Figure 1
Posteroanterior chest X-ray
Posteroanterior chest X-ray demonstrates a left paravertebral mass, of smooth contours, that follows the left paraspinal line.
Unicentric Castleman disease
SectionChest imaging
Case TypeClinical Cases
AuthorsAntunes N, Santos R, Fernandes O, Figueiredo L
Connected authors
36 years, male
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.
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.
Discussion
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.
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.
References
[1] Prokop M., Galanski M., van der Molen AJ. (2003) Principles of CT, spiral CT, and multislice CT. 380-391
[2] Bonekamp D., Horton KM., Hruban RH., Fishman EK (2011) Castleman disease: the great mimic. Radiographics 1793–1807 (PMID: 21997995)
[3] Cronin DM, Warnke RA. (2009) Castleman disease: an update on classification and the spectrum of associated lesions. Adv Anat Pathol 236-246 (PMID: 19546611)
Case information
| URL: | https://www.eurorad.org/case/12956 |
| DOI: | 10.1594/EURORAD/CASE.12956 |
| ISSN: | 1563-4086 |
License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Figure 2
Lateral chest X-ray
Lateral chest X-ray shows a very subtle soft tissue density over the vertebral bodies of TVIII and TIX.
Figure 3
Thoracic CT
Thoracic CT (axial section on mediastinal window) showed a left paravertebral mass, of soft tissue density, located at the posterior mediastinum.
Figure 4
Contrast-enhanced CT
Contrast-enhanced CT (axial section on mediastinal window) reveals the mass had homogeneous enhancement.
Figure 5
Coronal chest CT
Coronal chest CT demonstrating the left paraaortic mass.
Figure 6
Sagittal chest CT
Sagittal chest CT showing the posterior mediastinal mass and its anatomic relationship with the heart borders and aorta.
Figure 7
Follow-up chest X-ray
Follow-up posteroanterior chest X-ray after VATS surgery: no pathological findings.
Posteroanterior chest X-ray
Posteroanterior chest X-ray demonstrates a left paravertebral mass, of smooth contours, that follows the left paraspinal line.
Departament of Radiology, CHLC, Lisbon, PT
Departament of Radiology, CHLC, Lisbon, PT
Lateral chest X-ray
Lateral chest X-ray shows a very subtle soft tissue density over the vertebral bodies of TVIII and TIX.
Departament of Radiologiy, CHLC, Lisbon, PT
Departament of Radiologiy, CHLC, Lisbon, PT
Thoracic CT
Thoracic CT (axial section on mediastinal window) showed a left paravertebral mass, of soft tissue density, located at the posterior mediastinum.
Departamento of Radiology, CHLC, Lisbon, PT
Departamento of Radiology, CHLC, Lisbon, PT
Contrast-enhanced CT
Contrast-enhanced CT (axial section on mediastinal window) reveals the mass had homogeneous enhancement.
Departament of Radiology, CHLC, Lisbon, PT
Departament of Radiology, CHLC, Lisbon, PT
Coronal chest CT
Coronal chest CT demonstrating the left paraaortic mass.
Departament of Radiology, CHLC, Lisbon, PT
Departament of Radiology, CHLC, Lisbon, PT
Sagittal chest CT
Sagittal chest CT showing the posterior mediastinal mass and its anatomic relationship with the heart borders and aorta.
Departament of Radiology, CHLC, Lisbon, PT
Departament of Radiology, CHLC, Lisbon, PT
Follow-up chest X-ray
Follow-up posteroanterior chest X-ray after VATS surgery: no pathological findings.
Departament of Radiology, CHLC, Lisbon, PT
Departament of Radiology, CHLC, Lisbon, PT