Castleman’s Disease of the Pleura: Case Presentation and Review of Literature

Abstract

Purpose: Castleman's Disease is a very rare medical disease and the presence of this condition in the pleura is even rarer and there are only few reported cases. The presence of symptoms is also unusual and has been mostly described in multicentric cases of castleman's disease instead of solitary lesions (unicentric castleman). We report a case of unicentric pleural castlema's disease with presence of constitutional symptoms. Methods: A 36-year-old male without any significant past medical history who presented to the emergency due to an incidental large pleural effusion seen in chest radiograph, but referring chronic constitutional symptoms consistent of significant weight loss and chronic cough. Results: Chest computed tomography revealed a mass and several attemps with minimally invase approach failed to identify the lesion. The mass was excised through VATS but due to its significant vascularity, it had to be converted to open thoracotomy. Conclusion: The treatment of unicentric lesions is mainly complete surgical excision and the prognosis is excellent with some chances of recurrence. There are less than one dozen of reported pleural castleman reported in the literature. This case evidence than unicentric lesion may exhibit constitutional symptoms and confirmed than lesions above 5 cm can be removed by VATS but the chances for conversion to an open thoracotomy are high.

Intrathoracic Castleman's disease: “An important clinical mimicker”

“…Systemic inflammatory and hematological manifestations of patients with MCD are thought to be primarily a consequence of elevated IL-6 production. [ 10 ] Although histopathological examination of excisional biopsy of affected lymph node tissue still remains the gold standard for diagnosis of CD,[ 11 ] contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) and angiography are valuable diagnostic tools. [ 6 ] Mediastinal lesions on chest radiograph may mimic thymoma, lymphoma, or other solid tumors while hilar lesions may imitate lung malignancies.…”

“…[ 12 ] Further, a lesser degree of the enhancement is found in the plasma cell variant. [ 13 ] CT-guided fine-needle aspiration (FNA) of the mass is usually nondiagnostic in both UCD and MCD and are frequently “negative for malignant cells.”[ 2 9 10 11 ] According to Deschênes et al .,[ 14 ] FNA can be useful in diagnosing some cases of CD, but in author's opinion, excision biopsy should be preferred whenever possible.…”