Letter to the Editor
Mediastinal Castleman's Disease: Case Report
Enfermedad de Castleman mediastínica: presentación de un caso
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=> array:1 [ 0 => array:1 [ "paginaInicial" => "455" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hemotórax espontáneo como una forma de presentación del carcinoma broncogénico" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 746 "Ancho" => 930 "Tamanyo" => 85685 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The chest CT scan shows loculated pleural effusion, atelectasia of the lower lobe and lingula, and a 2<span class="elsevierStyleHsp" style=""></span>cm solitary pulmonary nodule in the apical segment of the left lower lobe.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ 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array:3 [ "nombre" => "Manuel" "apellidos" => "Mariñán Gorospe" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Irune" "apellidos" => "Albistur Lesmes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Cirugía Torácica, Hospital San Pedro, Logroño, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital San Pedro, Logroño, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Enfermedad de Castleman mediastínica: presentación de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 697 "Ancho" => 930 "Tamanyo" => 76170 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest computed tomography.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Although Castleman's disease is a pathological entity that has been well described in the scientific literature, there are few reported cases in Spain, and they may cause problems in the differential diagnosis. We present the case of a 33-year-old woman referred to our department by Internal Medicine with a diagnosis of a mediastinal mass found on a chest radiograph performed after an accident.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient reported an episode of self-limiting haemoptysis one month previously, weight loss that she related with anxiety, occasional retrosternal oppression accompanied by paraesthesia in the left arm and episodes of bronchospasm. Laboratory tests were normal. The chest computed tomography (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) revealed a soft tissue mass in the anterior mediastinum, 5<span class="elsevierStyleHsp" style=""></span>cm in diameter, occupying the prevascular space and aortopulmonary window. The lesion first suggested thymoma or lymphoma.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">As a surgical approach, we chose a left anterolateral mini-thoracotomy for various reasons: it provides good access to the lesion for biopsy, but at the same time can be easily widened if the lesion is resectable and, moreover, a sub-mammary incision is more cosmetic than an anterior mediastinotomy. A rounded, well-defined mass was found in the mediastinum, which abutted the superior pulmonary vein and artery, pericardium and left upper lobe, but did not infiltrate any of these structures and was completely excised.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The specimen was sent as an intraoperative biopsy and diagnosed as thymoma.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Definitive pathology: 6.16<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4.67<span class="elsevierStyleHsp" style=""></span>cm rounded, well-defined tumour. Benign giant lymph node hyperplasia consistent with Castleman's disease, histological subtype hyaline-vascular.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Castleman's disease (also known as angiofollicular lymph node hyperplasia or benign giant lymph node hyperplasia), first described by Benjamin Castleman in 1956,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> is a rare entity characterised by non-tumour proliferation of lymphoid tissue. The cause is unknown, although a subgroup of cases is associated with human herpesvirus-8 (HHV-8).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">It affects both sexes equally and can appear at any age and in any part of the body, although it occurs mainly in the thorax (70%), followed by the neck (15%) and the abdomen-pelvis (15%).</p><p id="par0040" class="elsevierStylePara elsevierViewall">Castleman's disease is classified into 3 histological subtypes: vascular-hyaline, plasma cell type and mixed.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> More recently though, a new classification into 4 variants has been proposed<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>: vascular-hyaline, plasma cell type, HHV-8-associated and non-specific multicentric Castleman's disease. The vascular-hyaline type is the most common variant (90%). It usually affects young people and is associated with the localised form. The plasma cell type represents 9% of cases, appears in adulthood and is usually characteristic of the generalised or multicentric form.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Clinically it can present in localised or multicentric form. The localised form appears more frequently in the thorax. The mean age is around 35 years and it affects both sexes equally. It usually presents as an asymptomatic, isolated mass, often diagnosed as a casual finding. It occasionally causes symptoms of compression, such as chest or abdominal pain. Peripheral lymphadenopathies are rare and laboratory tests show abnormalities in only 25% of cases. The multicentric form usually appears in older patients, affects more than one area of the body and presents with systemic manifestations: asthenia, weight loss, fever, generalised lymphadenopathies, skin lesions, neuropathy and hepatosplenomegaly. Laboratory tests usually show increased ESR, anaemia and hypergammaglobulinaemia. Unlike the localised form, it is strongly associated with immunosuppression and HHV-8 infection.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Its clinical evolution is often aggressive and fatal due to the development of infections and neoplasia, such as Kaposi's sarcoma and lymphomas.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The disease is suspected using imaging techniques, but definitive diagnosis requires a biopsy. The differential diagnosis includes other lymph node diseases, particularly lymphomas and tuberculosis, and indeed Bonekamp et al. called it “the great mimic”.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Treatment in the localised form is surgical resection<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>; recurrence has not been reported in most series, even with incomplete resection. The multicentric form requires multimodal therapies with radiotherapy, chemotherapy, corticosteroids and monoclonal antibodies.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of Interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors do not have any conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Miguélez Vara C, et al. Enfermedad de Castleman mediastínica: presentación de un caso. Arch Bronconeumol. 2013;49:455–6.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 697 "Ancho" => 930 "Tamanyo" => 76170 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest computed tomography.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Localized mediastinal lymph node hyperplasia resembling thymoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B. Castleman" 1 => "L. Iverson" 2 => "V.P. Menendez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "1956" "volumen" => "9" "paginaInicial" => "822" "paginaFinal" => "830" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13356266" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An attractive relation of human herpesvirus-8 with multicentric Castleman's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Katano" 1 => "T. Sata" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Intern Med" "fecha" => "1999" "volumen" => "38" "paginaInicial" => "221" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10337928" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hyaline-vascular and plasma-cell types of giant lymph node hyperplasia of the mediastinum and other locations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.R. Keller" 1 => "L. Hocholzer" 2 => "B. Castleman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "1972" "volumen" => "29" "paginaInicial" => "670" "paginaFinal" => "683" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4551306" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Castleman disease: an update on classification and the spectrum of associated lesions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.M. Cronin" 1 => "R.A. Warnke" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/PAP.0b013e3181a9d4d3" "Revista" => array:6 [ "tituloSerie" => "Adv Anat Pathol" "fecha" => "2009" "volumen" => "16" "paginaInicial" => "236" "paginaFinal" => "246" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19546611" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Castleman disease: the great mimic" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Bonekamp" 1 => "K. Horton" 2 => "R. Hruban" 3 => "E. Fishman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/rg.316115502" "Revista" => array:6 [ "tituloSerie" => "Radiographics" "fecha" => "2011" "volumen" => "31" "paginaInicial" => "1793" "paginaFinal" => "1807" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21997995" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The management of unicentric and multicentric Castleman's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W.B. Bowne" 1 => "J.J. Lewis" 2 => "D.A. Filippa" 3 => "R. Niesvizky" 4 => "A.D. Brooks" 5 => "M.E. Burt" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "1999" "volumen" => "85" "paginaInicial" => "706" "paginaFinal" => "717" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10091744" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000004900000010/v1_201309260158/S157921291300147X/v1_201309260158/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000004900000010/v1_201309260158/S157921291300147X/v1_201309260158/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157921291300147X?idApp=UINPBA00003Z" ]
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| 2017 February | 22 | 7 | 29 |
| 2017 January | 16 | 4 | 20 |
| 2016 December | 27 | 9 | 36 |
| 2016 November | 36 | 14 | 50 |
| 2016 October | 55 | 21 | 76 |
| 2016 September | 52 | 9 | 61 |
| 2016 August | 44 | 11 | 55 |
| 2016 July | 26 | 13 | 39 |
| 2016 March | 3 | 0 | 3 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 47 | 3 | 50 |
| 2015 September | 47 | 16 | 63 |
| 2015 August | 44 | 8 | 52 |
| 2015 July | 50 | 15 | 65 |
| 2015 June | 36 | 12 | 48 |
| 2015 May | 51 | 17 | 68 |
| 2015 April | 25 | 11 | 36 |
| 2015 March | 40 | 7 | 47 |
| 2015 February | 31 | 7 | 38 |
| 2015 January | 23 | 12 | 35 |
| 2014 December | 46 | 10 | 56 |
| 2014 November | 52 | 21 | 73 |
| 2014 October | 49 | 17 | 66 |
| 2014 September | 28 | 13 | 41 |
| 2014 August | 39 | 13 | 52 |
| 2014 July | 40 | 18 | 58 |
| 2014 June | 53 | 17 | 70 |
| 2014 May | 49 | 18 | 67 |
| 2014 April | 38 | 16 | 54 |
| 2014 March | 54 | 8 | 62 |
| 2014 February | 49 | 13 | 62 |
| 2014 January | 30 | 13 | 43 |
| 2013 December | 2 | 0 | 2 |
| 2013 November | 0 | 1 | 1 |
| 2013 October | 1 | 1 | 2 |
Show all
