Castleman's disease in left cardiophrenic angle ; a case report

A 43-year-old woman was referred to our hospital for evaluation of a mediastinal mass in the left cardiophrenic angle which had been discovered on a routine chest roentgenogram. CT and MRI demonstrated a solitary mass with smooth contour in the left cardiophrenic angle. Angiography revealed the vascular supply to be from a well-developed left internal mammary artery. At thoracotomy, a well-encapsulated mass approximately 7 cm in diameter was found to be adherent to the pericardium, anterior chest wall and diaphragm. It was resected completely. Histological examination showed lymphoid tissue containing numerous lymphoid follicles, some of which were transfixed by one or more vessels with thick walls surrounded by concentric cuffs of lymphocytes. The interfollicular areas showed extensive vascular proliferation and numerous lymphocytes. These findings lead to the diagnosis of the hyaline-vascular type of Castleman's disease. She recovered uneventfully and remains asymptomatic with a normal chest roentgenogram 10 months after operation. Castleman's disease in the cardiophrenic angle is extremely rare. Although lymph nodes are constantly present in this place, they are not usually seen on chest roentgenograms because of their small size and their investment with fat and connective tissue adjacent to the pleura. Enlargement of diaphragmatic lymph nodes, as in Castleman's disease, should be considered in the differential diagnosis of masses in the cardiophrenic angle.