V0154:右上纵膈局限性巨淋巴结增生（透明血管型）

pp

由caihe版主提供讨论的类似病例连接：
http://www.radida.com/bbs/forum.php?mod=viewthread&tid=17582

男性，26岁。右上胸部外伤急诊患者。平片发现右上纵膈异常而行ct和dsa检查。

[本贴已被 向医生 于 2008-12-9 23:12:20 修改过]

dyqct

占位性病变

[本贴已被 dyqct 于 2006-12-15 19:29:17 修改过]

卜一

定位:中纵隔.
特征:类圆形,边界清楚,占位效应明显,富血供.
定性:首先考虑_淋巴瘤.
建议:增强.

ssm999

畸胎瘤

漫步云端

中纵隔.类圆形,边界清楚,占位效应明显,富血供，良性病变可能性大。

pp

局限性巨淋巴结增生（透明血管型）。
]


请看由zhangyong版主发布的腹膜后局限性巨淋巴结增生病例：
v0090:http://www.radida.com/radinet/read.php?tid=15905

病例①：
age/sex: 58/m
chief complaints: extremity weakness, sensory change, and skin lesion



病例②：
age / sex：40 / m
chief complaint：routine check-up .  history of operation due to mediastinal mass
                           ten years before.



病例③：
age / sex：23 / male
chief complaint： recurrent lymphadenopathy in the preauricular,
                           elbow and bilateral inguinal areas
   diagnosis：       multicentric castleman&#39；s disease with lung involvement
                            (lymphocytic interstitial pneumonitis)



病例④：
age / sex：44 / female
chief complaint： asymptomatic, chest radiograph abnormality



病例⑤：
age / sex：21 / male
chief complaint：incidental detected mass at left hilum



病例⑥：
age / sex：31 / f
chief complaint：incidental cxr abnormality on routine health exam



病例⑦：
age / sex：40 / m
chief complaint： incidental abnormality on chest radiograph



病例⑧：
39 / m；    chest discomfort


病例⑨：
40 / f,  incidental mass on croutine check


病例⑩：
age / sex：28 / f
chief complaint： left hilar abnormality on routine chest radiograph

[本贴已被 pp 于 2006-12-24 17:07:30 修改过]

pp

brief review

      castleman disease, also known as angiofollicular hyperplasia

or giant lymph node hyperplasia, is a rare disorder of lymphoid tissue.

unclear etiology and pathogenesis. this disease may occur anywhere

along the lymphatic chain but it is most commonly found as a solitary mass

in the mediastinum. two distinct histologic patterns of castleman disease

have been described, including the hyaline-vascular type,

accounting for 90% of cases, and the remainder of cases as the plasma cell type,

which is often associated with constitutional symptoms. three patterns have

been reported on ct or mri, including a solitary noninvasive mass (50%),

a dominant infiltrative mass with associated lymphadenopathy (40%),

and a matted lymphadenopathy without a dominant mass (10%)
  
      in castleman disease, ct with contrast material usually shows a dense

uniform enhancement. dynamic ct demonstrates early rapid enhancement

and washout in the delayed phase, which are considered as typical imaging

characteristics that help to differentiate this disease from other mediastinal tumors

such as lymphoma etc. furthermore, peripheral hypervascularity is a characteristic

finding on power doppler ultrasonography. a punctate or arborizing pattern of

calcification may be seen. some recent studies have reported a considerable

number of cases showing heterogeneous attenuation. meador and mclarney reported

that tumors greater than 5 cm in diameter generally demonstrate heterogeneous

enhancement. in several studies, a focal low attenuation area within the mass

showing delayed enhancement on dynamic ct or mri, was pathologically proven

to be central stellate fibrosis interspersed within the mass. an mri study has

been reported to be useful for the evaluation of peripheral or tumoral hypervascularity

and the relationship with adjacent vascular structures, because vascular structures

appear signal void with high contrast to the mass.
  
       treatment of castleman disease is as follows. surgical resection is recommended

for patients with the unicentric variant of cd because surgical removal of a unicentric

mass of hyaline-vascular or hyaline-vascular/plasma cell type is curative.

but if it is not possible, partial resection, radiotherapy, or observation alone may

be helpful instead of excessively aggressivie therapy.

patients with multicentric disease, either hyaline-vascular or plasma cell type,

do not benefit from surgical management and should be candidates

for multimodality therapy, the nature of which has yet to be defined..

dyqct

结果收到，谢谢楼主。

zyx168

结果收到，谢谢版主。

李晓阳

学习了