Abstract
Purpose. Castleman’s Disease is a very rare medical disease and the presence of this condition in the pleura is even rarer and there are only few reported cases. The presence of symptoms is also unusual and has been mostly described in multicentric cases of castleman’s disease instead of solitary lesions (unicentric castleman). We report a case of unicentric pleural castlema’s disease with presence of constitutional symptoms. Methods. A 36-year-old male without any significant past medical history who presented to the emergency due to an incidental large pleural effusion seen in chest radiograph, but referring chronic constitutional symptoms consistent of significant weight loss and chronic cough. Results. Chest computed tomography revealed a mass and several attemps with minimally invase approach failed to identify the lesion. The mass was excised through VATS but due to its significant vascularity, it had to be converted to open thoracotomy. Conclusion. The treatment of unicentric lesions is mainly complete surgical excision and the prognosis is excellent with some chances of recurrence. There are less than one dozen of reported pleural castleman reported in the literature. This case evidence than unicentric lesion may exhibit constitutional symptoms and confirmed than lesions above 5 cm can be removed by VATS but the chances for conversion to an open thoracotomy are high.
Highlights
Dr Benjamin Castleman initially described this condition in 1956
A 36-year-old male without any significant past medical history who presented to the emergency due to an incidental large pleural effusion seen in chest radiograph, but referring chronic constitutional symptoms consistent of significant weight loss and chronic cough
The mass was excised through video assisted thoracoscopy (VATS) but due to its significant vascularity, it had to be converted to open thoracotomy
Summary
Dr Benjamin Castleman initially described this condition in 1956. Other names given to this condition are Angiofollicular lymph node hyperplasia or Giant lymph node Hyperplasia, Benign Lymphoma and Follicular Reticuloma [1,2]. There are 2 forms of presentation; unicentric and multicentric [3]. The presence of Castleman disease in the pleura is extremely rare, because most of the thoracic Castleman lesions affect the mediastinum or hilia. This case presented with pleural effusion and not all the pleural castleman’s lesions exhibit or present with pleural effusion [4]. The aim of this report is to report a very unusual case with a very uncommon presentation. Most reported cases of castleman’s disease of the pleura did not exhibit constitutional symptoms and pleural effusion as we have in this case
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