title: Multimodality imaging and clinical features in Castleman disease: single institute experience in 30 patients.
abstract: 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.
  
  
  CONCLUSIONS
  CD can be unicentric or multicentric and involve nodes above and below the diaphragm. Patients with CD can develop lymphoma.
  
  
  CONCLUSIONS
  Assessing individual risk of developing lymphoma in patients with CD is difficult, although the findings of splenomegaly, pleural effusion and ascites may be suggestive.
authors.affiliation: 1 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Hill
authors.forename: S H
authors.initials: SH
authors.lastname: Tirumani
authors.forename: M H
authors.initials: MH
authors.lastname: Rosenthal
authors.forename: A B
authors.initials: AB
authors.lastname: Shinagare
authors.forename: R D
authors.initials: RD
authors.lastname: Carrasco
authors.forename: N C
authors.initials: NC
authors.lastname: Munshi
authors.forename: N H
authors.initials: NH
authors.lastname: Ramaiya
authors.forename: S A
authors.initials: SA
authors.lastname: Howard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005871:Castleman Disease / Q000175:diagnosis* / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D012189:Retrospective Studies