Thoracoscopic Resection of Castleman Disease

Seirafi, Peter A.; Ferguson, Eric J.; Edwards, Fred H.

doi:10.1378/chest.123.1.280

Cited by 22 publications

(21 citation statements)

References 10 publications

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“…Needless to say, the risk of bleeding is even greater when surgery is contemplated. Although occasionally reported successful [15,16], thoracoscopy should be avoided in CD. One case of hemangiopericytoma, in which diagnosis was not known preoperatively, had to be operated on twice.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Embolization of Hypervascular Castleman’s Disease of the Mediastinum

Robert

Sgourdos

Kritikos

et al. 2007

Cardiovasc Intervent Radiol

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We report the case of a 31-year-old woman with mediastinal CastlemanÕs disease of the hyaline vascular type. This large tumor was safely resected after arterial embolization. We describe the steps of this interventional procedure and discuss related necessary precautions.Key words: CastlemanÕs disease-Hypervasular tumors-Mediastinum-Arterial embolization CastlemanÕs disease (CD) is a rare form of lymph node hyperplasia, most commonly presenting as a solitary mediastinal mass. Computed tomography (CT) and angiographic features of CD are nonspecific [1] and a definite diagnosis is only based on histology findings. The surgical approach is usually curative when the disease is unicentric [2], but it is frequently associated with profuse bleeding. Only a few previous reports have suggested arterial embolization in the preoperative management of CD [3,4]. We report a case of localized CD presenting as a voluminous mass in the posterior mediastinum. Preoperative arterial embolization of this tumor minimized intraoperative bleeding. Case ReportA 31-year-old nonsmoking Asian woman with no medical history presented with a dry cough for 6 months without any other symptoms. An abnormal opacity in the posterior mediastinum was found on chest X-ray (Figs. 1A and 1B). CT confirmed the presence of a 12-cm homogeneous, welldelineated hypervascular right paravertebral mass of the posterior mediastinum (Fig. 1C). There was no evidence of pleural fluid or bone invasion. Laboratory investigations were within the normal range. Fine-needle aspiration or needle-core biopsy was not performed considering the risk of bleeding from this hypervascular mass and because of its location.A preoperative descending thoracic aortogram was obtained by means of a 5F pigtail catheter (Cordis, Roden, The Netherlands), in order to visualize the origin of the bronchial and extrabronchial arteries from the aorta. A selective bronchial arteriography by means of a 5F steam-modified Cobra catheter (Cordis, Roden, The Netherlands) supported the presence of a hypervascular mediastinal mass. The lesion was exclusively supplied by two arterial branches of a broncho-intercostal trunk originating from the descending thoracic aorta; it drained into large uphill inferior esophageal varices (Fig. 2). In a second step, embolization of these two feeding arteries was performed, in order to minimize intraoperative bleeding. The superior arterial branch, which supplied the superior and lateral portions of the mass, was selectively catheterized with a 2.5F microcatheter (Tracker 18; Boston Scientific, Cork, Ireland) and embolized by means of gelatin cross-linked tris-acryl microspheres 500-750 lm in diameter (Embospheres; Biosphere Medical, Roissy-Charles-de-Gaulle, France). Occlusion of the proximal segment was completed by three 3-0 silk threads (Silkam; Aesculap, Tuttlingen, Germany). The second arterial branch, which supplied the inferior and medial portions of the mass, was superselectively catheterized beyond the left bronchial artery and embolized in the sa...

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Section: Discussionmentioning

confidence: 99%

Preoperative Embolization of Hypervascular Castleman’s Disease of the Mediastinum

Robert

Sgourdos

Kritikos

et al. 2007

Cardiovasc Intervent Radiol

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“…Rather, there are a variety of possibilities, including surgery and radiotherapy, as well as the use of steroids, antiviral agents, specific antibodies, monochemotherapy and polychemotherapy. (2,3,8,11) Castleman's disease, despite its rarity, should be included in the differential diagnosis of asymptomatic or oligosymptomatic nodules and mediastinal masses.…”

Section: Discussionmentioning

confidence: 99%

“…(5) Affected patients tend to be young (mean age, 23 years; range, 8-66 years), of either gender, and asymptomatic; the evolution is typically benign. (2,3) The differential diagnosis should include diseases that present large mediastinal masses, such as Hodgkin's lymphoma and the thymomas, as well as certain rheumatologic diseases that cause lymph node enlargement.…”

Section: Introductionmentioning

confidence: 99%

Doença de Castleman ou hiperplasia angiofolicular como nódulo pulmonar solitário: relato de caso

et al. 2007

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Castleman's disease is a rare disorder generally characterized by a mediastinal nodule, with a great variety of alternative presentations regarding age, clinical manifestations and evolution. This case report describes a 40-year-old female patient presenting with uncharacteristic chest pain for a few years. A chest X-ray revealed a hypotransparency on the right side. Computed tomography and pulmonary arteriography did not elucidate the diagnosis, which was made through surgical resection and anatomopathological examination of the nodule, which presented characteristics of angiofollicular hyperplasia, or Castleman's disease. This article emphasizes the importance of adding this disease to the list of morbidities in the differential diagnosis of pulmonary solitary nodules.

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“…Histopathological examination of the enlarged lymph nodes often shows a follicular hyperplasia of lymph nodes with abnormally increased interfollicular vascularity. This disease usually occurs in the chest, especially in the mediastinum and neck [2][3][4][5][6], and rarely occurs in the abdomen. The usual presentation is a solitary and well-circumscribed asymptomatic mass lesion, often becoming large size, with infrequent hematologic manifestations [2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Abdominal giant lymph node hyperplasia (Castleman’s disease): report of two cases

Wang

2011

Open Medicine

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Thoracoscopic Resection of Castleman Disease

Cited by 22 publications

References 10 publications

Preoperative Embolization of Hypervascular Castleman’s Disease of the Mediastinum

Preoperative Embolization of Hypervascular Castleman’s Disease of the Mediastinum

Doença de Castleman ou hiperplasia angiofolicular como nódulo pulmonar solitário: relato de caso

Abdominal giant lymph node hyperplasia (Castleman’s disease): report of two cases

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