Multimodality imaging and clinical features in Castleman disease: single institute experience in 30 patients

作者：Hill A J^*; Tirumani S H; Rosenthal M H; Shinagare A B; Carrasco R D; Munshi N C; Ramaiya N H; Howard S A

来源：British Journal of Radiology, 2015, 88(1049): 20140670.

DOI：10.1259/bjr.20140670

Objective: To analyse imaging features of subtypes of Castleman disease (CD), emphasizing differentiating features from lymphoma.
Methods: Institutional review board-approved, Health Insurance Portability and Accountability Act compliant, retrospective study examined 30 patients with CD. 30 patients (females, 20; mean age, 46 years; range, 22-87 years) with histopathologically confirmed CD and pre-treatment imaging formed the analytic cohort. Imaging at presentation in all patients [CT, 30; positron emission tomography (PET)/CT, 5; MR, 4; ultrasound, 3] and subsequent imaging in three cases that developed lymphoma was reviewed by two radiologists in consensus.
Results: Subtypes: hyaline-vascular (n=18); multicentric not otherwise specified (NOS) (n=6); human herpesvirus 8 associated (n=2); mixed unicentric (n=2); pure plasma-cell variant (n=1); and unicentric NOS (n=1). Distribution: unicentric (n=17); and multicentric (n=13). Nodal sites-unicentric: 13 thoracic, 3 abdominal and 1 cervical; multicentric: 9 abdominal, 8 thoracic, 6 cervical, 5 inguinal, 4 axillary and 4 supraclavicular. On CT, differentiating features from lymphoma were calcification (n=8; 26.7%) and heterogeneous enhancement (n=5; 19.2%). No association between CD subtype, degree or enhancement pattern, or calcification was noted. On PET/CT (n=5), nodes were typically fluorine-18 fludeoxyglucose avid (n=4). On ultrasound (n=3), nodes were hypoechoic, homogeneous with posterior acoustic enhancement. On MR (n=4), nodes were hypointense (n=2) to isointense (n=2) on T1 weighted images and isointense (n=1) to hyperintense (n=3) on T2 weighted images. All (n=4) demonstrated homogeneous enhancement. Three cases developed non-Hodgkin's lymphoma, two of the three had larger spleens, and these cases had effusions/ascites.
Conclusion: CD can be unicentric or multicentric and involve nodes above and below the diaphragm. Patients with CD can develop lymphoma.
Advances in knowledge: Assessing individual risk of developing lymphoma in patients with CD is difficult, although the findings of splenomegaly, pleural effusion and ascites may be suggestive.

• 出版日期2015