Successful Treatment of Mediastinal Unicentric Castleman’s Disease Using Video-Assisted Thoracoscopic Surgery with Preoperative Embolization

Abstract

Unicentric Castleman's disease is a rare, benign lymphoproliferative disorder that is curable with surgical resection. However, significant bleeding often occurs during surgery because of tumor hypervascularity. We herein present a case of hyaline-vascular-type mediastinal unicentric Castleman's disease, successfully resected using video-assisted thoracoscopic surgery with preoperative embolization. In the present case, tumor hypervascularity and feeding vessels were revealed by computed tomography (CT), which led us to perform preoperative angiography and embolization to the tumor feeding arteries to reduce intraoperative bleeding. Castleman's disease should be considered in the differential diagnosis of hypervascular mediastinal tumors. Tumor vascularity should be assessed prior to surgery, and preoperative embolization should be considered.

Imaging and clinical features of Castleman Disease

“…Preoperative evaluation of feeding and draining vessels around lesions is very important since the standard treatment for patients with UCD is complete surgical resection [18, 23]. Preoperative embolotherapy for hypervascular nodal vessels may facilitate uncomplicated surgical resection [24, 25].…”

Castleman disease: Report of a case and review of literature on role of preoperative embolization

“…Outcomes in the reported cases, such as estimated blood loss, effect on tumor size, time interval between angioembolization and surgery, postoperative complications, and use of a surgical drain have been reported. Table 1 lists the literature review on the role of preoperative angioembolization in CD [16] , [17] , [18] , [19] , [20] , [21] .…”

Combinatorial treatment for unresectable unicentric Castleman disease

“…Walter et al first reported in 1978 a patient treated with arterial embolization as a preoperative adjunct to surgery to limit intraoperative bleeding 9 . Several case reports have described embolization in Castleman disease, usually for mediastinal masses unresectable at diagnosis, and preoperative use of embolization ensured safer surgical resection 10‐21 . Modern angiography equipment and microcatheters make the identification and selection of vessels feeding the tumor possible.…”