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Published on: September 5, 2017
18F-FDG PET/CT in lung B lymphoid hyperplasia-type Castleman disease
Paula Fernández-Rodríguez1, Rosa Fernández López2, Irene Acevedo Báñez2
1Department of Nuclear Medicine, Virgen del Rocío University Hospital, Av. Manuel Siurot, 41013, Seville, Spain. paulafer.rodri@gmail.com.
Insights
Castleman disease, a rare condition, can mimic lung cancer. This case highlights unicentric Castleman disease presenting as a pulmonary mass, emphasizing its importance in differential diagnosis.
Area of Science:
- Pulmonology
- Oncology
- Pathology
Background:
- Castleman disease is a rare lymphoproliferative disorder.
- Unicentric Castleman disease (UCD) typically presents with a hyaline-vascular subtype and is often asymptomatic.
- Extranodal and pulmonary involvement of UCD are exceptionally rare.
Observation:
- A 62-year-old woman presented with a left lower lobe pulmonary mass after a catarrhal episode.
- Imaging revealed a pleural-based mass with mixed solid and ground-glass attenuation and an air-bronchogram.
- 18F-FDG PET/CT showed focal radiotracer uptake, suggesting a neoplastic etiology.
Findings:
- Histopathological examination of the resected mass confirmed Castleman disease, specifically the B lymphoid hyperplasia type.
- The pulmonary lesion was initially suspected to be bronchopneumonia or lepidic adenocarcinoma.
- The final diagnosis of Castleman disease in the lung challenges typical presentations.
Implications:
- Pulmonary Castleman disease should be considered in the differential diagnosis of primary pulmonary malignant tumors.
- This case underscores the diagnostic challenges posed by rare Castleman disease presentations.
- Accurate diagnosis is crucial as Castleman disease can be misdiagnosed as lymphoma, neoplasm, or infection.
Abstract:
We present a 62-year-old woman who, after a catarrhal episode, underwent a chest xray and a chest CT, identifying a pleural-based mass in the left lower lobe. This lesion presented a mixed pattern with solid and peripheral ground-glass attenuation, and an air-bronchogram sign. Despite de suspicion of bronchopneumonia, a lung neoplasm like a predominantly lepidic adenocarcinoma could not be ruled. A 18 F-FDG PET/CT showed a focal radiotracer uptake with SUVmax of 5.34 in the pulmonary lesion, supporting the neoplastic etiology. Consequently, a lower lobectomy was performed and histological examination concluded that the final diagnosis was a B lymphoid hyperplasia-type Castleman disease. Castleman's disease is an uncommon disorder that can be easily misdiagnosed as lymphoma, neoplasm or infection. Unicentric Castleman's disease (UCD) usually presents a hyaline-vascular histological subtype and is usually asymptomatic. Extranodal involvement is very rare. Only a few cases of solid organ involvement such us spleen or parotid gland have been described. UCD originating in the lung is extremely rare and should be considered in the differential diagnosis of a primary pulmonary malignant tumor.
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