MyPACS.net: Radiology Teaching Files > Case 50917591

Last visited 04-06-2011 HILAR MASS
Contributed by: Aaron Wickley, Resident, SAMMC, Texas, USA.
Patient: 37 year old female
History: 37 year old female with no prior medical history
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Fig. 5: T1 HASTE

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Findings: Radiographs of the chest reveal a solitary right hilar mass. CT confirms a well-circumscribed enhancing mass in the right hilum measuring 2.3 cm. The lesion has moderate T2 intensity and is isointense to muscle on T1. There is avid enhancement on post-contrast imaging(not pictured). The lesion is F-18 FDG avid on PET imaging with a maximum SUV of 5.8.
Diagnosis: Castleman's Disease Unicentric
Discussion:

Castleman's Disease

  • Rare
  • Lymphoproliferative disorder of nodes
  • Usually asymptomatic found as an incidental finding
  • May be localized or multicentric
  • Associated with Human Herpes Virus-8
  • May be concurrent with Kaposi Sarcoma

Histologic Types

  • Hyaline vascular (90%), often unicentric and asymptomatic
  • Plasma cell (9%), often multicentric and symptomatic
  • Mixed (<1%)

Imaging Features

  • 70% in the thorax
  • Smooth or lobulated enlarged node
  • Along tracheobronchial lymph nodes (Perihilar and middle or posterior mediastinum)
  • Avid uniform contrast enhancement(plasma cell type less intense)
  • May have prominent feeding vessels

Treatment

  • Surgical excision for unicentric form with recurrence rare
  • Prognosis for multicentric form is poor (chemotherapy and/or antiviral therapy)
References:
  • StatDx.com "Castleman's Disease"
  • McAdams, HP. et Al. "Castleman's Disease of the Thorax: radiological features with clinical and histopathologic correlation" October 1998 Radiology, 209, 221-228.
Comments:
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Additional Details:

Case Number: 50917591Last Updated: 04-06-2011
Anatomy: Chest   Pathology: Neoplasm
Modality: CT, Conventional Radiograph, MR, PETAccess Level: Readable by all users
Keywords: castleman's disease, hilar mass

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