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Click 52-year-old female with Castleman disease.
1)
FINDINGS: Transabdominal ultrasonography revealed an heterogeneous hypo-echoic solid lesion, located into the right pelvis. The mass was situated near the right ovary, without a secure cleavage plan. The lesion showed a maximum diameter of 5 x 3 cm, with lobulated margins. Uterine leiomyoma and a small amount of free fluid into the rectouterine pouch were also detected.
TECHNIQUE: Ultrasound, convex probe, 12-21 Hz

2)
FINDINGS: Transabdominal ultrasonography revealed an heterogeneous hypo-echoic solid lesion, located into the right pelvis. The lesion showed a maximum diameter of 5 x 3 cm, with lobulated margins and with peripheral hypervascularity at color-doppler.
TECHNIQUE: Ultrasound, convex probe, 12-21 Hz

3)
FINDINGS: Transvaginal ultrasonography confirmed the presence of a heterogeneous hypo-echoic solid lesion, located into the right pelvis, close to the right ovary. The lesion showed a maximum diameter of 5 x 3 cm, with lobulated margins.
TECHNIQUE: Ultrasound, transvaginal probe, 15-22 Hz

4)
FINDINGS: Transvaginal ultrasonography confirmed the presence of a heterogeneous hypo-echoic solid lesion with lobulated margins and with peripheral hypervascularity at color-doppler.
TECHNIQUE: Ultrasound, transvaginal probe, 15-22 Hz

Click 52-year-old female with Castleman disease.
FINDINGS: Axial abdominal basal CT shows the presence of multiple and hypodense hepatic focal lesion, located in all hepatic segments. These lesion are well defined, show low value of HU, regular and smooth margins and most of them are 1 cm in diameter. The larger one has a maximum diameter of 45mm. These findings are consistent with hepatic cysts. Moreover a voluminous ill-defined hypodense focal lesion, with irregular edge is detectable into left hepatic lobe.
TECHNIQUE: Axial CT, 156mAs, 100kV, 5,00 mm slice thickness.

Click 52-year-old female with Castleman disease - pre-surgery
FINDINGS: Axial contrast enhanced CT, arterial phase, shows the presence of multiple and hypodense hepatic focal lesion, located in all hepatic segments. These lesion are well defined, show low value of HU even after contrast medium administration, regular and smooth margins and most of them are 1 cm in diameter. The larger one has a maximum diameter of 45mm. These findings are consistent with hepatic cysts. Moreover a voluminous ill-defined hypodense focal lesion, with irregular edge is detectable into left hepatic lobe. That lesion show early peripheral nodular discontinuous enhancement on the arterial phase.
TECHNIQUE: Axial CT, 156mAs, 100kV, 5,00 mm slice thickness, 80 ml Iodixanol 320mgI/ml

Click 52-year-old female with Castleman disease - pre-surgery
FINDINGS: Axial contrast enhanced CT, porto-venous phase, shows the presence of multiple and hypodense hepatic focal lesion, located in all hepatic segments. These lesion are well defined, show low value of HU even after contrast medium administration, regular and smooth margins and most of them are 1 cm in diameter. The larger one has a maximum diameter of 45mm. These findings are consistent with hepatic cysts. Moreover a voluminous ill-defined hypodense focal lesion, with irregular edge is detectable into left hepatic lobe. That lesion show centripetal filling enhancement on the porto-venous phase, these characteristics are consistent with hepatic haemangioma.
A voluminous intra-peritoneal right pelvic solid mass is detected. It is located behind right rectus abdominis muscle, medially respect right superficial femoral vessels and anterior to the uterus. The maximum diameter on the axial plane is of 4,7 cm. The lesion showed 113 HU of peak after contrast administration, displays regular but lobulated margins and several calcification spots inside. The intraperitoneal location is recognizable due to the moderate upper-external dislocation of external iliac vascular pedicle. Uterine leiomyoma and a small amount of free fluid into the rectouterine pouch are also detected. Neither lytic bone lesions nor sclerotic bone lesions are detectable.
TECHNIQUE: Axial CT, 156mAs, 100kV, 5,00 mm slice thickness, 80 ml Iodixanol 320mgI/ml

Click 52-year-old female with Castleman disease - pre-surgery
FINDINGS: Axial contrast enhanced CT, delayed phase, shows the presence of multiple and hypodense hepatic focal lesion, located in all hepatic segments. These lesion are well defined, show low value of HU even after contrast medium administration, regular and smooth margins and most of them are 1 cm in diameter. The larger one has a maximum diameter of 45mm. These findings are consistent with hepatic cysts. Moreover a voluminous ill-defined hypodense focal lesion, with irregular edge is detectable into left hepatic lobe. That lesion show centripetal filling enhancement on the delayed phase, these characteristics are consistent with hepatic haemangioma.
A voluminous intra-peritoneal right pelvic solid mass is detected. It is located behind right rectus abdominis muscle, medially respect right superficial femoral vessels and anterior to the uterus. The maximum diameter on the axial plane is of 4,7 cm. The lesion showed 93 HU of peak in delayed phase, displays regular but lobulated margins and several calcification spots inside. The intraperitoneal location is recognizable due to the moderate upper-external dislocation of external iliac vascular pedicle. Uterine leiomyoma and a small amount of free fluid into the rectouterine pouch are also detected. Neither lytic bone lesions nor sclerotic bone lesions are detectable.
TECHNIQUE: Axial CT, 156mAs, 100kV, 5,00 mm slice thickness, 80 ml Iodixanol 320mgI/ml

Click 52-year-old female with Castleman disease - after-surgery.
FINDINGS: Post-surgery axial abdominal basal CT shows the presence of multiple hepatic cysts, a voluminous hepatic haemangioma of left lobe, these lesions are the same as in the previous CT exam. There is no evidence of residual mass in right pelvis, but it shows the persistence of the enlarged right obturator lymph node.
TECHNIQUE: Axial CT, 156mAs, 100kV, 5,00 mm slice thickness.

Click 52-year-old female with Castleman disease - after-surgery.
FINDINGS: Post-surgery axial thoracic-abdominal contrast-enhanced CT shows no evidence of thoracic enlarged lymph nodes suggestive of Castleman disease`s localizations. The presence of multiple hepatic cysts, a voluminous hepatic haemangioma of left lobe is confirmed. There is no evidence of residual mass in right pelvis, but it shows the persistence of the enlarged right obturator lymph node.
TECHNIQUE: Axial CT, 156mAs, 100kV, 5,00 mm slice thickness, 80 ml Iodixanol 320mgI/ml

Click 52-year-old female with Castleman disease - post-surgery.
1)
FINDINGS: coronal MIP of the whole-body PET demonstrates no more evidence of FDG avid area into the right pelvis, especially in the right obturator lymph node that used to show metabolic activity into pre-operative FDG/PET.
TECHNIQUE: 18F-FDG-PET, 213 MBq/Kg, 60 min after i.v. injection.

2)
FINDINGS: axial MIP of the whole-body PET demonstrates no more evidence of FDG avid area into the right pelvis, especially in the right obturator lymph node that used to show metabolic activity into pre-operative FDG/PET.
TECHNIQUE: 18F-FDG-PET, 213 MBq/Kg, 60 min after i.v. injection.

3)
FINDINGS: coronal 18F-FDG PET-CT fusion image demonstrates no more evidence of FDG avid area into the right pelvis, especially in the right obturator lymph node that used to show metabolic activity into pre-operative FDG/PET.
TECHNIQUE: 18F-FDG-PET, 213 MBq/Kg, 60 min after i.v. injection.

4)
FINDINGS: axial 18F-FDG PET-CT fusion image demonstrates no more evidence of FDG avid area into the right pelvis, especially in the right obturator lymph node that used to show metabolic activity into pre-operative FDG/PET.
TECHNIQUE: 18F-FDG-PET, 213 MBq/Kg, 60 min after i.v. injection.

Click 52-year-old female with Castleman disease.
1)
FINDINGS: Transabdominal ultrasonography revealed an heterogeneous hypoechoic solid lesion, located into the right pelvis. The mass was situated near the right ovary, without a secure cleavage plan. The lesion showed a maximum diameter of 5 x 3 cm, with lobulated margins and with peripheral hypervascularity at color-doppler. Uterine leiomyoma and a small amount of free fluid into the rectouterine pouch were also detected.
TECHNIQUE: Ultrasound, convex probe, 12-21 Hz

2)
FINDINGS: Transvaginal ultrasonography confirmed the presence of a heterogeneous hypoechoic solid lesion, located into the right pelvis, close to the right ovary. The lesion showed a maximum diameter of 5 x 3 cm, with lobulated margins and with peripheral hypervascularity at color-doppler.
TECHNIQUE: Ultrasound, transvaginal probe, 15-22 Hz

3)
FINDINGS: Axial contrast enhanced CT of the pelvis in the parenchymal phase demonstrates a voluminous intra-peritoneal right pelvic solid mass (arrow). It is located behind right rectus abdominis muscle, medially respect right superficial femoral vessels and anterior to the uterus. The maximum diameter on the axial plane is of 4,7 cm. The lesion showed 113 HU of peak after contrast administration, displayed regular but lobulated margins and several calcification spots inside. The intraperitoneal location is recognizable due to the moderate upper-external dislocation of external iliac vascular pedicle. Uterine leiomyoma and a small amount of free fluid into the rectouterine pouch were also detected. Neither lytic bone lesions nor sclerotic bone lesions are detectable.
TECHNIQUE: Axial CT, 156mAs, 100kV, 5,00 mm slice thickness, 80 ml Iodixanol
320 mgI/ml.

4)
FINDINGS: Axial contrast enhanced CT of the pelvis in the portal phase also shows the presence of an isolated right obturator enlarged lymph node with maximum diameter of 26 mm (arrow). Uterine leiomyoma and a small amount of free fluid into the rectouterine pouch were also detected. Neither lytic bone lesions nor sclerotic bone lesions are detectable.
TECHNIQUE: Axial CT, 156mAs, 100kV, 5,00 mm slice thickness, 80 ml Iodixanol 320mgI/ml

5)
FINDINGS: axial 18F-FDG PET-CT fusion images of the pelvis demonstrate moderate metabolic activity (SUVmax 5) in both the right pelvic mass (asterisk) located near the right ovary, and the right external obturator lymph node (arrow).
TECHNIQUE: 18F-FDG-PET, 213 MBq/Kg, 60 min after i.v. injection

6)

TECHNIQUE: Hematoxylin- eosin, 20x
c) FINDINGS: Immunostaining for Bcl-2 resulting negative on germinal centers, supporting the reactive pattern
TECHNIQUE: Immunostaining for Bcl-2 (2x, Envision Flex Peroxidase)
d) FINDINGS: Immunostaining for CD-23 documenting increased number of FDCs
TECHNIQUE: Immunostaining for Bcl-2 (2x, Envision Flex Peroxidase)

8)
FINDINGS: Post-surgery axial contrast-enhanced CT of the right pelvis in the parenchymal phase shows no residual mass in right pelvis (A) and the persistence of the enlarged right obturator lymph node (B, empty arrow).
TECHNIQUE: Axial CT, 156mAs, 100kV, 5,00 mm slice thickness, 80 ml Iodixanol 320mgI/ml

9)
FINDINGS: MIP of the whole-body PET and fusion CT-PET images demonstrate no FDG avid areas in the right pelvis, specially in the right obturator lymph node that used to show metabolic activity into pre-operative FDG/PET.
TECHNIQUE: 18F-FDG-PET, 220 MBq/Kg, 60 min after i.v. injection.
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FINDINGS: MIP of the whole-body PET demonstrates two FDG avid areas in the pelvis (SUVmax 5) in both the right pelvic mass (full arrow) and in the right obturator lymph node (empty arrow).
TECHNIQUE: 18F-FDG-PET, 213 MBq/Kg, 60 min after i.v. injection.

7)
a) FINDINGS: low magnification picture showing several lymphoid follicles, some of them regressively transformed, composed predominantly by FDCs cells with a hyper vascular interfollicular zone
TECHNIQUE: Hematoxylin- eosin, 2x
b) FINDINGS: (HE 20x) picture showing vascular hyalinized vessels radially penetrated into the germinal center to form the characteristic "lollipop" follicle
TECHNIQUE: Hematoxylin- eosin, 20x
c) FINDINGS: Immunostaining for Bcl-2 resulting negative on germinal centers, supporting the reactive pattern
TECHNIQUE: Immunostaining for Bcl-2 (2x, Envision Flex Peroxidase)
d) FINDINGS: Immunostaining for CD-23 documenting increased number of FDCs
TECHNIQUE: Immunostaining for Bcl-2 (2x, Envision Flex Peroxidase)

8)
FINDINGS: Post-surgery axial contrast-enhanced CT of the right pelvis in the parenchymal phase shows no residual mass in right pelvis (A) and the persistence of the enlarged right obturator lymph node (B, empty arrow).
TECHNIQUE: Axial CT, 156mAs, 100kV, 5,00 mm slice thickness, 80 ml Iodixanol 320mgI/ml

9)
FINDINGS: MIP of the whole-body PET and fusion CT-PET images demonstrate no FDG avid areas in the right pelvis, specially in the right obturator lymph node that used to show metabolic activity into pre-operative FDG/PET.
TECHNIQUE: 18F-FDG-PET, 220 MBq/Kg, 60 min after i.v. injection.
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