Lump on the left side of the neck
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There is a soft tissue mass, measuring 3.5 x 1.9 x 5.3 cm (AP x T x CC), in the left posterior cervical space beneath the sternocleidomastoid muscle and posterior to the carotid artery and jugular vein. The mass exhibits intense enhancement on the contrast-enhanced images. Subcentimeter cervical lymph nodes are also seen bilaterally.
The patient underwent neck exploration and excision of the left cervical mass.
Histopathologic examination of the mass revealed Castleman disease (hyaline vascular type).
Castleman disease is a rare disease of lymph nodes and related tissues. It is also known as giant lymph node hyperplasia and angiofollicular lymph node hyperplasia. It was first described by Dr. Benjamin Castleman in the 1950s1-3.
Neck involvement in Castleman disease accounts for approximately 14% of all cases of the disorder4.
These are some imaging clues for the hyaline vascular type of Castleman disease on computed tomography (CT)4,5:
- solitary enlarged lymph node or localized nodal masses
- can occur anywhere in the body wherever there are lymph nodes
- lesions exhibit homogeneous intense enhancement after contrast material administration - classic appearance
- 1. Keller AR, Hochholzer L, Castleman B. Hyaline-vascular and plasma-cell types of giant lymph node hyperplasia of the mediastinum and other locations. Cancer. 1972;29 (3): 670-83. Pubmed citation
- 2. Kim JH, Jun TG, Sung SW et-al. Giant lymph node hyperplasia (Castleman's disease) in the chest. Ann. Thorac. Surg. 1995;59 (5): 1162-5. Pubmed citation
- 3. Johkoh T, Müller NL, Ichikado K et-al. Intrathoracic multicentric Castleman disease: CT findings in 12 patients. Radiology. 1998;209 (2): 477-81. doi:10.1148/radiology.209.2.9807577 - Pubmed citation
- 4. Frizzera G, Banks PM, Massarelli G et-al. A systemic lymphoproliferative disorder with morphologic features of Castleman's disease. Pathological findings in 15 patients. Am. J. Surg. Pathol. 1983;7 (3): 211-31. Pubmed citation
- 5. Bonekamp D, Horton KM, Hruban RH et-al. Castleman disease: the great mimic. Radiographics. 2011;31 (6): 1793-807. doi:10.1148/rg.316115502 - Pubmed citation