Ahmet URAL, MD; Veysel YURTTAŞ, MD; Ahmet KUTLUHAN, MD; Aykut ONURSEVER, MD; Sami BERÇİN, MD Castleman's Disease As A Cause Of Chronic Dyspnea: Case Report KBB-Forum 2010;9(1) www.KBB-Forum.net CASE REPORT CASTLEMAN'S DISEASE AS A CAUSE OF CHRONIC DYSPNEA: CASE REPORT Ahmet URAL, MD 1 ; Veysel YURTTAŞ, MD 1 ; Ahmet KUTLUHAN, MD 1 ; Aykut ONURSEVER, MD 2 ; Sami BERÇİN, MD 1 1 Atatürk Eğitim ve Araştırma Hastanesi, Kulak-Burun-Boğaz Kliniği, Ankara, Türkiye 2 Atatürk Eğitim ve Araştırma Hastanesi, Patoloji Bölümü, Ankara, Türkiye SUMMARY Castleman hastalığı, boyun bölgesinde kitle ile karşımıza çıkabilen bir hastalıktır. Castleman's diesase may cause neck mass. A patient complaining of chronic dyspnea had been treated with the presumptive diagnosis of bronchial asthma. However, her complaints did not subside after treatment. She applied to our clinic due to a mass in lower jugular region that was compressing the trachea. Fine needle aspiration biopsy was reported to be consisting of benign cytology. Complete excision of the mass was done under general anesthesia and the histopathologic assessment was consistent with Castleman's disease. Dyspnea was found to be almost totally relieved in the postoperative period. Castleman's disease may cause neck mass and result in various symptomatology due to compression of the surrounding structures. Keywords: Castleman hastalığı, anjiyofolliküler lenf nodu hiperplazisi, kronik dispne KRONİK DİSPNEYE SEBEP OLAN CASTLEMAN HASTALIĞI: OLGU SUNUMU ÖZET Castleman hastalığı, boyun bölgesinde kitle ile karşımıza çıkabilen bir hastalıktır. Kronik dispne nedeniyle bronşial astım ön tanısı konulan ve uzun süredir tedavi almasına karşın şikayetlerinde kayda değer azalma olmayan hasta, boyunda kitle nedeniyle başvurmuştur. Yapılan tetkikler sonrası alt juguler bölgedeki kitlenin trakeaya bası yapmakta olduğu görülmüş, ince iğne aspirasyon biyopsi sonucu benign vasıflı olarak bildirilmiştir. Lezyon genel anestezi altında komplet olarak eksize edilmiş, histopatolojik olarak Castleman hastalığı olduğu rapor edilmiştir. Postoperatif dönemde hastanın dispne şikayetinde anlamlı bir gerileme olduğu saptanmıştır. Boyunda kitleye sebep olabilen bir hastalık olan Castleman hastalığı, çevre dokularda bası oluşturarak farklı semptomlara yol açabilmektedir. Anahtar Sözcükler: Bazal Castleman hastalığı, anjiyofolliküler lenf nodu hiperplazisi, kronik dispne INTRODUCTION Castleman's disease (CD) is a rare, benign lymphoproliferative disorder of unknown etiology 1 . It is also known as angiofollicular lymph node hyperplasia, angiomatous lymph node hamartoma, follicular lymphoreticuloma, and giant lymph node hyperplasia 1-4 . The lesions were classified into two types with respect to clinical and histopathological criteria: Hyaline vascular type constitutes 90% of cases and is usually asymptomatic, but occasionally it can result in symptoms due to mass effect on surrounding structures 5 . Plasma cell type comprises 10% of cases and exists as a fulminant multicentric disease with systemic symptoms 1 . Noninvasive methods usually do not suffice for diagnosis, therefore histopathological evaluation after complete excision is essential. Corresponding Author: Ahmet Ural MD; Atatürk Eğitim ve Araştırma Hastanesi, Kulak-Burun-Boğaz Kliniği, Ankara, Türkiye, E- mail: ahmetural@mynet.com Received: 31 Aralık 2007, revised for: 23 Nisan 2008, accepted for publication: 29 Nisan 2008 In this case report, we present a case with a neck mass due to Castleman's disease, whose complaint of chronic dyspnea disappeared after compression over trachea by the mass was relieved. CASE PRESENTATION A 24-year-old female patient presented with a mass on right side of the neck for 3 months. She had recurrent expiratory dyspnea attacks and she was diagnosed to have bronchial asthma. There were no additional symptoms, nor there was a noteworthy data in her family history. The physical examination revealed a firm, mobile, and non-tender mass of 4X4 cm, in right lower jugular area just behind sternocleidomastoid muscle. The results of complete blood count and biochemistry panel were within normal limits. Computed tomography scans with contrast showed a well circumscribed lesion extending towards the mediastinum. The mass was compressing the trachea resulting in considerable decrease of lumen size (Figure 1). Fine needle aspiration biopsy revealed lymphoepithelial cells of 12