[A case of bronchobronchiolitis obliterans with Castleman's lymphoma]

The aim of this paper is to report a very rare case of bronchobronchiolitis obliterans accompanied by mesenteric Castleman's lymphoma. A 45-year-old woman was admitted to our hospital with progressive exertional dyspnea. Chest radiography showed overinflated lungs suggesting emphysema and pulmonary function tests revealed severely restrictive as well as obstructive impairments. Selective alveolobronchogram and endoscopy using a thin fiberoptic bronchoscope (3 mm in diameter) demonstrated multiple obstructions of small bronchi. Using a biopsy forceps, a small piece of tissue of bronchial wall was obtained from the focus of obstructive change, which showed histologically nonspecific inflammatory change including granulation. Therefore, we diagnosed her disease as bronchobronchiolitis obliterans (BBO). In addition, she had a large abdominal mass. On operation, it was found to be located in the mesenterium. It was then removed and the histological examination revealed Castleman's lymphoma, hyaline-vascular type. After operation, the blood IgM level, which was high on admission decreased rapidly and her dyspnea was reduced, suggesting that Castleman's lymphoma was related to the pathogenesis of her respiratory disease.