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.
Castleman's disease (CD) is an uncommon lymphoproliferative disorder that was initially described by Dr Castleman in 1954 (
The study was approved by the Ethics Committee of Tongji University (Shanghai, China). Written informed consent was obtained from the patient. A 39-year-old female presented to Shanghai Pulmonary Hospital (Shanghai, China) in May 2013, with a mass in the lower lobes of the right lung that had been identified 2 months before. Computed tomography (CT) imaging clarified the presence of a high-density mass in the right lower lung. Compressed bronchiostenosis was identified in the outer and posterior basal segments during bronchoscopy and a lung biopsy revealed lymphocytes in the tissues. Therefore, the patient received anti-inflammatory treatment (cefuroxime, 0.75 g, 3 times/day) for 2 months; however, no evident change was observed in the lesion.
Physical examination identified no enlargement in superficial lymph nodes. Breath sounds were moderately rough and no dry or wet rales were noted. Results of routine laboratory tests and biochemical analysis of blood samples were within the normal ranges. Furthermore, rheumatoid, allergy, lung function and sputum examinations were normal. However, a conventional chest CT scan revealed a homogenous soft-tissue mass in the lower lobes of the right lung, multiple nodules in the two lungs and enlarged lymph nodes in the hilum and mediastinum (
Open lung biopsy was performed and a 3.5×3.0×4.5-cm3 mass was identified in the lower lobes of the right lung. In addition, numerous 0.3-cm nodes were distributed in the upper and lower lobes of both lungs. Histopathological examination identified lymphoid hyperplasia with numerous PCs and few blood vessels were present in the interfollicular areas of the lymph nodes (
A 40-year-old male presented to the Shanghai Pulmonary Hospital on 2 February 2013, with the symptoms of coughing and shortness of breath. A physical examination revealed numerous hard, mobile lymph nodes in the neck and supraclavicular fossa. Breath sounds were moderately rough and no dry or wet rales were noted. Biochemical analysis of blood samples identified a globulin concentration of 85 g/l (normal range, 20–40 g/l). An abdominal ultrasound identified hepatosplenomegaly and enlarged retroperitoneal lymph nodes. In addition, a contrast-enhanced CT scan revealed multiple nodules in the two lungs and enlarged lymph nodes in the hilum and mediastinum (
CD is a rare disease characterized by hyperplasia of the lymphoid follicles (
CD has two clinical subtypes: Multicentric and unicentric (localized) (
Radiological examinations, such as CT scans, can provide important information regarding CD tumors, including tumor site, characteristics and association with other tissues (
The majority of localized CD cases can be cured by resection of the involved lymph nodes (
In conclusion, CD is a rare lesion that is frequently misdiagnosed as lymphoma, thymoma, sarcoidosis or metastatic tumor, since non-specific symptoms or imaging findings are observed. The findings of the current study indicate that a diagnosis of CD should be considered for certain patients with masses in the lungs, particularly when accompanied by enlarged lymph nodes at distinct sites.
The present study was funded by the National Natural Science Foundation of China (grant no. 30971323), the Shanghai Municipal Science and Technology Commission (grant no. 09411951500) and the Shanghai Health Bureau (grant no. 2010006).
Conventional computed tomography scan of case 1, revealing a well-defined, homogenous mass at the lower lobes of right lungs, as well as enlarged nodes in the hilum and mediastinum. (A) Lung and (B) mediastinal window.
Contrast-enhanced computed tomography scan of case 2, revealing multiple nodules in both lungs, as well as the hilum and mediastinum. (A) Lung and (B) mediastinal window.
Typical histological features of Castleman's disease, demonstrating (A) numerous plasma cells and few blood vessels in the interfollicular areas in a 39-year-old female; and (B) numerous plasma cells in the interfollicular areas in a 40-year-old male (hematoxylin and eosin staining; magnification, x100).