Abdominal CT findings characteristic of Castleman disease: multi-centre review of 76 adult cases with abdominopelvic nodal involvement

Author:

Pickhardt Perry J1ORCID,Wong Vincenzo K2,Mellnick Vincent3,Sugi Mark4,Aswani Yashant5ORCID

Affiliation:

1. Department of Radiology, University of Wisconsin School of Medicine and Public Health , Madison, WI 53792-3252, United States

2. Department of Abdominal Imaging, MD Anderson Cancer Center , Houston, TX 77030-4009, United States

3. Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine , St Louis, MO 63110, United States

4. Department of Radiology, University of California-San Francisco , San Francisco, CA 94143, United States

5. Department of Radiology, University of Iowa Hospitals and Clinics , 200 Hawkins Dr , Iowa City, Iowa 52242, United States

Abstract

Abstract Objective Characterize the CT findings of abdominopelvic Castleman disease, including a new observation involving the perinodal fat. Methods Multi-centre search at 5 institutions yielded 76 adults (mean age, 42.1 ± 14.3 years; 38 women/38 men) meeting inclusion criteria of histopathologically proven Castleman disease with nodal involvement at abdominopelvic CT. Retrospective review of the dominant nodal mass was assessed for size, attenuation, and presence of calcification, and for prominence and soft-tissue infiltration of the perinodal fat. Hypervascular nodal enhancement was based on both subjective and objective comparison with aortic blood pool attenuation. Results Abdominal involvement was unicentric in 48.7% (37/76) and multicentric in 51.3% (39/76), including 31 cases with extra-abdominal involvement. Histopathologic subtypes included hyaline vascular variant (HVV), plasma cell variant (PCV), mixed HVV/PCV, and HHV-8 variant in 39, 25, 3 and 9 cases, respectively. The dominant nodal mass measured 4.4 ± 1.9 cm and 3.2 ± 1.7 cm in mean long- and short-axis, respectively, and appeared hypervascular in 58.6% (41/70 with IV contrast). Internal calcification was seen in 22.4% (17/76). Infiltration of the perinodal fat, with or without hypertrophy, was present in 56.6% (43/76), more frequent with hypervascular vs non-hypervascular nodal masses (80.5% vs 20.7%; P < .001). Among HVV cases, 76.9% were unicentric, 71.1% appeared hypervascular, and 69.2% demonstrated perinodal fat infiltration. Conclusion Hypervascular nodal masses demonstrating prominence and infiltration of perinodal fat at CT can suggest the specific diagnosis of Castleman disease, especially the HVV. Advances in knowledge Abdominopelvic nodal masses that demonstrate hypervascular enhancement and prominent infiltration of the perinodal fat at CT can suggest the diagnosis of Castleman disease, but nonetheless requires tissue sampling.

Publisher

Oxford University Press (OUP)

Reference17 articles.

1. Pathology of Castleman disease;Wu;Hematol Oncol Clin North Am,2018

2. Case records of the Massachusetts General Hospital: case no. 40231;Castleman;N Engl J Med,1954

3. Imaging of Castleman disease;Pitot;Radiographics,2023

4. Imaging and clinical features of Castleman disease;Zhao;Cancer Imaging,2019

5. Castleman disease: the great mimic;Bonekamp;Radiographics,2011

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