CASE 12956 Published on 03.09.2015

Unicentric Castleman disease


Chest imaging

Case Type

Clinical Cases


Antunes N, Santos R, Fernandes O, Figueiredo L

Lisboa, Portugal

36 years, male

Area of Interest Thorax ; Imaging Technique CT, Conventional radiography, Digital radiography
Clinical History
A 36-year-old man, with a history of smoking (9 UPY) and dyslipidemia was referred to thoracic surgery consultation due to an alteration in his routine chest X-ray. The patient was asymptomatic.
Imaging Findings
The posteroanterior chest radiograph revealed a left inferior paravertebral mass of smooth contours.
Thoracic CT with intravenous contrast showed a left paravertebral and para-aortic mass, of soft tissue density, with well-defined limits and homogeneous contrast enhancement. Its axial diameters were 6.3 x 2.9 cm. In addition, inferiorly there were small paravertebral nodules. The patient was submitted to VATS (Video-assisted thoracoscopic surgery) with resection of the posterior mediastinal mass. Pathological results were consistent with Castleman disease, classic hyaline vascular type.
Follow-up chest radiograph shows no pathological findings.
A. The differential diagnosis of posterior mediastinum lesions includes: neurogenic tumours or cysts, lymph nodes, oesophageal tumours, extramedullary haematopoiesis, enterogenic cysts, meningoceles, azygos vein anomalies and Bochdalek hernias [1].

B. Solid masses of the posterior mediastinum range from neurogenic tumours, lymph nodes, Non-Hodgkin lymphomas, oesophageal tumours and extramedullary haematopoiesis [1].

C. Castleman disease is a lymphoproliferative disorder that occurs in 70% of cases in the chest, 15% in the neck, and 15% in the abdomen and pelvis [2]. The most common form of presentation is as a solitary lymphadenopathy, but it can present with systemic symptoms and multicentric disease.

D. The disease may be unicentric or multicentric. The unicentric form is most commonly the hyaline vascular histological type, which represents 90% of the cases. The multicentric type has been associated with the infection of Human Herpes Virus-8 [3].

E. Hyaline vascular Castleman disease usually manifests as an asymptomatic mass lesion in young adults, with a median age of 30-40 years. Treatment usually includes curative surgical resection and/or steroid treatment or systemic chemotherapy for aggressive forms. This form of Castleman disease has the best prognosis.

F. The radiologic appearance of hyaline vascular Castleman disease is that of a solitary enlarged lymph node or localized nodal masses that demonstrate intense homogeneous contrast enhancement.
Differential Diagnosis List
Unicentric Castleman disease as a posterior mediastinal mass.
Neurogenic tumours
Oesophageal tumours
Non-Hodgkin\'s lymphoma
Extramedullary haematopoiesis
Final Diagnosis
Unicentric Castleman disease as a posterior mediastinal mass.
Case information
DOI: 10.1594/EURORAD/CASE.12956
ISSN: 1563-4086