Masatsugu Hamaji, MD, Joel W. Neal, MD, PhD, Bryan M. Burt, MD

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Unicentric, Multifocal Castleman Disease of the Mediastinum Associated With Cerebellitis Masatsugu Hamaji, MD, Joel W. Neal, MD, PhD, Bryan M. Burt, MD The Annals of Thoracic Surgery Volume 99, Issue 1, Pages e7-e9 (January 2015) DOI: 10.1016/j.athoracsur.2014.10.028 Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Axial sections of a T1-weighted magnetic resonance image show an abnormal pattern of surface enhancement of the bilateral cerebellar fissures and folia (arrow). (B) Axial intravenous contrast chest computed tomography image reveals the presence of a multilobulated mass (arrow) in the location of the thymus gland in the anterior mediastinum, which extended from the level of the thoracic inlet cranially to the main pulmonary artery caudally. The Annals of Thoracic Surgery 2015 99, e7-e9DOI: (10.1016/j.athoracsur.2014.10.028) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Histologic evaluation of the thymus and lymph nodes of the anterior mediastinum demonstrated hyaline vascular Castleman disease. (A) The initial surgical biopsy specimen of the 0.7-cm lymph node in the left anterior horn of the thymus demonstrated atypical follicles and interfollicular vascular proliferation typical of this disease (hematoxylin and eosin staining, original magnification ×2). (B) The mediastinal mass located within the thymus gland showed regressed germinal centers with concentric ringing by mantle zone cells (“onion-skinning”; hematoxylin and eosin staining, original magnification ×10), whereas (C) others showed atretic germinal centers associated with radially penetrating hyalinized penetrating vessels (“lollipop sign”; hematoxylin and eosin staining, original magnification ×40). The Annals of Thoracic Surgery 2015 99, e7-e9DOI: (10.1016/j.athoracsur.2014.10.028) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions