J Korean Soc Radiol.  2013 Mar;68(3):201-204. 10.3348/jksr.2013.68.3.201.

Castleman Disease of Hyaline Vascular Type in the Infrathyroidal Region: A Masquerader of Parathyroid Adenoma

• Lee SK
• Kwon SY

• KMID: 1748451
• DOI: http://doi.org/10.3348/jksr.2013.68.3.201

Abstract

Castleman disease of the infrathyroidal region is extremely rare. We report both CT and sonographic findings of a case of infrathyroidal paratracheal Castleman disease of hyaline vascular type, which masquerades parathyroid adenoma, in a 48-year-old woman. We further provide its histological findings at sonographically guided core-needle biopsy (US-CNB) and excisional biopsy. The lesion was ovoid with homogeneous intense enhancement on contrast-enhanced CT (CECT), and was homogeneous, markedly hypoechoic, and hypervascular on ultrasonography (US). Histological findings of the specimen obtained by US-CNB suggested lymphoproliferative lesion, and thus was inconclusive; those obtained by excisional biopsy were characteristics of Castleman disease of hyaline vascular type. Hyaline vascular type Castleman's disease should be included in the differential diagnosis of a mass of the infrathyroidal region with homogeneous intense enhancement on CECT, as well as with marked hypoechogenicity and hypervascularity on US. US-CNB may be of limited value in the histological diagnosis of this entity.

MeSH Terms

Biopsy
Diagnosis, Differential
Female
Giant Lymph Node Hyperplasia
Humans
Hyalin
Parathyroid Neoplasms
Tomography, X-Ray Computed

Figure

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  Fig. 1 Castleman disease of hyaline vascular type in the left infrathyroidal paratracheal region (level VI) in a 48-year-old woman. A. A non-enhanced CT image shows a well-demarcated, ovoid, slightly lobular, and homogeneous solid mass (arrows) with attenuation value similar to adjacent muscles. B, C. Contrast-enhanced axial and coronal reformatted CT images reveal an infrathyroidal paratracheal mass with homogeneous, intense enhancement (arrows). D, E. Transverse and longitudinal gray-scale sonographic images show a well-demarcated, homogeneous, and markedly hypoechoic solid mass (arrows) in the left infrathyroidal paratracheal region. F. A longitudinal power Doppler sonographic image reveals prominent vascularity in the central and peripheral portions of the mass. G. A photomicrograph of histological examination of the specimen obtained by sonographically guided core-needle biopsy demonstrates numerous small lymphocytes and markedly increased vascularity (arrowheads) without germinal center (hematoxylin-eosin, × 200), and immunohistochemical staining for CD20 reveals strong positivity for numerous small B cells (inset: CD20, × 200). H. A photomicrograph of the histological examination of the specimen obtained by surgical excision exhibits a germinal center pierced by a hyalinized blood vessel (arrow) ("lollipop" appearance) and cuffed by the characteristically expanded mantle zone composed of small lymphocytes arranged in a concentric onionskin pattern (arrowheads), which are characteristic of Castleman disease of hyaline vascular type (hematoxylin-eosin, × 400).

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