Journal of the Louisiana State Medical Society
treatment. Contrastly, the multicentric variety is often the plasma cell type, which is associated with systemic mani- festations. 2,6 Patients with the hyaline-vascular type of disease tend to be asymptomatic, but may complain about symptoms caused by compression of adjacent structures or may present with a palpable mass. However, 50% of cases involving the plasma cell variant show systemic manifestations, including fever, anemia, and hyperglobulinemia. 7 Laboratory evaluation of a patient with Castleman’s disease, hyaline vascular type, is almost always within normal limits, and laboratory assessment is almost never useful for the clinical diagnosis. The differential diagnosis, especially in the head and neck region, should include other benign lesions such as pleomorphic adenomas, Warthin tumor, schwannoma, carotid body tumors, and inflam- matory lymphadenectasis; but malignant tumors such as lymphoma, mucoepidermoid carcinoma, adenoid cystic carcinoma, and metastatic lymph node should also be con- sidered. Imaging studies such as US, CT, MRI/MRA are sometimes helpful for establishing a differential diagnosis. In Castleman’s disease, ultrasonography and CT always show uniformly hypoechoic masses with good through transmission. 9 Treatment for Castleman’s Disease, hyaline vascular type, in the parotid and neck region is surgical resection. These patients tend to have a good prognosis without re- currence. However, for the plasma cell type, the prognosis is poor, and the patient usually undergoes radiation and chemotherapy with or without surgical resection. 9 REFERENCES 1. Chaloupka JC, Castillo M, Hudgins P. Castleman disease in the neck: atypical appearance on CT. AJR Am J Roentgenol 1990;154:1051–2. 2. Johkoh T, Muller NL, Ichikado K, et al. Intrathoracic multicentric Castleman disease: CT findings in 12 patients. Radiology 1998;209:477–481.
3. Johnson JT, Oral A, Nalesnik M, Roscoe GJ, Whiteside TL. Giant lymph node hyperplasia: clinical and immunohistologic correlation of an intermediate variant. Ear Nose Throat J 1985; 64:249–254. 4. Keller AR, Hochholzer L, Castleman B. Hyaline-vascular and plasma-cell types of giant lymph node hyperplasia of the mediastinum and other locations. Cancer 1972; 29:670–683. 5. Ko, Sheung-Fat, Hsieh, Ming-Jeng, Ng, Shu-Hang, Lin, JUI-Wei, Wan, Yung-Liang, Lee, Tze-Yu, Chen, Wei-Jen, Chen, Min-Chi. Pictorial Essay: Imaging Spectrum of Castleman’s Disease. AJR 2004; 182: 769-775. 6. McAdams HP, Rosado-de-Christenson M, Fishback NF, Templeton PA. Castleman disease of the thorax: radiologic features with clinical and histopathologic correlation. Radiology 1998; 209:221–228. 7. Shin JH, Lee HK, Kim SY, Khang SK, Park SH, Choi CG, et al. Castleman’s disease in the retropharyngeal space: CT and MR imaging findings. AJNR Am J Neuroradiol 2000; 21:1337–9. 8. Tan, T Y, Pang, K P, Goh, H K C, Teo, E L H, Abilash, B, Walford, N. Castleman’s disease of the neck: a description of four cases on contrast-enhanced CT. The British Journal of Radiology 2004; 77:253-6. 9. Zhong L, Wang L, et al. Clinical analysis of Castleman Disease (hyaline vascular type) in parotid and neck region. Oral Surgery Oral Medicine Oral Pathology Oral Radiology & Endodontics 2010;109:432-40. Mr. Bordlee Jr. and Mr. Oncale are fourth-year Medical Students at Tulane University Health Sciences Center in New Orleans. Dr. Stone is a Pathology Resident at Tulane University Health Sciences Center. Dr. Palacios is Section Chief of Neuroradiology and Clinical Professor of Otorhinolaryngology at Tulane University Health Sciences Center. Dr. Neitzschman is a Professor of Radiology and the Chairman of the Department of Radiology at Tulane University Health Sciences Center.
80 J La State Med Soc VOL 166 March/April 2014
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