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Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
Published on: June 16, 2020
Imaging and clinical features of Castleman Disease
Shuang Zhao1, Ying Wan2, Zixing Huang1
1Department of Radiology, West China Hospital, Sichuan University, No. 37, GUOXUE Alley, Chengdu, 610041, China.
Insights
Castleman disease (CD) imaging findings can be mistaken for lymphoma. This study highlights key CT and MRI features, including lymph node appearance and enhancement patterns, to improve CD diagnosis.
Area of Science:
- Radiology
- Oncology
- Pathology
Background:
- Castleman disease (CD) is a rare lymphoproliferative disorder.
- CD is often misdiagnosed as lymphoma or solid tumors due to overlapping clinical and imaging features.
Purpose of the Study:
- To evaluate the imaging and clinical findings of Castleman disease.
- To improve the understanding and diagnostic accuracy of CD.
Main Methods:
- Retrospective analysis of 74 patients with histopathologically confirmed CD.
- Evaluation of CT and MRI findings, including enhancement patterns, vessel hypertrophy, and calcification.
- Correlation of imaging findings with clinical presentation and histopathologic characteristics.
Main Results:
- Hyaline vascular variant (82.4%) and plasma cell variant (17.6%) were identified.
- Unicentric CD (87.8%) was more common than multicentric CD (12.2%).
- CT/MRI showed enlarged, hypodense/isodense nodes with variable enhancement; hypertrophied vessels and calcification were noted in a significant proportion of patients.
Conclusions:
- Castleman disease typically presents as well-defined lymph nodules on non-enhanced CT/MRI.
- Contrast-enhanced CT/MRI reveals intermediate to marked enhancement.
- Calcification and hypertrophied vessels are valuable diagnostic indicators for CD.
Background:
Castleman disease (CD) is a group of uncommon lymphoproliferative disorders that is easily confused with lymphoma or other solid tumors. The purpose of our study was to evaluate the imaging and clinical findings of CD, and thus improve the understanding and diagnosis of CD.
Methods:
This retrospective study included 74 patients (37 men and 37 women, mean age ± standard deviation, 35 ± 15.2 years,) with histopathologically confirmed CD diagnosed based on CT or MRI between January 2010 and May 2017. The CT and MRI findings were analyzed by two radiologists in consensus, and clinical presentation and histopathologic characteristics were documented.
Results:
The CD subtypes included 61 hyaline vascular variant cases (82.4%) and 13 plasma cell variant cases (17.6%). Unicentric CD and multicentric CD were observed in 65 (87.8%) and 9 (12.2%) patients, respectively. On non-enhanced CT, enlarged nodes with hypodensity or isodensity were seen, whereas varying degrees of enhancement were observed in contrast-enhanced CT. Homogeneous and heterogeneous enhancements were observed in 43 (62.3%) and 26 (37.7%) patients, respectively. Hypertrophied vessels and calcification were detected in 38 (51.2%) and 18 (24.3%) patients, respectively. MRI revealed hypointense to isointense lesions on T1-weighted images, isointense to hyperintense lesions on T2-weighted images, and hyperintense lesions on diffusion-weighted imaging; 9 (75%) and 3 (25%) patients demonstrated homogeneous and heterogeneous enhancement, respectively.
Conclusion:
CD often shows well-defined, mildly hypodense or isodense, homogeneous lymph nodules on non-enhanced CT/MRI, with intermediate and marked enhancement on contrast-enhanced CT/MRI. Calcification and hypertrophied vessels may be valuable diagnostic features.
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