Focal bone marrow involvement in multicentric Castleman disease demonstrated by FDG PET/CT

Castleman disease is a lymphoproliferative disorder, which usually occurs in the chest. Multicentric Castleman disease with multiple foci involving many anatomic locations is rare. The authors describe a 75-year-old man with a history of fever, shivering, and multiple lymphadenopathies who had a cervical lymph node biopsy which defined the diagnosis as multicentric Castleman disease, hyaline-vascular type, stroma-rich variant. A whole-body F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) was performed for evaluation of the extent of the disease. The images demonstrated focal areas of intense FDG uptake in multiple foci of enlarged lymph nodes and heterogeneous FDG uptake in the skeleton. Of interest, PET/CT fusion images clearly showed focal areas of more intense FDG uptake in the bone marrow of the right scapula, ribs, right iliac bone, and left acetabulum. © 2007 Lippincott Williams & Wilkins, Inc.