CTICasesCastleman's Disease, Hyaline Vascular Type, with Cystic Lung Disease
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Imaging findings
Chest radiograph showed diffuse lung disease and bulky hilar and mediastinal lymphadenopathy, extending below the bronchus. CT confirmed extensive mediastinal, hilar, and subcarinal lymphadenopathy with well-defined borders. Lung parenchyma displayed predominantly cystic disease with punched-out lesions and paraseptal emphysema, worse in the upper lobes with relative sparing of the bases. Patchy ground-glass opacities were also present in lower lung zones.
Key takeaways
An unusual presentation of hyaline vascular type Castleman's disease with extensive multi-station lymphadenopathy and diffuse cystic lung disease. While typically unicentric, this case showed lymphoid follicles throughout the lung, akin to Lymphocytic Interstitial Pneumonia (LIP) or follicular bronchitis, which can lead to cyst formation. The case was confirmed by lung transplantation pathology, but the combination of hyaline vascular type and diffuse lung disease/multi-station lymphadenopathy was considered very atypical.
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