
- Chiharu Sakaguchi
- Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-0042, Japan
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Su IH, Wan YL, Pan KT, Hung CF, Tseng JH, Hsieh CH, Liu NJ. Symptomatic mesentery Castleman disease mimicking a pancreatic tumor. Clin Imaging 2005; 29:348-51. [PMID: 16153543 DOI: 10.1016/j.clinimag.2005.01.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2005] [Revised: 01/25/2005] [Accepted: 01/31/2005] [Indexed: 10/25/2022]
Abstract
Castleman disease (CD) is an uncommon lymphoproliferative disorder of unknown etiology. It can be localized or multicentric. There are two major histological variants. The hyaline-vascular type predominates in the thorax and the mesenteric disease is usually of the plasma cell type. Hyaline-vascular CD of the mesentery is very rare. We report such a neoplasm of mesenteric root in a 38-year-old woman who presented with abdominal discomfort. Dynamic magnetic resonance imaging (MRI) of CD has rarely been reported previously. The imaging findings of CD on computed tomograms, MR images and angiograms were described.
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Affiliation(s)
- I-Hao Su
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Linkou, College of Medicine and School of Medical Technology, Chang-Gung University, Taoyuan 333, Taiwan
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Chen JH, Yu CY, Pai CY, Chan DC, Chen CJ, Yu JC, Liu YC. Castleman's disease in the left upper retroperitoneal space mimicking an adrenal neoplasm: report of a case and literature review. Jpn J Clin Oncol 2005; 35:353-6. [PMID: 15928190 DOI: 10.1093/jjco/hyi092] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Castleman's disease is a rare disorder characterized by benign proliferation of lymphoid tissue. Most cases occur as a mediastinal mass, although extrathoracic involvement including nodal and extranodal locations has been reported. The left suprarenal location of this localized disease may be mistaken for an adrenal tumor. We report a case of a 51-year-old woman with a Castleman's tumor located superomedial to the upper pole of the left kidney that mimicked an adrenal neoplasm.
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Affiliation(s)
- Jia-Hui Chen
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defence Medical Center, Taipei, Taiwan, Republic of China
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Matsumura KI, Nakasu S, Tanaka T, Nioka H, Matsuda M. Intracranial Localized Castleman's Disease-Case Report-. Neurol Med Chir (Tokyo) 2005; 45:59-65. [PMID: 15699624 DOI: 10.2176/nmc.45.59] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 68-year-old woman presented with generalized clonic seizure following a 2-month history of initiative loss, incoherent speech, headache, and left hemiparesis. No systemic signs or symptoms were seen and laboratory studies were within normal range. Computed tomography and magnetic resonance imaging demonstrated a well-delineated small mass with homogeneous enhancement in the right parietal convexity, associated with unusually extensive perifocal edema compared to the size of the mass. Cerebral angiography showed a faint stain fed by the middle meningeal artery. These imaging features were very similar to those of meningioma. Full recovery from the symptoms was achieved by total removal of the lesion and no recurrence was found after 3 years. Histological examination identified the hyaline-vascular type of angiofollicular lymph node hyperplasia (Castleman's disease). Castleman's disease involving the central nervous system is rare, with only 12 previous cases, but should be considered in the diagnosis of intracranial meningeal tumors. The treatment of choice for localized Castleman's disease is complete surgical resection, which is curative in most of the cases.
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Affiliation(s)
- Ken-ichi Matsumura
- Department of Neurosurgery, Kusatsu General Hospital, Kusatsu, Shiga, Japan.
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Ko SF, Wan YL, Ng SH, Lin JW, Hsieh MJ, Fang FM, Lee TY, Chen WJ. Imaging features of atypical thoracic Castleman disease. Clin Imaging 2004; 28:280-5. [PMID: 15246479 DOI: 10.1016/s0899-7071(03)00202-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2003] [Indexed: 12/11/2022]
Abstract
The imaging features of 16 cases of pathologically proven atypical thoracic Castleman disease (CD) were retrospectively reviewed. Thirteen out of 16 tumors originated from atypical locations, including eight from the pleura and one each from the axilla, supraclavicular fossa, intercostal space, pericardium, and lung. Six out of 16 tumors revealed atypical enhancement, including poor CT enhancement in three tumors, target-like CT enhancement in two tumors, and concentric MR enhancement pattern in one tumor. These atypical enhancement patterns were histopathologically corresponded to various degrees of degeneration, necrosis, and fibrosis.
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Affiliation(s)
- Sheung-Fat Ko
- Department of Radiology, Chang Gung Memorial Hospital at Kaohsiung, Chang Gung University, 123 Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien 833, Taiwan.
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