Korean J Radiol.  2012 Oct;13(5):658-663. 10.3348/kjr.2012.13.5.658.

Plasma Cell Type of Castleman's Disease Involving Renal Parenchyma and Sinus with Cardiac Tamponade: Case Report and Literature Review

• Kim TU
• Kim S
• Lee JW
• Lee NK
• Jeon UB
• Ha HG
• Shin DH

• KMID: 1392948
• DOI: http://doi.org/10.3348/kjr.2012.13.5.658

Abstract

Castleman's disease is an uncommon disorder characterized by benign proliferation of the lymphoid tissue that occurs most commonly in the mediastinum. Although unusual locations and manifestations have been reported, involvement of the renal parenchyma and sinus, and moreover, manifestations as cardiac tamponade are extremely rare. Here, we present a rare case of Castleman's disease in the renal parenchyma and sinus that also accompanied cardiac tamponade.

Keyword

Cardiac tamponade; Castleman's disease; Plasma cell type; Renal sinus; Renal parenchyma

MeSH Terms

Cardiac Tamponade/*diagnosis/pathology
Diagnosis, Differential
Diagnostic Imaging
Giant Lymph Node Hyperplasia/*diagnosis/pathology/surgery
Humans
Kidney Diseases/*diagnosis/pathology/surgery
Male
Middle Aged
Nephrectomy

Figure

• 

  Fig. 1 Plasma cell type of Castleman's disease involving renal parenchyma and sinus in 59-year-old man. A. Axial contrast-enhanced computed tomography (CT) scan obtained at level of ventricles shows pericardial effusiod producing abnormal flattening of anterior surface of heart (arrow) suggestive of cardiac tamponade. B. Axial contrast-enhanced CT scan obtained at level of renal hilum shows mildly homogenous enhancement of soft-tissue mass (arrows) in left renal sinus. Due tothes mass, renal sinus had mild effect on renal pelvis, causing mild hydronephrosis. C. T1-weighted magnetic resonance (MR) image (TR/TE, 117/4.9) shows soft-tissue mass in left renal sinus (open arrow) with isointense signal compared to that of renal cortex. D. T2-weighted MR image (800/80) shows soft-tissue mass in left renal sinus (open arrow) with slightly hypointense signals compared to that of renal cortex. E. Gadolinium-enhanced T1-weighted MR image shows mild contrast enhancement. F. Diffusion-weighted MR image (b = 1000 s/mm2) shows that mass (open arrow) is mildly hyperintense. G. T1-weighted MR image (TR/TE, 117/4.9) shows contour-bulging masses of renal parenchyma (open arrows) with isointense signals compared to that of renal cortex. H. T2-weighted MR image (800/80) shows contour-bulging masses of renal parenchyma (open arrows) with isointense signals relative to those of renal cortex. I. Gadolinium-enhanced T1-weighted MR image shows contrast enhancement with similar degree as renal parenchyma (open arrows). J. Diffusion-weighted MR image (b = 1000 sec/mm2) shows that masses (open arrows) are mildly hyperintense. K. Photograph of sectioned gross specimen shows whitish tumors (arrows) in renal sinus fat tissue and renal parenchyma. L. Photomicrograph (original magnification, × 40; hematoxylin-eosin stain) shows hyperplastic lymphoid follicles (asterisks) in renal sinus fat tissue below normal renal parenchyma and pelvis in left upper corner. M. Interfollicular areas show heavy infiltration with mature plasma cells (original magnification, × 400; hematoxylin-eosin stain).

Reference

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. 29:670–683.

2. Castleman B, Towne VW. Case records of the Massachusetts General Hospital: Case No. 40231. N Engl J Med. 1954. 250:1001–1005.

3. Flendrig JA. Clark RL, Cumley RW, editors. Benign giant lymphoma: clinicopathologic correlation study. The year book of cancer. 1970. Chicago: Year Book Medical Publishers;296–299.

4. McCarty MJ, Vukelja SJ, Banks PM, Weiss RB. Angiofollicular lymph node hyperplasia (Castleman's disease). Cancer Treat Rev. 1995. 21:291–310.

5. Weisenburger DD, Nathwani BN, Winberg CD, Rappaport H. Multicentric angiofollicular lymph node hyperplasia: a clinicopathologic study of 16 cases. Hum Pathol. 1985. 16:162–172.

6. Stallone G, Infante B, Manno C, Campobasso N, Pannarale G, Schena FP. Primary renal lymphoma does exist: case report and review of the literature. J Nephrol. 2000. 13:367–372.

7. Karadeniz C, Oguz A, Ataoglu O, Citak C, Buyan N, Pinarli G, et al. Primary renal lymphoma and xanthogranulomatous pyelonephritis in childhood. J Nephrol. 2002. 15:597–600.

8. Cupisti A, Riccioni R, Carulli G, Paoletti S, Tognetti A, Meola M, et al. Bilateral primary renal lymphoma treated by surgery and chemotherapy. Nephrol Dial Transplant. 2004. 19:1629–1633.

9. Nagahama K, Higashi K, Sanada S, Nezumi M, Itou H. [Multicentric Castleman's disease found by a renal sinus lesion: a case report]. Hinyokika Kiyo. 2000. 46:95–99.

10. Nishie A, Yoshimitsu K, Irie H, Aibe H, Tajima T, Shinozaki K, et al. Radiologic features of Castleman’s disease occupying the renal sinus. AJR Am J Roentgenol. 2003. 181:1037–1040.

11. De Feudis L, Carota G, Sargiacomo R, Traisci G. [Castleman's disease with isolated renal location: clinical case]. Ann Ital Med Int. 1998. 13:117–120.

12. Mah NA, Peretsman SJ, Teigland CM, Banks PM. Castleman disease of the hyaline-vascular type confined to the kidney. Am J Clin Pathol. 2007. 127:465–468.

13. Hatano K, Fujita S, Tsujimoto Y, Takada T, Honda M, Tsujimoto M, et al. Rare case of the hyaline vascular type of Castleman's disease of the kidney. Int J Urol. 2007. 14:1098–1100.

14. Zhu YC, Huang Y, Yao J, Li X, Zhao S, Wei Q, et al. A rare case of Castleman's disease of plasma cell type within kidney. Chin Med J (Engl). 2009. 122:2396–2398.

15. Soler R, Rodríguez E, Bello MJ, Alvarez M. Pancreatic Castleman's disease: MR findings. Eur Radiol. 2003. 13:Suppl 4. L48–L50.

16. Mangini M, Aiani L, Bertolotti E, Imperatori A, Rotolo N, Paddeu A, et al. Parapancreatic Castleman disease: contrast-enhanced sonography and CT features. J Clin Ultrasound. 2007. 35:207–211.

17. Oida Y, Shimizu K, Mukai M, Imaizumi T, Nakamura M, Makuuchi H. FDG-PET and diffusion-weighted MR imaging appearance in retroperitoneal Castleman's disease: a case report. Clin Imaging. 2008. 32:144–146.

18. Sheth S, Ali S, Fishman E. Imaging of renal lymphoma: patterns of disease with pathologic correlation. Radiographics. 2006. 26:1151–1168.

19. Takahashi N, Kawashima A, Fletcher JG, Chari ST. Renal involvement in patients with autoimmune pancreatitis: CT and MR imaging findings. Radiology. 2007. 242:791–801.

20. Fukukura Y, Fujiyoshi F, Nakamura F, Hamada H, Nakajo M. Autoimmune pancreatitis associated with idiopathic retroperitoneal fibrosis. AJR Am J Roentgenol. 2003. 181:993–995.

21. Pannala R, Chari ST. Autoimmune pancreatitis. Curr Opin Gastroenterol. 2008. 24:591–596.

22. Nicolosi AC, Almassi GH, Komorowski R. Cardiac tamponade secondary to giant lymph node hyperplasia (Castleman's disease). Chest. 1994. 105:637–639.

23. Zhang C, Miao Q, Chen G, Liu X, Ma G, Cao L, et al. Pericardial tamponade secondary to Castleman's disease. Ann Thorac Surg. 2009. 88:2039.