Castleman disease of the pleura: experience with eight surgically proven cases.
BACKGROUND
Castleman disease of the pleura is unusual, and we present our experience with eight surgically proven cases.


METHODS
Between 1980 and 2002, 8 patients (7 women and 1 man; age range, 20 to 53 years; mean, 26.5 years) with surgically proven, pleural Castleman disease (six hyaline vascular type, one plasma cell type, and one mixed type) were encountered. Their clinical, imaging, and surgical findings were reviewed.


RESULTS
Five patients were asymptomatic, 1 had dyspnea, 1 had cough, and 1 experienced chest discomfort. Chest radiography showed a well-circumscribed interlobar, cardiophrenic, or paraaortic mass in 6 patients, a massive effusion in 1, and a focal diaphragmatic bulge in 1. Six tumors showed varying degrees of contrast enhancement (10 to 95 HU; mean, 46 HU) on computed tomography. Three cases appeared as well-defined, heterogeneously hyperintense pleural masses on magnetic resonance imaging. The masses varied in size from 3 to 10 cm (mean, 5.2 cm). Five masses greater than 5 cm had prominent pleural arterial blood supply and severe adhesions requiring thoracotomy and resection of nearby structures for radical tumor excision. Blood loss from patients varied between 100 and 850 mL (mean, 620 mL). No tumor recurrence was noted during follow-up (range, 1 to 16 years; mean, 6.5 years).


CONCLUSIONS
Pleural Castleman disease predominately affects young women and manifests as a well-circumscribed mass with a varying degree of contrast enhancement on computed tomography and heterogeneity on magnetic resonance imaging. Tumors greater than 5 cm have profuse pleural blood supplies and severe adhesion necessitating open thoracotomy and resection of neighboring structures. Radical resection can produce a satisfactory outcome.
Ko
Sheung-Fat
SF
Departments of Radiology, Keelung Hsien and Taoyuen Hsien, Taiwan. sfatko@adm.cgmh.org.tw
Ng
Shu-Hang
SH
Hsieh
Ming-Jang
MJ
Lin
Jui-Wei
JW
Huang
Chung-Cheng
CC
Lee
Tze-Yu
TY
Chen
Wei-Jen
WJ
D000328:Adult; D001707:Biopsy, Needle; D005871:Castleman Disease / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000175:diagnosis* / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D035583:Rare Diseases; D018570:Risk Assessment; D012494:Sampling Studies; D019616:Thoracic Surgical Procedures / Q000379:methods; D013906:Thoracoscopy / Q000379:methods; D016896:Treatment Outcome