罗义琳;顾芳;范海晴;杜金辉;高勤;余晖;廖欣;
LUO Yilin;GU Fang;FAN Haiqing;DU Jinhui;GAO Qin;YU Hui;LIAO Xin;Teaching and Research Department of Imaging Diagnosis,Guizhou Medical University;Department of Pathology,the Affiliated Hospital of Guizhou Medical University;

• 1:贵州医科大学影像诊断学教研室
• 2:贵州医科大学附属医院病理科

摘要(Abstract)：

目的探讨Castleman病(CD)的多排螺旋CT(MDCT)影像学特点。方法收集18例CD患者的病例资料,其中12例同时行MDCT平扫和多期增强检查,2例行MDCT平扫检查,4例行MDCT多期增强检查,收集患者的临床、影像及病理类型资料,比较影像资料中病灶部位、形态、平扫特点、强化程度以及强化方式等特征。结果 18例CD患者,发生部位在胸部9例、腹部4例、颈部2例、盆腔2例以及多部位1例; 17例为单中心型(UCD),1例为多中心型(MCD); 18例CD病理类型均为透明血管型(HVV);术前正确诊断4例、误诊5例、不定性诊断9例; 14例MDCT平扫表现为6例不均质,6例合并钙化,2例边缘模糊,1例多发软组织密度肿块,其余表现为质地均匀、边缘清楚的单发软组织密度结节或肿块; 16例多期增强扫描表现为病灶动脉期呈中度或显著强化,静脉期及延迟期呈显著强化,其中11例可见瘤周滋养血管。结论 CD在MDCT上多为密度均质、边界清楚的孤立性软组织结节或肿块,增强扫描显示显著强化及瘤周滋养血管。
Objective To explore the imaging features of multi-detector row spiral CT( MDCT) in Castleman disease( CD). Methods The clinical,imaging,and pathological characteristics of 18 patients with CD were collected. Among these patients,12 patients were given MDCT plain scan and multi-phase enhanced examination at the same time,2 patients MDCT plain scan examination,and 4 patients MDCT multi-phase enhanced examination. The locations,shapes,size,characteristics of plain scan,degrees of enhancement,patterns of enhancement of the lesions were recorded and compared. Results Locations of the lesions were found in the chest( n = 9),abdomen( n = 4),neck( n = 2),pelvic( n = 2),and multiple locations( n = 1). There were 17 patients with unicenrtic CD( UCD) and 1 patient with multi-centric CD( MCD). All 18 patients were hyaline vascular variant( HVV). Before operation,4 patients were correctly diagnosed,5 patients misdiagnosed and 9 patients undiagnosed. MDCT scans of 14 patients revealed 6 patients with inhomogeneity,6 patients with calcification,2 patients with blurred edges,1 patient with multiple soft tissue with density masses. The rest showed single soft tissue density nodules or masses with uniform texture and clear edges. Multiphase enhanced scans of 16 patients showed moderate or remarkable enhancement in the arterial phase,while remarkable enhancement in the venous phase and delayed phase. Additionally,blood vessels nourishing the tumor were seen in 11 patients. Conclusion CD mainly appears as a homogeneous density,soft-tissue nodule or mass on MDCT scans with or without calcification. The enhanced scan shows significant enhancement and blood vessels nourishing the tumor.

关键词(KeyWords)： 诊断,鉴别;Castleman病;多排螺旋CT;透明血管型
castleman disease(CD);multi-deterctor row helical computed tomography(MDCT);hyaline vascular variant;diagnosis,idifferential

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金(81960537);; 贵州省卫生计生委科学技术基金项目(gzwjkj2018-1-075)

作者(Author): 罗义琳;顾芳;范海晴;杜金辉;高勤;余晖;廖欣;
LUO Yilin;GU Fang;FAN Haiqing;DU Jinhui;GAO Qin;YU Hui;LIAO Xin;Teaching and Research Department of Imaging Diagnosis,Guizhou Medical University;Department of Pathology,the Affiliated Hospital of Guizhou Medical University;

Email:

DOI: 10.19367/j.cnki.2096-8388.2021.01.013

参考文献(References)：

• [1]CASTLEMAN B,IVERSON L,MENENDEZ V P. Localized mediastinal lymphnode hyperplasia resembling thymoma[J]. Cancer,1956,9(4):822-830.
• [2] FAJGENBAUM D C,SHILLING D. Castleman disease pathogenesis[J]. Hematol Oncol Clin North Am,2018,32(1):11-21.
• [3]DUC P H,VAN DOAN N,HUY H Q. Unicentric Castleman's disease in the female pelvis[J]. Radiology Case Reports,2020,15(11):2221-2224.
• [4]LIU A Y,NABEL C S,FINKELMAN B S,et al. Idiopathic multicentric Castleman's disease:a systematic literature review[J]. Lancet Haematol,2016,3(4):163-175.
• [5]KIM H J,HAN J H,BANG C H,et al. Cutaneous disorders associated with Castleman's disease[J]. Acta Derm Venereol,2019,99(11):984-989.
• [6]WU D,LIM M S,JAFFE E S. Pathology of castleman disease[J]. Hematol Oncol Clin North Am,2018,32(1):37-52.
• [7]WANG W,MEDEIROS L J. Castleman disease[J]. Surg Pathol Clin,2019,12(3):849-863.
• [8]KLIGERMAN S J,AUERBACH A,FRANKS T J,et al.Castleman disease of the thorax:clinical,radiologic,and pathologic correlation:from the radiologic pathology archives[J]. Radiographics,2016,36(5):1309-1332.
• [9]MANTAS D,DAMASKOS C,DAILIANI P,et al. Castleman's disease of the spleen[J]. Acta Chir Belg,2017,117(3):203-208.
• [10]SIMPSON D. Epidemiology of castleman disease[J].Hematol Oncol Clin North Am,2018,32(1):1-10.
• [11]JIANG X H,SONG H M,LIU Q Y,et al. Castleman disease of the neck:CT and MR imaging findings[J].Eur J Radiol,2014,83(11):2041-2050.
• [12]MITSOS S,STAMATOPOULOS A,PATRINI D,et al.The role of surgical resection in unicentric Castleman's disease:a systematic review[J]. Adv Respir Med,2018,86(1):36-43.
• [13]RABOSO E,BARBERR,GUIMARAENS L,et al.Castleman's disease as an unusual cause for dysphagia and dyspnea in a pediatric patient[J]. Int J Pediatr Otorhinolaryngol,2019,125:164-167.
• [14]HILL A J,TIRUMANI S H,ROSENTHAL M H,et al.Multimodality imaging and clinical features in castleman disease:single institute experience in 30 patients[J].Br J Radiol,2015,88(1049):20140670.
• [15]WONG R S M. Unicentric castleman disease[J]. Hematol Oncol Clin North Am,2018,32(1):65-73.
• [16]HAAP M,WIEFELS J,HORGER M,et al. Clinical,laboratory and imaging findings in Castleman's diseasethe subtype decides[J]. Blood Rev,2018,32(3):225-234.
• [17]ZHAO S,WAN Y,HUANG Z X,et al. Imaging and clinical features of castleman disease[J]. Cancer Imaging,2019,19(1):53.
• [18]KWON S,LEE K S,AHN S,et al. Thoracic castleman disease:computed tomography and clinical findings[J].J Comput Assist Tomogr,2013,37(1):1-8.
• [19]BACHA S,ZRIBI H,HABIBECH S,et al. Unicentric Castleman's disease:an uncommon cause of chronic cough[J]. Tunis Med,2018,96(2):148-151.
• [20]SCHELBLE A P,MERRITT D F. Pelvic Castleman's disease presenting as an adnexal mass in an adolescent[J].J Pediatr Adolesc Gynecol,2019,32(1):86-89.
• [21]KHAN M K,TALUKDER R H,KAMRUZZAMAN M.The Castleman's disease and related disorders--a case report[J]. Mymensingh Med J,2016,25(1):168-175.

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