Robotic Resection of Castleman Disease in a Patient with Hemophilia A

2015 Resident Video Competition Award Winner

Castleman disease is a rare cause of benign lymphoid hyperplasia, commonly occurring in the abdomen, peripheral lymph nodes, and mediastinum. Localized disease is more common than the multifocal type, and it is often asymptomatic. However, compressive symptoms can occur secondary to mass effect. In this video, the authors report a case of mediastinal Castleman disease in a carrier of Hemophilia A.

A 35-year-old woman with the chief complaint of chest pain and pressure was referred to thoracic surgery after a mediastinal mass was identified on a chest x-ray. Chest CT confirmed the presence of a 4.6 cm mass adjacent to the aorta and superior to the left main pulmonary artery. PET/CT imaging identified a smooth mass lateral to the aortic arch and superior to the left main pulmonary artery, which was found to be FDG-avid with a max SUV of 8.14. The patient underwent robotic resection for diagnosis and treatment. Histological examination revealed expansion of mantle zones with concentric rings of lymphocytes, characteristic of localized Castleman disease, hyalin vascular type.  The patient’s postoperative course was uneventful, and she was discharged on postoperative day two with oral analgesics for pain management. At the two-week follow-up visit, the patient was doing well. She will have long-term follow up with hematology.