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Lin HY, Liao PS, Shih LC, Hua CH, Tsai MH, Lin CD. A novel diagnostic tool for hyaline vascular Castleman disease versus lymphoma based on contrast-enhanced computed tomography in neck mass. J Chin Med Assoc 2022; 85:935-938. [PMID: 35818930 DOI: 10.1097/jcma.0000000000000778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Castleman disease and lymphoma each have a distinct treatment plan; however, they share the same features on contrast-enhanced computed tomography. METHODS To assess the quantitative outcomes of Castleman disease versus lymphoma using contrast-enhanced computed tomography based on Hounsfield units (HU). We retrospectively reviewed eight patients with unicentric Castleman disease and 30 patients with lymphoma based on pathological diagnosis at China Medical University Hospital between 2015 and 2020. Preoperative computed tomography with contrast scans was reviewed, and the HU of each tumor were measured. RESULTS This study included eight patients with unicentric Castleman disease (four men and four women; mean age, 33 years) and 25 patients with lymphoma (11 men and 14 women; mean age, 53 years). There was no significant difference in heterogeneity between the two diseases (0.161 ± 0.052 vs 0.239 ± 0.063, p = 0.22); however, enhancement in Castleman disease was higher than that in lymphoma (126.40 ± 31.90 vs 74.19 ± 7.11, p < 0.001), providing a very good diagnostic tool (cutoff point at 88.5-91.3, sensitivity 0.86/specificity 0.88). Furthermore, we found a highly linear relationship in Castleman disease, which was not noted in lymphoma. CONCLUSION The value of HU provides a good diagnostic tool for the differential diagnosis of Castleman disease versus lymphoma in the neck lymph nodes. Considering the linear relationship in Castleman disease, an increasingly accurate differential diagnosis can be made.
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Affiliation(s)
- Huan-Yu Lin
- Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan, ROC
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Pei-Shao Liao
- Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan, ROC
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Liang-Chun Shih
- Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan, ROC
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Chun-Hung Hua
- Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan, ROC
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Ming-Hsui Tsai
- Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan, ROC
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, China Medical University Hospital, Taichung, Taiwan, ROC
| | - Chia-Der Lin
- Department of Otolaryngology-Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan, ROC
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, China Medical University Hospital, Taichung, Taiwan, ROC
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Iwami E, Ito F, Sasahara K, Kuroda A, Matsuzaki T, Nakajima T, Abe D, Matsumoto K, Sasaki A, Eguchi K, Terashima T. Pulmonary Intravascular Large B-cell Lymphoma in a Patient Administered Methotrexate for Rheumatoid Arthritis. Intern Med 2020; 59:429-433. [PMID: 31619597 PMCID: PMC7028407 DOI: 10.2169/internalmedicine.3216-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
A 70-year-old woman with rheumatoid arthritis undergoing methotrexate (MTX) treatment presented with dyspnea and a subfever. Computed tomography (CT) revealed a diffuse minimal ground-glass appearance in both lungs and splenomegaly. The gallium scintigram showed a diffuse, mild uptake in both lungs and the spleen. The lung biopsy specimen revealed the presence of CD20-positive atypical lymphocytes in the small pulmonary vessels. The patient was diagnosed with pulmonary intravascular diffuse large B-cell lymphoma (IVLBCL) and exhibited spontaneous regression after MTX was discontinued. This report describes a rare case of MTX-associated lymphoproliferative disorder expressing pulmonary IVLBCL.
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Affiliation(s)
- Eri Iwami
- Department of Respiratory Medicine, Tokyo Dental College Ichikawa General Hospital, Japan
| | - Fumimaro Ito
- Department of Respiratory Medicine, Tokyo Dental College Ichikawa General Hospital, Japan
| | - Kotaro Sasahara
- Department of Respiratory Medicine, Tokyo Dental College Ichikawa General Hospital, Japan
| | - Aoi Kuroda
- Department of Respiratory Medicine, Tokyo Dental College Ichikawa General Hospital, Japan
| | - Tatsu Matsuzaki
- Department of Respiratory Medicine, Tokyo Dental College Ichikawa General Hospital, Japan
| | - Takahiro Nakajima
- Department of Respiratory Medicine, Tokyo Dental College Ichikawa General Hospital, Japan
| | - Daichi Abe
- Department of Internal Medicine, Tokyo Dental College Ichikawa General Hospital, Japan
| | - Kimihiro Matsumoto
- Department of Internal Medicine, Tokyo Dental College Ichikawa General Hospital, Japan
| | - Aya Sasaki
- Department of Pathology and Laboratory Medicine, Tokyo Dental College Ichikawa General Hospital, Japan
| | - Keisuke Eguchi
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Japan
| | - Takeshi Terashima
- Department of Respiratory Medicine, Tokyo Dental College Ichikawa General Hospital, Japan
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Li J, Wang J, Yang Z, Wang H, Che J, Xu W. Castleman disease versus lymphoma in neck lymph nodes: a comparative study using contrast-enhanced CT. Cancer Imaging 2018; 18:28. [PMID: 30115111 PMCID: PMC6097448 DOI: 10.1186/s40644-018-0163-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/07/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the contrast-enhanced CT characteristics for differentiating between Castleman disease (CD) and lymphoma in neck lymph nodes. METHODS This retrospective study evaluated the number (solitary or multiple), strength of contrast-enhancement, type of contrast-enhancement, surrounding vessels, contrast-enhanced Hounsfield unit (HU) values, and anatomical distributions of lymph nodes in 34 patients with confirmed CD and 55 patients with newly diagnosed untreated lymphoma. Independent t-tests, receiver operating characteristic (ROC) curve analysis, and chi-square tests were used to evaluate the variables and CT features. RESULTS Several significant differences were found between CD and lymphoma. The interval between first contrast-enhanced CT and biopsy/surgery was significantly longer in the CD group (mean 72 ± 105 days, median 60 days) than in the lymphoma patients (mean 30 ± 2 days, median 12 days; p = 0.015). The lymphoma patients presented significantly more often with fatigue and fever (p = 0.023 and p = 0.016 respectively) than did the CD subjects. HU values of nodules after enhancement were significantly higher in the CD patients than in the lymphoma patients. In cases involving multiple lymph nodes, in all the CD cases, all affected nodes were located in only the left or right side of the neck, not bilaterally. ROC analysis showed a significant difference in contrast-enhanced CT attenuation values between lymphoma and CD (p < 0.001, area under the curve = 0.954), with a cut-off value of 92.5 HU. We constructed a decision tree according to these imaging characteristics. CONCLUSIONS Contrast-enhanced CT can be useful for differentiating between CD and lymphoma.
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Affiliation(s)
- Jie Li
- Department of Radiology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, Shandong, China
| | - Jia Wang
- Department of Ultrasound, Qingdao Women and Children Hospital, Qingdao, Shandong, China
| | - Zhitao Yang
- Department of Radiology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, Shandong, China
| | - Hexiang Wang
- Department of Radiology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, Shandong, China
| | - Junyi Che
- Department of Radiology, Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Wenjian Xu
- Department of Radiology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, Shandong, China.
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