PET/CT findings in a multicentric form of Castleman's disease.

Abstract We report a case of a multicentric form of Castleman’s disease (CD). A thoracic computerized to-mography (CT) scan showed multiple mediastinal and bilateral axillary lymph nodes. Fluoro-18 flu-oro deoxyglucose ( 18 F-FDG) positron emission tomography-PET/CT scan demonstrated increased 18 F-FDG accumulation in multiple lymphatic regions and in bilateral pleural areas. The histopatho-logical sampling of an excised left axillary lymph node revealed a multicentric form of CD, of an in-termediate (mixed) cell type. The disease, its differential diagnosis and the diagnostic contribution ofnuclear medicine imaging, are described. Hell J Nucl Med 2007; 10(3): 172-174 n Published online: 19 November 2007 Introduction C astleman’s disease (CD) or angiofollicular lymph node hyperplasia is a rare benignlymphoproliferative disorder, which was first described in 1954 [1]. The etiology ofthis disorder is unknown. CD is most often found in the mediastinum (67%), but canbe identified wherever lymphoid tissue is normally present [2]. Histologically, CD is classifiedinto tree subtypes: the hyaline vascular type, the plasma cell type and the intermediate(mixed) cell type [3]. The hyaline vascular cell variant, accounts for more than 80%-90% ofthe cases and is usually asymptomatic. Patients with systemic illness may have fever, sweats,weight loss and fatigue. The majority of these cases are unicentric, usually appear as a slow-growing mass and are successfully treated by surgery. The plasma cell type makes up 10%-20% of CD cases and is usually multicentric. Multicentric form is characterized by systemicsymptoms and laboratory findings of inflammatory activity and is associated with relativelyhigher morbidity and mortality compared to the unicentric form. The patients with the mul-ticentric form do not benefit from surgery and are often referred to multimodality treatment[4]. Multicentric CD may degenerate into malignant lymphoma or vascular neoplasms suchas Kaposi’s sarcoma, follicular dendritic cell tumor and plasmacytoma [5]. In these patientsradiotherapy, chemotherapy, corticosteroids treatment and anti-cytokinetreatment have allbeen used, with variable responses [6].We report a case of a multicentic form of CD and evaluate the importance of fluoro-18fluoro deoxy glycose (