Angiofollicular lymph node hyperplasia (Castleman's disease) associated with vertebral destruction

A 45-year-old man presented with lower thoracic pain, proteinuria, and destruction of thoracic vertebra from an adjacent unresectable paraspinal mass which, on biopsy, demonstrated angiofollicular lymph node hyperplasia (AFLNH). The patient received 3939 rad in 22 fractions to the mass and associated area of vertebral destruction. The patient is currently asymptomatic without recurrence of pain or progression of neurologic symptoms 5 years after radiotherapy. There has been resolution of the previous proteinuria. Serial computerized tomography scans and x-rays show no change in the paraspinal mass nor resolution of the vertebral destruction adjacent to the mass. A search of the English literature has failed to identify any previous association of AFLNH and bone destruction.