Castleman病7例临床分析

Clinical analysis of 7 cases of Castleman disease

目的分析Castleman病(Castleman disease,CD)的临床特点。方法收集Castleman病7例,男性4例,女性3例,中位年龄48岁,局灶型5例,弥漫型2例,均经病理证实。回顾性分析其临床特征。结果7例CD中2例无任何症状;胸部X线上3例表现为纵隔内软组织肿块,强化明显,4例表现为肺内小结节;肺扫描3例阴性,4例阳性;气管镜检1例管腔呈外压性狭窄;5例局灶型CD手术治疗效果好,2例弥漫型CD疗效欠佳;术前均未明确诊断,分别误诊为肺癌、肺结核、结节病等。结论Castleman病临床表现复杂,局灶型多表现为强化明显的纵隔内肿块,弥漫型影像学缺乏特征性,术前极易误诊,应争取早日手术活检。

Objective To review the clinical characteristics of Castleman disease（CD）. Methods Seven patients including 4 males and 3 females with a mean age of 48 years were proved to be CD by pathology. All the patients might be divided into localized type group （ n = 5） and disseminated type group （ n = 2）. The clinical characteristics were retrospectively analyzed. Results Two patients had no clinical symptoms. The lesion presented in 3 cases as a mediastinal soft-tissue mass with marked enhancement, but the pulmonary small nodules were seen in other 4 patients. The pulmonary isotope scanning were negative in 3 patients and positive in 4. The stricture of bronchus due to external pressure was seen in one patient on fiber bronchoscopy. The localized CD （ n = 5） had good prognosis after operation on contrary to the disseminated type. The pre-operation diagnosis was made in none of the 7 patients. Conclusion The clinical manifestation of CD is complicated. The localized type usually presented as a soft-tissue mass with marked enhancement in the middle mediastinurn. The disseminated type lacked of specific medical imaging signs which should have biopsy as soon as possible.