Surg Today (2004) 34:772–773 DOI 10.1007/s00595-004-2776-7 Posterior Mediastinal Localization of Castleman’s Disease: Report of a Case Abdullah Erdogan 1 , I . rfan Eser 1 , and Gülay Özbilim 2 Departments of 1 Cardiothoracic Surgery and 2 Pathology, Faculty of Medicine GKDC, Akdeniz University, Anabilim Dali, 07058 Antalya, Turkey found incidentally on a routine chest X-ray. The patient was asymptomatic and had no remarkable medical his- tory. No pathologic signs were found by physical exami- nation, and laboratory investigation showed a normal blood count and full biochemical screen. Chest X-ray and computed tomography (CT) scan of the chest (Fig. 1) confirmed a left posterior mediastinal opacity, 2  4  4 cm in size. The lesion was shown as densely homo- geneous, well defined soft tissue in the left costoverte- bral sulcus. We performed a left lateral thoracotomy, and explo- ration of the left hemithorax confirmed a 2  4  4-cm encapsulated mass in the costovertebral sulcus, covered by the parietal pleura. The tumor was located in the sixth intercostal space and paravertebral area in the posterior mediastinum, and was firmly adherent to the chest wall. There was no pleural effusion or adhesion between the tumor and the lung surface. We were able to remove the tumor completely with its capsule and the surrounding soft tissue. The lesion had hypervascular features, and many vessels arising from the intercostal arteries had to be clipped or ligated to control conspicu- ous bleeding. However, there were no perioperative complications and the patient was discharged on post- operative day 5. Histopathologically, the tumor was composed of lym- phoid follicles, which contained multiple capillaries sur- rounded by hyaline sheaths (Fig. 2). The microscopic features were characteristic of the hyaline vascular type seen in Castleman’s disease. When last seen 6 months after his operation, the patient was well and asymptom- atic. Chest X-ray and CT scans showed no evidence of recurrence. Discussion Since Castleman et al. first reported a case of “localized mediastinal lymph node hyperplasia resembling Abstract Castleman’s disease, defined as angiofollicular lymphoid hyperplasia, is a rare lymphoproliferative disorder, which usually occurs in the chest. The tumor is often asymptomatic, but it can cause nonspecific thoracic symptoms such as cough and dyspnea. Surgical removal is curative and malignant transformation has not been described. We report an unusual case of Castleman’s disease localized in the posterior medi- astinum and bordering the chest wall, and review the relevant literature. Key words Castleman’s disease · Chest wall tumor Introduction Castleman’s disease, also known as “angiofollicular lymph node hyperplasia,” “giant lymph node hyperpla- sia,” and “angiomatous lymphoid hamartoma,” is an uncommon lymphoproliferative disorder, which most frequently occurs as an asymptomatic mass in the medi- astinum. 1 The disease was first described by Castleman in 1954 as a form of “benign lymph node hyperplasia simulating thymoma.” 2 Castleman’s disease can be found wherever lymph nodes are present; however, 71% of cases are located in the chest, along the tracheo- bronchial tree in the mediastinum or lung hilus, al- though it can occur in other areas such as the pelvis, neck, retroperitoneum, and muscle. 3 We report a case of Castleman’s disease extending from the bordering point of the posterior mediastinum and intercostal space. Case Report A 52-year-old man was referred to our department for investigation of a well-defined left para-aortic opacity, Reprint requests to: A. Erdogan Received: January 27, 2003 / Accepted: January 20, 2004