J Korean Soc Radiol.  2017 Jan;76(1):73-77. 10.3348/jksr.2017.76.1.73.

Adrenal Castleman's Disease Mimicking Other Adrenal Neoplasms: A Case Report

• Hong SB
• Lee NK
• Kim S
• Han GJ
• Ha HK
• Ku JY
• Ahn SJ
• Lee CH

• KMID: 2365055
• DOI: http://doi.org/10.3348/jksr.2017.76.1.73

Abstract

We present a rare case of adrenal Castleman's disease with hyaline vascular type mimicking other adrenal neoplasms in a 65-year-old woman. Although rare, the hyaline vascular type of adrenal Castleman's disease should be included in the differential diagnosis if an adrenal mass shows a well-defined, highly enhancing solid adrenal mass with peripheral rim enhancement, multiple satellite lymph nodes, and peritoneal thickening around the dominant mass on computed tomography as shown in this patient.

MeSH Terms

Adrenal Gland Neoplasms*
Adrenal Glands
Aged
Diagnosis, Differential
Female
Giant Lymph Node Hyperplasia*
Humans
Hyalin
Lymph Nodes
Multidetector Computed Tomography

Figure

• 

  Fig. 1 Adrenal Castleman's disease mimicking other adrenal neoplasms in a 65-year-old woman. A. Pre-enhanced CT showing a well-defined homogenous soft tissue density mass of 5.0 cm in long dimension (arrow) in the left adrenal gland. B. Contrast-enhanced CT showing a highly enhancing mass with peripheral rim enhancement (arrow). Peritoneal thickening (arrowhead) surrounding the mass is noted. C. Contrast-enhanced CT showing multiple small enhancing retroperitoneal lymph nodes (arrow). Increased fat stranding in the left perirenal space was also noted.

• 

  Fig. 2 Hyaline-vascular type Castleman's disease of the adrenal gland in a 65-year-old woman. A. Photomicrograph (original magnification, × 200 hematoxylin-eosin stain) of the mass showing lymphoid follicles with small hyalinized germinal centers and broad mantle zone. Mantle zone lymphocytes are arranged in concentric rings (“onion skin” pattern). B. The “onion skin” pattern is highlighted by immunochemical staining for CD20 (original magnification, × 200). C. Photomicrograph (original magnification, × 200; immunochemical staining for CD34) of the mass showing some follicles with penetration by blood vessels (“lollipop follicle”, arrow). D. Photomicrograph (original magnification, × 100 hematoxylin-eosin stain) of the mass showing prominent vascular proliferation (arrow) in the periphery of the mass.

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