A challenging case of angioproliferative Castleman's disease in the mediastinum

Castleman disease (CD) is a rare lymphoproliferative disorder, most often presenting as a solitary hypervascular mediastinal mass and classified clinically into unicentric (UCD) and multicentric (MCD) forms, with histopathologic subtypes including hyalinized vascular, plasma cell, mixed and HHV-8-associated variants. Surgical resection remains both diagnostic and therapeutic, but significant intraoperative hemorrhage is a known risk given the tumor's vascularity. We report the case of a 55-year-old woman with a 52 × 28 mm hypervascular mass encircling the trachea-primarily below the carina and abutting the right esophageal border. Angiography revealed extensive tumor vascularization with early venous drainage. To minimize intraoperative bleeding, preoperative embolization was performed using a histoacryl-lipiodol mixture (1:3 ratio), achieving complete occlusion of the two feeding arteries on post-embolization angiography. Two weeks later, the posterior mediastinal lesion was resected with less than 50 mL of blood loss and complete excision. The patient recovered uneventfully, confirming that targeted preoperative embolization can safely facilitate resection of hypervascular mediastinal Castleman lesions.