Castleman disease is an rare entity.

Castleman disease is an rare entity, most often occurring in patients presenting with localized mediastinal lymph node enlargement. While surgical resection is the preferr treatment, there are disturbs about approaching this highly vascular tumor with thoracoscopy. We not away the second reported case of thoracoscopic resection of a patient with Castleman disease and review the literature.

first note of the scale words: Castleman disease; giant lymph node hyperplasia; mediastinal tumors; thoracoscopy; video-assisted thoracic surgery

Abbreviation: VATS = video-assisted thoracic surgery

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Castleman disease, or giant lymph node hyperplasia, is a rare disorder that is located mostly commonly in the visceral mediastinum. Surgical resection is curative in the majority of cases and has traditionally been accomplished with an lay open thoracotomy. Thoracoscopic surgery has been shown to be a safe and effective technique for the treatment of certain benign mediastinal tumors. (1-3) While a variety of pathologic tumors has been remov with videoassisted thoracoscopic surgery (VATS), to our knowledge no other than one such case has been reported of a patient with Castleman disease. (4) We report our case and review the literature.

CASE REPORT

A 30-year-old African-American woman, after being in a motor vehicle accident, was noted to have a widened mediastinum upon a chest radiograph. A chest CT scan revealed a 5-cm well-circumscribed, paratracheal mass (Fig 1) The patient was referr to the thoracic surgery clinic after an uncheckered hospital stay. The patient was asymptomatic, and an MRI showed a 5 x 6 x 5-cm right paratracheal mass. There was no radiologic evidence of tracheobronchial compression or invasion of pleural or bony tissues, nor was there evidence of any other pathology. The patient was taken to the operating chamber for planned thoracoscopic resection. During the operation, bronchoscopy was unremarkable. A double-lumen endotracheal tube was placed, and the patient was positioned in a left lateral decubitus position. With single-lung ventilation, an initial 12-mm port was placed in the lower midaxillary line, followed by the agency of the placement of two additional 10-mm ports in the fifth intercostal space at the anterior and posterior axillary lines. A visual examination revealed no other gros abnormalities leave out for the mass located at the apex of the pleural cavity (Fig 2 top), which was situated between the azygous and superior vena cava. Aspiration of this lesion was ill-starred Incising the parietal pleura revealed this mass, which was highly vascularized (Fig 2 bottom). Cautious use of electrocautery, as well as the liberal application of clips, allowed this mass to be mobilized and remov en bloc without damage to surrounding formations The mass was removed from the pleural cavity with an endoscopic bag. With hemostasis achieved, a single chest tube was placed. The patient had the chest tube remov in succession the first postoperative day and was discharged to family circle the second day. A pathologic examination revealed a 49 x 29 x 19-cm specimen having a tan-pink coloration, with follicular lymphocytic concentration and marked capillary proliferation, consistent with hyaline, vascular-type Castleman disease.

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DISCUSSION

Castleman disease, which is also referr to as giant lymph node hyperplasia, angiofollicular lymph node hyperplasia, lymph node hamartoma, and benign lymph node lymphoma, was first described by means of Castleman (5) in 1956. Castleman disease is a rare disorder and is principally commonly characterized by mediastinal lymph node enlargement. The clinical presentation and course varies, whether patients have the more of common occurrence localized form or the frequently rarer multicentric form. Histologic images include hyaline vascular, plasma small cavity as well as a mixed protoplast The hyaline vascular type accounts for approximately 90% of cases and greatest in number often presents in a localized form. Radiologically, these local tumors generally not absent as well-circumscribed masses in the visceral compartment of the mediastinum. These patients keep to be younger (median age, 235 years), to be asymptomatic, and to have a benign clinical course. Surgical excision is curative, with a 5-year survival rate of 100% although choke follow-up is recommended due to reports of resort (6)

Thoracoscopic resection of certain benign mediastinal lesions has been increasing in oftenness and has been shown to be a safe and effective alternative to render free of access thoracotomy. (1-3) The most usual pathologic diagnosis with thoracoscopic resection varies with the reported series. Akashi et al (1) and Demmey et al (2) have reported neurogenic tumors and pouchs most frequently, and Roviaro et al (3) have reported a preponderance of early-stage thymoma and thymic hyperplasia; While the part of VATS for the treatment of thymic tumors has not been clearly established, (2) VATS is contraindicated in cases of malignancy. (3)

The patient's age and symptoms, as well as the tumor location and characteristics in succession radiographic studies are very important in the decision-making proces to proce with VATS. Experience with thoracoscopic surgery and peculiar port placement to optimize visualization are elucidation for successful resection. The thoracoscopic approach should not compromise the goal of the operation, and, if necessary, conversion to an unclose procedure should be performed.

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