Surgical approach to posterior mediastinal Castleman´s disease: a case report

Castleman´s disease (CD) is a rare lymphoproliferative disorder often presenting as a hypervascular mass. This case highlights the unique challenges of surgically managing a posterior mediastinal CD mass adherent to vital structures. A 58-year-old woman was incidentally diagnosed with an asymptomatic posterior mediastinal mass during routine imaging for COVID-19. Computed tomography angiography revealed a 34 x 26 mm hypervascular mass closely associated with the esophagus, pulmonary artery, and bronchus. Initial surgical resection via VATS was converted to a posterolateral thoracotomy due to significant bleeding and adhesions. Histopathological examination confirmed hyaline vascular Castleman´s disease. The patient experienced an uneventful recovery and demonstrated a one-year remission. This case underscores the importance of advanced imaging and intraoperative flexibility in managing rare mediastinal masses. It also highlights the excellent prognosis achievable with complete resection, even in anatomically challenging cases.