The Sonographic Characteristics of Unicentric Castleman Disease - a single-center Retrospective Study

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This study aims to summarize the specific ultrasonic manifestations of UCD. Methods This retrospective study included patients who underwent preoperative ultrasound for enlarged lymph nodes and were later diagnosed with UCD between January 2016 and March 2024. Ultrasound features, including lymph node size, cortical characteristics, corticomedullary interface, hyperechoic regions, and Doppler flow signals, were recorded. Pathological types were classified as hyaline vascular (HV), plasma cell (PC), or mixed. The ultrasonic features of each UCD subtype were systematically analyzed. Results A total of 41 patients were enrolled, including 29 patients with HV-type, 4 with PC-type and 8 with mixed type. All patients exhibited enlarged LNs characterized by solitary mass, well-defined margins and increased cortical thickness. Among them, 95.12% (39/41) of cases had an indistinct corticomedullary interface. 41.46% (17/41) showed eccentric or asymmetrical cortical thickening, and 58.54% (24/41) demonstrated complete effacement of the fatty hilum. About 24.39% (10/41) of cases exhibited macrocalcification, and 56.10% (23/41) displayed short linear hyperechoic foci within the LNs. Additionally, HV-type and mixed-type patients had more abundant blood flow signals than PC-type patients (75.86% vs 25% vs 87.50%, P = 0.018). Conclusions Ultrasound features of UCD typically include large, solitary masses with well-defined margins, a thickened cortex, and loss of the fatty hilum. Key imaging findings are micro-calcifications and short linear hyper echoes. Ultrasound is an effective and non-invasive tool for the early detection and diagnosis of UCD. Trial registration retrospectively registered. Unicentric Castleman disease Ultrasonography​​ Lymph node ​​Diagnostic imaging ​​​​Hyaline vascular subtype​​ Echo pattern Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Castleman disease (CD) is a heterogeneous group of non-neoplastic lymphoproliferative disorders[ 1 ], first described by Castleman and Towne in a patient with a mediastinal mass in 1954[ 2 ]. According to clinical manifestations and disease course, CD can be classified into unicentric CD (UCD) and multicentric CD (MCD). UCD accounts for about 75% of the newly emerging CD. It is a relatively benign clinical course that characterizes a localized and indolent disease involving a single enlarged lymph node (LN) or multiple enlarged LNs within one area[ 3 , 4 ]. Surgical resection is the gold standard of treatment for UCD, achieving the definitive diagnosis and surgical cure of UCD[ 4 , 5 ]. However, UCD is relatively uncommon and demonstrates no specific clinical or laboratory findings[ 6 , 7 ]; therefore, its preoperative diagnosis warrants a radiological evaluation. In particular, image-guided surgery is crucial for diagnosing and treating UCD. Computed tomography (CT) of the neck, chest, abdomen, and pelvis is recommended as the initial imaging modality to assess lymph node involvement and differentiate unicentric (UCD) from multicentric (MCD) types during the diagnosis of Castleman disease (CD)[ 4 ]. Ultrasound, as a convenient and versatile imaging examination method without radiation, is suitable for rapid assessment of easily accessible areas such as the neck, axilla, and groins. With the rapid development and widespread use, more and more CDs are incidentally detected by the US during physical examination. Especially for patients with symptoms of palpable masses, ultrasound is the preferred method[ 8 ]. However, there is limited data available for systematic analysis of CD ultrasound imaging characteristics. Most studies were case reports[ 9 – 11 ], and the largest number of UCD cases was 15[ 12 ]. At present, the ultrasound findings of UCD are often described together with MCD, and there is no conclusion regarding the different pathological types, leading to a poor understanding of this disease. We therefore conducted a retrospective analysis of patients with UCD transferred to our hospital, reviewing their US images based on a relatively large sample size. We aim to summarize the characteristic ultrasonic features of UCD, thereby enhancing diagnostic accuracy for clinicians. Materials and Methods Study design and patients This retrospective study was approved by our institutional review board and written informed consent was waived. Patients from Peking Union Medical College Hospital between January 2016 and March 2024 were included. The inclusion criteria were as follows: 1) Patients diagnosed with unicentric Castleman disease (UCD) based on complete lymph node resection biopsy and clinical features consistent with solitary enlarged lymph nodes; 2) Patients who had undergone preoperative ultrasound examination. Ultrasonic imaging All US examinations were performed with Resona 7 or 8 devices (L 5-14, Mindray Medical, XXX), Acuson S2000 (L 8-14, Siemens Healthcare, XXX), and iU22 machine (L 5-12, Philips Healthcare, XXX). Both 2D and color Doppler images were reviewed. Based on previous reports, the following US features were used to assess LNs. For multiple enlarged lymph nodes (LNs) within a single station, ultrasound (US) images of the biopsied LNs were evaluated. In grayscale ultrasound, lymph-node size (long and short diameter), LN shape (regular, lobulated), margin (well-defined, obscure), the cortex characteristic (eccentrical or asymmetrical thickened cortex and complete effacement of fatty hilum), corticomedullar interface (clear, unclear), matting (yes, no), macrocalcification (yes, no), short linear sign (yes, no) were recorded[13,14]. The macrocalcification is defined as coarse hyper echo, which may be accompanied by an acoustic shadow. The short linear sign is the short-liner strong echo within the LN ( Fig. 1 ). For Color Doppler, the color flow distribution (absent, hilar, non-hilar)[13] and the amount of blood flow signals (no color, minimal and abundant) were recorded. The color Doppler flow characteristics of the lesion were observed and semi-quantitatively classified into 3 types: no color, absence of blood flow signals; minimal blood flow, with minimal scattered color signals,1 to 2 punctate or thin linear vessels visible; the length of linear blood flow does not exceed half of the lesion's diameter; abundant blood flow, the entire length of the vessel/vessels can be observed, with more than 4 punctate vessels or more than one longer vessel penetrating the lesion, its length can approach or exceed half of the mass's radius[15]. Pathological diagnosis of SLNs Combined with clinical and imaging examinations, surgical resection or core biopsy was performed for patients with suspected lymphadenopathy (LN). Pathological findings were used to classify the lesions into three subtypes of Castleman disease (CD): hyaline vascular subtype (HV), plasma cell subtype (PC), and mixed subtype[16]. The HV subtype was identified by atrophic follicles with hyaline vessels and concentric rings of lymphocytes, along with a predominance of lymphocytes in the interfollicular areas. The PC subtype was characterized by the absence of follicular hyaline vessels in LN structures and marked aggregation of plasma cells in the interfollicular zone. Lesions exhibiting both HV and PC features were classified as the mixed subtype[17,18]. Statistical analyses The continuous variable was shown as the mean ± standard deviation and analyzed by an independent two-sample t-test. Categorical variables were expressed as cases and percentages and analyzed by the chi-square test or Fisher's exact test. P<0.05 was considered significant. The software Image J was used to calculate the long and short diameters of LN and the thickness of the cortex. Statistical analysis was performed using SPSS 26 software. Results Patient C haracteristics of the Cohorts A total of 41 patients were ultimately included in this study, comprising 25 females (60.98%) and 16 males (39.02%). The mean age of the patients was 34.34 years, with a standard deviation of 13.57 years. Regarding clinical manifestations, 36.59% (15/41) of UCD patients were asymptomatic and incidentally detected during imaging examinations, while 46.34% (19/41) had palpable masses. 56.10% (23/41) of cases involve superficial lymph nodes, including inguinal (n=2), axillary (n=5), and cervical (n=16) areas. Additionally, 72.50% (29/41) of patients exhibited single LN enlargement at a single station, whereas 27.50% (11/41) of patients had multiple LN enlargements at a single station. Detailed clinical baseline characteristics of the enrolled patients are summarized in Table 1 . Table 1 The clinical baseline of UCD patients Clinical characteristics UCD (n=41) Age 34.34±13.57 Gender Female 25(60.98) Male 16(39.02) Histopathology Hyaline vascular type (HV) 29 (70.73) Plasma cell type (PC) 4(9.76) Mixed type 8(19.51) Clinical manifestations By palpation at physical examination 19(46.34) Compression symptoms 7(17.07) Incidentally discovered by imaging 15(36.59) Distribution superficial 22(53.66) deep 19(46.34) Lymph node distribution Single enlarged LN 29(72.50) Multiple enlarged LN in one area 11(27.50) Lymph node Location Retroperitoneal 11(26.83) Abdominal pelvic cavity 7(17.07) Inguinal 2(4.88) Axilla 5(12.20) Cervical 16(39.02) US F indings for UCD and Image Analysis The ultrasound findings for all patients are summarized in Table 2 . The median long diameter of the enlarged lymph nodes was 4.36 cm (range, 1.6-8.7 cm), while the median short diameter was 2.46 cm (range, 0.6-6.6 cm). The average L/S (long/short) diameter ratio was 1.99. All patients exhibited enlarged lymph nodes characterized by solitary, well-defined margins, regular shape, and increased cortical thickness. Notably, 95.12% (39/41) of the lymph nodes demonstrated an indistinct cortico-medullary interface. Eccentric or asymmetrical thickening of the cortex was observed in 41.46% (17/41) of the lymph nodes ( Fig. 2 ), and 58.54% (24/41) of the lymph nodes showed complete effacement of the fatty hilum. Specifically, 24.39% (10/41) of patients exhibited macrocalcification (Pattern I), and 56.10% (23/41) displayed short linear hyperechoic foci (Pattern II). A total of 73.17% (30/41) of patients had the characteristic distribution patterns. Table 2 The ultrasound characteristics of all patients with UCD Ultrasound characteristics UCD (n=41) Long axis (length, L) (cm) 4.36±1.52 Short axis (depth, S) (cm) 2.46±1.20 Long/short-axis ratio (L/S ratio) 1.99±0.77 L/S ratio <2.00 22 L/S ratio≥2.00 13 L/S ratio≥3.00 6 Nodal shape Oval 33(80.49) Lobulated 8(19.51) Cortex thickness（cm） 2.12±1.26 Cortex characteristic Eccentrical or asymmetrical thickened cortex 17(41.46) Complete effacement of fatty hilum 24(58.54) Corticomedullar interface Clear 2(4.88) Unclear 39(95.12) Macrocalcification 0 31(75.61) 1 10 (24.39) Short linear hyperechoic foci 0 18(43.90) 1 23(56.10) Either macrocalcification or short linear hyperechoic foci 30(73.17%) Both macrocalcification and short linear hyperechoic foci 3(7.32%) Blood distribution None 4(9.76) Hilar color flow 3(7.32) Non-Hilar color flow 34(82.92) Blood volume No color 4(9.76) Minimal 7(17.07) Abundant 30(73.17) Color Doppler imaging revealed increased blood flow in 73.81% (30/41) of the lymph nodes, with a non-hilar color pattern, observed in 82.92% (34/41) of cases. The US images of 2 representative cases are shown in Figs.3-4 . US F indings for HV, PV and HVPC and Image Analysis According to the pathological results, 70.73% (29/41) of the patients were classified as hyaline vascular type (HV), 9.76% (4/41) as plasma cell type (PC), and 19.51% (8/41) as mixed type. The US findings of different pathological types were shown in Table 3 . 75.86% (22/29) of HV patients and 87.50% (7/8) of mixed-type patients exhibited enlarged lymph nodes with abundant blood flow, while only 25.00% (1/4) of PC patients showed rich blood flow, indicating a statistically significant difference (P = 0.018). When comparing HV and non-HV types, statistically significant differences were observed in cortical features (p = 0.035). In the HV group, 68.97% (20/29) of patients demonstrated complete effacement of the fatty hilum, and 33.33% (4/12) showed thickened cortex. When comparing HV and PC types, significant statistical differences were noted in both blood volume and cortical characteristics. For the HV group, 75.86% (22/29) of patients exhibited abundant lymph node blood flow, whereas 25.00% (1/29) of patients in the PC group showed rich blood flow signals (P = 0.007). Table 3 US Findings for HV, PV, and HVPC Ultrasound characteristics Pathology P * value P † value P † value HV (n=29) PC (n=4) Mixed (n=8) Cortex characteristic 0.077 0.451 0.035** Eccentrical or asymmetrical thickened cortex 9(31.03) 2(50.00) 6(75.00) Complete effacement of fatty hilum 20(68.97) 2(50.00) 2(25.00) Macrocalcification 0.226 0.133 0.098 No 24(82.76) 2(50.00) 5(62.50) Yes 5(17.24) 2(50.00) 3(37.50) Short linear hyperechoic foci 0.880 0.744 0.613 No 12(41.38) 2(50.00) 4(50.00) Yes 17(58.62) 2(50.00) 4(50.00) Blood distribution 0.303 0.306 0.971 None 3(10.34) 1(25.00) 0(0.00) Hilar color flow 2(6.90) 1(25.00) 0(0.00) Non-Hilar color flow 24(82.76) 2(50.00) 8(100.00) Blood volume 0.018** 0.007** 0.112 No color 4(13.79) 0(0.00) 0(0.00) Minimal 3(10.34) 3(75.00) 1(12.50) Abundant 22(75.86) 1(25.00) 7(87.50) * P values compare all three groups. † P values compare hyaline vascular type (HV) and plasma cell type (PC). ‡ P values compare hyaline vascular type (HV) and non-hyaline vascular type. ** P <0.05 Discussion This paper evaluated the ultrasound features of UCD based on a larger dataset, contributing to a deeper understanding of the disease in clinical practice. Our results demonstrated that the UCD usually exhibited enlarged lymph nodes with complete effacement of the fatty hilum and unclear corticomedullar interface. 73.17% of patients showed a strong echo including either macrocalcification or short linear hyperechoic foci within the LNs, which were notably characteristic findings for UCD. In addition, compared with the PCV, the HV groups exhibited more abundant blood flow signals for lymph nodes. In our study, the majority of UCDs were detected incidentally by physical examination or medical visits for palpable masses. UCD classically presents as hypoechoic masses with increased volume and cortical thickening, which is associated with pronounced follicular hyperplasia in the cortical region and atrophic germinal centers[ 18 ]. Additionally, the reactive proliferation of B cells and T cells within the cortex may further contribute to cortical thickening[ 17 ]. The macrocalcifications and short linear strong echoes in the LNs were characteristic findings in this study. The macrocalcifications on US appear as echogenic shadowing foci with discrete, coarse, arborizing configurations[ 19 – 21 ]. The presence of calcification may indicate a diagnosis of UCD[ 22 – 24 ]. Calcification may be due to the calcium deposition occurring based on the specific pathology changes, including thickening of the proliferative capillary wall, accompanied by hyaline degeneration, fibrinolysis, and degeneration of other connective tissues. This study is the first to observe short linear echogenicity in the central region of UCD lesions, which may be highly correlated with the characteristic pathological feature of lymphoid follicle proliferation in UCD. In our study, 73.17% of patients had the characteristic distribution pattern, therefore, we suggest that this new US finding may be an important indicator of UCD. For different CD histological types, HV-type patients generally exhibit combined blood flow patterns and abundant flow signals. According to a previous study, after the administration of a contrast agent, the enhancement degree of the PV type is usually lower than that of the HV type[ 19 ]. The blood flow perfusion of UCD was consistent with our results, which is due to the proliferation and expansion of the capillary network around the lymphoid follicles in the HV subtype, while in PV subtype lesions, the diffuse plasma cell infiltration and fibrotic tissue compress or occupy normal vascular spaces, increasing vascular resistance and reducing blood flow. The mixed subtype is characterized by a pattern that may depend on whether hyaline vascular changes or plasma cell infiltration is more predominant in the pathological process[ 18 ]. The diagnosis of CD is often suspected initially owing to radiographic findings. In this study, we propose some imaging signs to provide auxiliary guidance for physicians during clinical procedures. In particular, the two characteristic patterns may be helpful for the diagnosis of CD. However, accurate preoperative diagnosis of CD is difficult based on radiologic features alone. The US findings can be manifestations of several diseases, including lymphoma, metastatic LN, and other diseases. Future research will therefore require considerably larger cohorts to investigate any difference. Our study has some limitations. First, it is a single-center retrospective study; due to the low incidence of UCD, the number of cases included in this study was relatively limited. As our hospital is a comprehensive tertiary hospital for the rarity of CD, our study includes the largest UCD cohort to date. Second, for some deep-seated LNs, the richness of blood flow might be underestimated due to the application of a relatively low-frequency probe. Future prospective studies need to be conducted with a standardized diagnostic workup. Conclusions UCD is typically manifested as a solitary enlarged lymph node with a thick cortex, absence of medullary structure, and an unclear cortico-medullary demarcation. These lesions showed macrocalcification or short linear hyperechoic patterns. They may indicate a diagnosis of UCD. Additionally, compared with PV, the HV group presented more often with abundant color flow signals on color Doppler flow imaging. Ultrasound is expected to play a significant role in the evaluation of UCD and guiding appropriate regions for biopsies. Abbreviations CD, Castleman disease ; UCD, Unicentric Castleman disease ; MCD, Multicentric Castleman disease ; HVV, Hyaline vascular variant; PCV, Plasma cell variant ; HVPC, hyaline-vascular plasma cell variant; US, Ultrasound Declarations All manuscripts must contain the following sections under the heading 'Declarations': Ethics approval and consent to participate Institutional Review Board approval was obtained. IRB#S-K1539 Written informed consent was obtained from all patients in this study. Consent for publication The authors consent to the publication of this work. Availability of data and material s The datasets generated or analyzed during the study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study has received funding from the National High-Level Hospital Clinical Research Funding (2022-PUMCH-B-066). Authors' contributions LZH analyzed the patient data and was a major contributor in writing the manuscript. NZH was a major contributor to collect the patient data and writing the manuscript. GYH substantially analyzed and interpreted the patient data. XMS was a major contributor to the investigation and data curation. WY Formal was a major contributor to analysis and data curation. ZQL was a major contributor to the conception of the project and writing of the manuscript. ZL was a major contributor to the writing and revision of the manuscript. All authors have read and approved the final version of the manuscript and agree with the order of presentation of the authors. Acknowledgements Not applicable. References X. Zhang, H. Rao, X. Xu, et al. (2018). Clinical characteristics and outcomes of Castleman disease: A multicenter study of 185 Chinese patients. Cancer Sci, 109 (1), 199-206. B. Castleman, V.W. Towne. (1954). Case records of the Massachusetts General Hospital; weekly clinicopathological exercises; Case No. 40351. N Engl J Med, 251 (10), 396-400. C. Hoffmann, E. Oksenhendler, S. Littler, L. Grant, K. Kanhai, D.C. Fajgenbaum. (2024). The clinical picture of Castleman disease: a systematic review and meta-analysis. Blood Adv, 8 (18), 4924-4935. F. van Rhee, E. Oksenhendler, G. Srkalovic, et al. (2020). International evidence-based consensus diagnostic and treatment guidelines for unicentric Castleman disease. Blood Adv, 4 (23), 6039-6050. N. Talat, A.P. Belgaumkar, K.M. Schulte. (2012). Surgery in Castleman's disease: a systematic review of 404 published cases. Ann Surg, 255 (4), 677-84. M.A. Pitot, A.D. Tahboub Amawi, L.F. Alexander, et al. (2023). Imaging of Castleman Disease. Radiographics, 43 (8), e220210. M. Haap, J. Wiefels, M. Horger, A. Hoyer, K. Müssig. (2018). Clinical, laboratory and imaging findings in Castleman's disease - The subtype decides. Blood Rev, 32 (3), 225-234. Y.J. Ho, C.C. Huang, C.H. Fan, H.L. Liu, C.K. Yeh. (2021). Ultrasonic technologies in imaging and drug delivery. Cell Mol Life Sci, 78 (17-18), 6119-6141. P. Wang, G. Hou, F. Li, X. Cheng. (2021). Hypermetabolic Unicentric Castleman Disease of Kidney on FDG PET/CT. Clin Nucl Med, 46 (6), 510-511. J.W. Brubaker, R.P. Harrie, B.C. Patel, D.K. Davis, N. Mamalis. (2011). CT and orbital ultrasound findings in a case of Castleman disease. Ophthalmic Plast Reconstr Surg, 27 (2), e37-9. W.K. Moon, W.S. Kim, I.O. Kim, K.M. Yeon, M.C. Han. (1994). Castleman disease in the child: CT and ultrasound findings. Pediatr Radiol, 24 (3), 182-4. K. Lv, Y. Zhao, W. Xu, C. Zhang, P. Huang. (2020). Ultrasound and radiological features of abdominal unicentric castleman's disease: A case series study. Medicine (Baltimore), 99 (18), e20102. D. Fischerova, G. Garganese, H. Reina, et al. (2021). Terms, definitions and measurements to describe sonographic features of lymph nodes: consensus opinion from the Vulvar International Tumor Analysis (VITA) group. Ultrasound Obstet Gynecol, 57 (6), 861-879. A.T. Ahuja, M. Ying, S.Y. Ho, et al. (2008). Ultrasound of malignant cervical lymph nodes. Cancer Imaging, 8 (1), 48-56. D.D. Adler, P.L. Carson, J.M. Rubin, D. Quinn-Reid. (1990). Doppler ultrasound color flow imaging in the study of breast cancer: preliminary findings. Ultrasound Med Biol, 16 (6), 553-9. R. Alaggio, C. Amador, I. Anagnostopoulos, et al. (2022). The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Lymphoid Neoplasms. Leukemia, 36 (7), 1720-1748. S. El Hussein, A.G. Evans, H. Fang, W. Wang, L.J. Medeiros. (2024). Unicentric Castleman Disease: Illustration of Its Morphologic Spectrum and Review of the Differential Diagnosis. Arch Pathol Lab Med, 148 (1), 99-106. D.M. Cronin, R.A. Warnke. (2009). Castleman disease: an update on classification and the spectrum of associated lesions. Adv Anat Pathol, 16 (4), 236-46. D. Bonekamp, K.M. Horton, R.H. Hruban, E.K. Fishman. (2011). Castleman disease: the great mimic. Radiographics, 31 (6), 1793-807. H.P. McAdams, M. Rosado-de-Christenson, N.F. Fishback, P.A. Templeton. (1998). Castleman disease of the thorax: radiologic features with clinical and histopathologic correlation. Radiology, 209 (1), 221-8. S.-F. Ko, M.-J. Hsieh, S.-H. Ng, et al. (2004). Imaging Spectrum of Castleman's Disease. American Journal of Roentgenology, 182 (3), 769-775. K. Lv, Y. Zhao, W. Xu, C. Zhang, P. Huang. (2020). Ultrasound and radiological features of abdominal unicentric castleman's disease. Medicine, 99 (18). A.J. Hill, S.H. Tirumani, M.H. Rosenthal, et al. (2015). Multimodality imaging and clinical features in Castleman disease: single institute experience in 30 patients. Br J Radiol, 88 (1049), 20140670. S. Zhao, Y. Wan, Z. Huang, B. Song, J. Yu. (2019). Imaging and clinical features of Castleman Disease. Cancer Imaging, 19 (1), 53. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 29 Sep, 2025 Read the published version in Cancer Imaging → Version 1 posted Editorial decision: Revision requested 25 Aug, 2025 Reviews received at journal 21 Aug, 2025 Reviewers agreed at journal 18 Aug, 2025 Reviewers agreed at journal 16 Aug, 2025 Reviewers invited by journal 13 Aug, 2025 Editor assigned by journal 12 Aug, 2025 Submission checks completed at journal 12 Aug, 2025 First submitted to journal 09 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7334976","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":502047109,"identity":"aac0423a-70a5-4be1-b514-d82542d78900","order_by":0,"name":"Zihan Liu","email":"","orcid":"","institution":"Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College","correspondingAuthor":false,"prefix":"","firstName":"Zihan","middleName":"","lastName":"Liu","suffix":""},{"id":502047110,"identity":"5c995357-56ee-49fd-94dd-0b0891b66bf1","order_by":1,"name":"Zihan Niu","email":"","orcid":"","institution":"Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College","correspondingAuthor":false,"prefix":"","firstName":"Zihan","middleName":"","lastName":"Niu","suffix":""},{"id":502047111,"identity":"ca54a272-616a-4697-b759-f8b05ff2134d","order_by":2,"name":"Yuhan Gao","email":"","orcid":"","institution":"Chinese Academy of Medical Sciences and Peking Union Medical College","correspondingAuthor":false,"prefix":"","firstName":"Yuhan","middleName":"","lastName":"Gao","suffix":""},{"id":502047112,"identity":"6a423514-9ca9-4862-a524-92005346df96","order_by":3,"name":"Mengsu Xiao","email":"","orcid":"","institution":"Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College","correspondingAuthor":false,"prefix":"","firstName":"Mengsu","middleName":"","lastName":"Xiao","suffix":""},{"id":502047113,"identity":"dda46006-98ee-4afb-ac32-3b37f4f1ff26","order_by":4,"name":"Ying Wang","email":"","orcid":"","institution":"Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College","correspondingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Wang","suffix":""},{"id":502047114,"identity":"a2c59ef7-691b-4900-b2ba-2fbe094c6e7a","order_by":5,"name":"Qingli Zhu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuUlEQVRIiWNgGAWjYFAC5gYQmcDPzHzwAZFaGCFaJNvZkg1I02JwnsdMgCgN8u2JbY95c+zyjA8zmDEw1NhEE7aj52G7Me+25GKzwwxpDxiOpeU2ENLCLJHYJs277UDitsMMxw0YGw4T1sIG07K5mbFNgigtPDAtG5iZ2YjTIsHzsN1w7rbkxBmH2ZgNEojxi3x78rEHb7fZJfb3n//44EONDWEtwBhhQ2ITVo6uZRSMglEwCkYBNgAAk8A93z8FFSMAAAAASUVORK5CYII=","orcid":"","institution":"Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College","correspondingAuthor":true,"prefix":"","firstName":"Qingli","middleName":"","lastName":"Zhu","suffix":""},{"id":502047115,"identity":"f56f11cf-c1d2-49b5-9d14-4c4c489baef4","order_by":6,"name":"Lu Zhang","email":"","orcid":"","institution":"Chinese Academy of Medical Sciences and Peking Union Medical College","correspondingAuthor":false,"prefix":"","firstName":"Lu","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2025-08-09 16:08:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7334976/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7334976/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s40644-025-00937-2","type":"published","date":"2025-09-29T15:57:43+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":89562787,"identity":"ad248544-f092-47f2-bd98-2336560e4dfe","added_by":"auto","created_at":"2025-08-21 10:26:30","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":125323,"visible":true,"origin":"","legend":"\u003cp\u003eTwo sonographic presenting patterns of unicentric Castleman disease. The grayscale US images (left) and the schematic illustration images (right) are shown in the figures.\u003c/p\u003e\n\u003cp\u003eA (A1-A2) Pattern I, the hypoechoic enlarged LN had a thickened cortex or hilum effacement. The macro strong echo with acoustic shadow was shown inside the node. B (B1-B2) Pattern II, the hypoechoic enlarged LN had a thickened cortex or hilum effacement. The short linear strong echo was visible inside the LN.\u003c/p\u003e\n\u003cp\u003eUS, ultrasound; LN, lymph node\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7334976/v1/998c51127a955b3cfd577af3.jpg"},{"id":89564387,"identity":"a349cb8c-395a-49d5-b885-82a3796e0f9c","added_by":"auto","created_at":"2025-08-21 10:34:30","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":110280,"visible":true,"origin":"","legend":"\u003cp\u003eUS images from a 36-year-old man with a palpable mass in the left cervical region. The pathological diagnosis of the enlarged LN was hyaline vascular type.\u003c/p\u003e\n\u003cp\u003e(A-B) The enlarged cervical lymph node grayscale US. The size of the lymph nodes was 4.7×3.4×1.7 cm. The LN showed a thickened cortex. Short linear hyperechoic areas are visible within the LN. (C) The color Doppler image. The LN showed abundant hilar color flow.\u003c/p\u003e\n\u003cp\u003eUS, ultrasound; LN, lymph node; cm, centimeter\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7334976/v1/2ed97081a956eb38a3db9594.jpg"},{"id":89562789,"identity":"8d6428d3-3d3a-4ccb-a889-f469ec30a56a","added_by":"auto","created_at":"2025-08-21 10:26:30","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":97466,"visible":true,"origin":"","legend":"\u003cp\u003eThe US findings of enlarged LN in a 50-year-old woman with a palpable mass in the right lower quadrant. The pathological diagnosis of the enlarged LN was the mixed type.\u003c/p\u003e\n\u003cp\u003e(A-B) The enlarged lymph node grayscale US. The retroperitoneal lymph node presented 7.8×7.2×6.6 cm in size. The LN showed complete effacement of the fatty hilum and a short linear hyper-echo within the LN. (C) The Color Doppler image. The LN showed moderate non-hilar color flow.\u003c/p\u003e\n\u003cp\u003eUS, ultrasound; LN, lymph node; cm, centimeter\u003c/p\u003e","description":"","filename":"Figure3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7334976/v1/324fef505bbb9fb3f2f40cd1.jpg"},{"id":89562790,"identity":"12ac77c6-a3b8-4b1d-89d3-3cda6276bba0","added_by":"auto","created_at":"2025-08-21 10:26:30","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":103388,"visible":true,"origin":"","legend":"\u003cp\u003eUS images from a 36-year-old man with a palpable mass in the right lower quadrant. The pathological diagnosis of the enlarged LN was the mixed type.\u003c/p\u003e\n\u003cp\u003e(A-B) The enlarged lymph node grayscale US. The retroperitoneal lymph node presented 6.1×5.1×4.4 cm in size. A macro strong echo with the posterior shadow is visible in the enlarged LN. (C) The color Doppler image. The LN showed abundant hilar color flow.\u003c/p\u003e\n\u003cp\u003eUS, ultrasound; LN, lymph node; cm, centimeter\u003c/p\u003e","description":"","filename":"Figure4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7334976/v1/511b67aa6ddcf062e2572385.jpg"},{"id":92883781,"identity":"07181d00-dc31-4cf9-91b4-f2759b8e9674","added_by":"auto","created_at":"2025-10-06 16:09:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1209238,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7334976/v1/538bf858-62ea-4ee7-b112-1c25bc902508.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eThe Sonographic Characteristics of Unicentric Castleman Disease - a single-center Retrospective Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCastleman disease (CD) is a heterogeneous group of non-neoplastic lymphoproliferative disorders[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], first described by Castleman and Towne in a patient with a mediastinal mass in 1954[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. According to clinical manifestations and disease course, CD can be classified into unicentric CD (UCD) and multicentric CD (MCD). UCD accounts for about 75% of the newly emerging CD. It is a relatively benign clinical course that characterizes a localized and indolent disease involving a single enlarged lymph node (LN) or multiple enlarged LNs within one area[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Surgical resection is the gold standard of treatment for UCD, achieving the definitive diagnosis and surgical cure of UCD[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, UCD is relatively uncommon and demonstrates no specific clinical or laboratory findings[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]; therefore, its preoperative diagnosis warrants a radiological evaluation. In particular, image-guided surgery is crucial for diagnosing and treating UCD.\u003c/p\u003e\u003cp\u003eComputed tomography (CT) of the neck, chest, abdomen, and pelvis is recommended as the initial imaging modality to assess lymph node involvement and differentiate unicentric (UCD) from multicentric (MCD) types during the diagnosis of Castleman disease (CD)[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Ultrasound, as a convenient and versatile imaging examination method without radiation, is suitable for rapid assessment of easily accessible areas such as the neck, axilla, and groins. With the rapid development and widespread use, more and more CDs are incidentally detected by the US during physical examination. Especially for patients with symptoms of palpable masses, ultrasound is the preferred method[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, there is limited data available for systematic analysis of CD ultrasound imaging characteristics. Most studies were case reports[\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], and the largest number of UCD cases was 15[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. At present, the ultrasound findings of UCD are often described together with MCD, and there is no conclusion regarding the different pathological types, leading to a poor understanding of this disease.\u003c/p\u003e\u003cp\u003e We therefore conducted a retrospective analysis of patients with UCD transferred to our hospital, reviewing their US images based on a relatively large sample size. We aim to summarize the characteristic ultrasonic features of UCD, thereby enhancing diagnostic accuracy for clinicians.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective study was approved by our institutional review board and written informed consent was waived. Patients from Peking Union Medical College Hospital between January 2016 and March 2024 were included. The inclusion criteria were as follows: 1) Patients diagnosed with unicentric Castleman disease (UCD) based on complete lymph node resection biopsy and clinical features consistent with solitary enlarged lymph nodes; 2) Patients who had undergone preoperative ultrasound examination.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUltrasonic imaging\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll US examinations were performed with Resona 7 or 8 devices (L 5-14, Mindray Medical, XXX), Acuson S2000 (L 8-14, Siemens Healthcare, XXX), and iU22 machine (L 5-12, Philips Healthcare, XXX). Both 2D and color Doppler images were reviewed. Based on previous reports, the following US features were used to assess LNs. For multiple enlarged lymph nodes (LNs) within a single station, ultrasound (US) images of the biopsied LNs were evaluated.\u003c/p\u003e\n\u003cp\u003eIn grayscale ultrasound, lymph-node size (long and short diameter), LN shape (regular, lobulated), margin (well-defined, obscure), the cortex characteristic (eccentrical or asymmetrical thickened cortex and complete effacement of fatty hilum), corticomedullar interface (clear, unclear), matting (yes, no), macrocalcification (yes, no), short linear sign\u0026nbsp;(yes, no) were recorded[13,14]. The macrocalcification is defined as coarse hyper echo, which may be accompanied by an acoustic shadow. The short linear sign is the short-liner strong echo within the LN (\u003cstrong\u003eFig.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e). \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor Color Doppler, the color flow distribution (absent, hilar, non-hilar)[13] and the amount of blood flow signals (no color, minimal and abundant) were recorded. The color Doppler flow characteristics of the lesion were observed and semi-quantitatively classified into 3 types: no color, absence of blood flow signals; minimal blood flow, with minimal scattered color signals,1 to 2 punctate or thin linear vessels visible; the length of linear blood flow does not exceed half of the lesion\u0026apos;s diameter; abundant blood flow, the entire length of the vessel/vessels can be observed, with more than 4 punctate vessels or more than one longer vessel penetrating the lesion, its length can approach or exceed half of the mass\u0026apos;s radius[15].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePathological diagnosis of SLNs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCombined with clinical and imaging examinations, surgical resection or core biopsy was performed for patients with suspected lymphadenopathy (LN). Pathological findings were used to classify the lesions into three subtypes of Castleman disease (CD): hyaline vascular subtype (HV), plasma cell subtype (PC), and mixed subtype[16]. The HV subtype was identified by atrophic follicles with hyaline vessels and concentric rings of lymphocytes, along with a predominance of lymphocytes in the interfollicular areas. The PC subtype was characterized by the absence of follicular hyaline vessels in LN structures and marked aggregation of plasma cells in the interfollicular zone. Lesions exhibiting both HV and PC features were classified as the mixed subtype[17,18].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analyses\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe continuous variable was shown as the mean \u0026plusmn; standard deviation and analyzed by an independent two-sample t-test. Categorical variables were expressed as cases and percentages and analyzed by the chi-square test or Fisher\u0026apos;s exact test. P\u0026lt;0.05 was considered significant. The software Image J was used to calculate the long and short diameters of LN and the thickness of the cortex. Statistical analysis was performed using SPSS 26 software.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003ePatient\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eC\u003c/strong\u003e\u003cstrong\u003eharacteristics of the Cohorts\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 41 patients were ultimately included in this study, comprising 25 females (60.98%) and 16 males (39.02%). The mean age of the patients was 34.34 years, with a standard deviation of 13.57 years. Regarding clinical manifestations, 36.59% (15/41) of UCD patients were asymptomatic and incidentally detected during imaging examinations, while 46.34% (19/41) had palpable masses. 56.10% (23/41) of cases involve superficial lymph nodes, including inguinal (n=2), axillary (n=5), and cervical (n=16) areas. Additionally, 72.50% (29/41) of patients exhibited single LN enlargement at a single station, whereas 27.50% (11/41) of patients had multiple LN enlargements at a single station. Detailed clinical baseline characteristics of the enrolled patients are summarized in \u003cstrong\u003eTable 1\u003c/strong\u003e.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 553px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1 \u0026nbsp;The clinical baseline of UCD patients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 553px;\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"left\" width=\"510\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp\u003eClinical characteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eUCD\u003c/p\u003e\n \u003cp\u003e(n=41)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e34.34\u0026plusmn;13.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e25(60.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e16(39.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp\u003eHistopathology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp\u003eHyaline vascular\u0026nbsp;type (HV)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e29 (70.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp\u003ePlasma cell type (PC)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e4(9.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp\u003eMixed type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e8(19.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp\u003eClinical manifestations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp\u003eBy palpation at physical examination\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e19(46.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp\u003eCompression symptoms\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e7(17.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp\u003eIncidentally discovered by imaging\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e15(36.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp\u003eDistribution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp\u003esuperficial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e22(53.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp\u003edeep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e19(46.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp\u003eLymph node distribution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp\u003eSingle enlarged LN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e29(72.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp\u003eMultiple enlarged LN in one area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e11(27.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp\u003eLymph node Location\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp\u003eRetroperitoneal \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e11(26.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp\u003eAbdominal pelvic cavity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e7(17.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp\u003eInguinal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e2(4.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp\u003eAxilla\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e5(12.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 340px;\"\u003e\n \u003cp\u003eCervical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e16(39.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eUS\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eF\u003c/strong\u003e\u003cstrong\u003eindings\u003c/strong\u003e \u003cstrong\u003efor UCD and Image Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ultrasound findings for all patients are summarized in \u003cstrong\u003eTable 2\u003c/strong\u003e. The median long diameter of the enlarged lymph nodes was 4.36 cm (range, 1.6-8.7 cm), while the median short diameter was 2.46 cm (range, 0.6-6.6 cm). The average L/S (long/short) diameter ratio was 1.99. All patients exhibited enlarged lymph nodes characterized by solitary, well-defined margins, regular shape, and increased cortical thickness. Notably, 95.12% (39/41) of the lymph nodes demonstrated an indistinct cortico-medullary interface. Eccentric or asymmetrical thickening of the cortex was observed in 41.46% (17/41) of the lymph nodes (\u003cstrong\u003eFig. 2\u003c/strong\u003e), and 58.54% (24/41) of the lymph nodes showed complete effacement of the fatty hilum. Specifically, 24.39% (10/41) of patients exhibited macrocalcification (Pattern I), and 56.10% (23/41) displayed short linear hyperechoic foci (Pattern II). A total of 73.17% (30/41) of patients had the characteristic distribution patterns.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 553px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2 \u0026nbsp;The ultrasound characteristics of all patients with UCD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 553px;\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"left\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eUltrasound characteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003eUCD\u003c/p\u003e\n \u003cp\u003e(n=41)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eLong axis (length, L) (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e4.36\u0026plusmn;1.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eShort axis (depth, S) (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e2.46\u0026plusmn;1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eLong/short-axis ratio (L/S ratio)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e1.99\u0026plusmn;0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eL/S ratio \u0026lt;2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eL/S ratio\u0026ge;2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eL/S ratio\u0026ge;3.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eNodal shape\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eOval\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e33(80.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eLobulated\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e8(19.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eCortex thickness（cm）\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e2.12\u0026plusmn;1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eCortex characteristic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eEccentrical or asymmetrical thickened cortex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e17(41.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eComplete effacement of fatty hilum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e24(58.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eCorticomedullar interface\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eClear\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e2(4.88) \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eUnclear\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e39(95.12) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eMacrocalcification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e0\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e31(75.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e10 (24.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eShort linear hyperechoic foci\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e18(43.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e23(56.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eEither macrocalcification or short linear hyperechoic foci\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e30(73.17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eBoth macrocalcification and short linear hyperechoic foci\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e3(7.32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eBlood distribution\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eNone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e4(9.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eHilar color flow\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e3(7.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eNon-Hilar color flow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e34(82.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eBlood volume\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eNo color \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e4(9.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eMinimal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e7(17.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003eAbundant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 26px;\"\u003e\n \u003cp\u003e30(73.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eColor Doppler imaging revealed increased blood flow in 73.81% (30/41) of the lymph nodes, with a non-hilar color pattern, observed in 82.92% (34/41) of cases. The US images of 2 representative cases are shown in \u003cstrong\u003eFigs.3-4\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUS\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eF\u003c/strong\u003e\u003cstrong\u003eindings\u003c/strong\u003e \u003cstrong\u003efor HV, PV and HVPC and Image Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the pathological results, 70.73% (29/41) of the patients were classified as hyaline vascular type (HV), 9.76% (4/41) as plasma cell type (PC), and 19.51% (8/41) as mixed type. The US findings of different pathological types were shown in\u0026nbsp;\u003cstrong\u003eTable 3\u003c/strong\u003e. 75.86% (22/29) of HV patients and 87.50% (7/8) of mixed-type patients exhibited enlarged lymph nodes with abundant blood flow, while only 25.00% (1/4) of PC patients showed rich blood flow, indicating a\u0026nbsp;statistically\u0026nbsp;significant\u0026nbsp;difference (P = 0.018).\u003cbr\u003e\u0026nbsp;When comparing HV and non-HV types, statistically significant differences were observed in cortical features (p = 0.035). In the HV group, 68.97% (20/29) of patients demonstrated complete effacement of the fatty hilum, and 33.33% (4/12) showed thickened cortex. When comparing HV and PC types, significant statistical differences were noted in both blood volume and cortical characteristics. For the HV group, 75.86% (22/29) of patients exhibited abundant lymph node blood flow, whereas 25.00% (1/29) of patients in the PC group showed rich blood flow signals (P = 0.007). \u0026nbsp;\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"128%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3 \u0026nbsp;US Findings for HV, PV, and HVPC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"left\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 39px;\"\u003e\n \u003cp\u003eUltrasound characteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 33px;\"\u003e\n \u003cp\u003ePathology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e*\u003c/p\u003e\n \u003cp\u003e\u003cem\u003evalue\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026dagger;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003evalue\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026dagger;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003evalue\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003eHV\u003c/p\u003e\n \u003cp\u003e(n=29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003ePC\u003c/p\u003e\n \u003cp\u003e(n=4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003eMixed\u003c/p\u003e\n \u003cp\u003e(n=8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eCortex characteristic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.451\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.035**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eEccentrical or asymmetrical thickened cortex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e9(31.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e2(50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e6(75.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eComplete effacement of fatty hilum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e20(68.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e2(50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e2(25.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eMacrocalcification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e24(82.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2(50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e5(62.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e5(17.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2(50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e3(37.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eShort linear hyperechoic foci\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.880\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.744\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.613\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e12(41.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2(50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e4(50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 39px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e17(58.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2(50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e4(50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eBlood distribution\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.306\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.971\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eNone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e3(10.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1(25.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eHilar color flow\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2(6.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1(25.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eNon-Hilar color flow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e24(82.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e2(50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e8(100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eBlood volume\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.018**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.007**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eNo color\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e4(13.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0(0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eMinimal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e3(10.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e3(75.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1(12.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003eAbundant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e22(75.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e1(25.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e7(87.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e*\u003cem\u003e\u0026nbsp;P\u003c/em\u003e values compare all three groups.\u003c/p\u003e\n \u003cp\u003e\u0026dagger; \u003cem\u003eP\u003c/em\u003e values compare hyaline vascular type (HV) and plasma cell type (PC).\u003c/p\u003e\n \u003cp\u003e\u0026Dagger;\u003cem\u003eP\u003c/em\u003e values compare hyaline vascular type (HV) and non-hyaline vascular type.\u003c/p\u003e\n \u003cp\u003e** \u003cem\u003eP\u003c/em\u003e \u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis paper evaluated the ultrasound features of UCD based on a larger dataset, contributing to a deeper understanding of the disease in clinical practice. Our results demonstrated that the UCD usually exhibited enlarged lymph nodes with complete effacement of the fatty hilum and unclear corticomedullar interface. 73.17% of patients showed a strong echo including either macrocalcification or short linear hyperechoic foci within the LNs, which were notably characteristic findings for UCD. In addition, compared with the PCV, the HV groups exhibited more abundant blood flow signals for lymph nodes.\u003c/p\u003e\u003cp\u003eIn our study, the majority of UCDs were detected incidentally by physical examination or medical visits for palpable masses. UCD classically presents as hypoechoic masses with increased volume and cortical thickening, which is associated with pronounced follicular hyperplasia in the cortical region and atrophic germinal centers[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Additionally, the reactive proliferation of B cells and T cells within the cortex may further contribute to cortical thickening[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The macrocalcifications and short linear strong echoes in the LNs were characteristic findings in this study. The macrocalcifications on US appear as echogenic shadowing foci with discrete, coarse, arborizing configurations[\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The presence of calcification may indicate a diagnosis of UCD[\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Calcification may be due to the calcium deposition occurring based on the specific pathology changes, including thickening of the proliferative capillary wall, accompanied by hyaline degeneration, fibrinolysis, and degeneration of other connective tissues. This study is the first to observe short linear echogenicity in the central region of UCD lesions, which may be highly correlated with the characteristic pathological feature of lymphoid follicle proliferation in UCD. In our study, 73.17% of patients had the characteristic distribution pattern, therefore, we suggest that this new US finding may be an important indicator of UCD.\u003c/p\u003e\u003cp\u003eFor different CD histological types, HV-type patients generally exhibit combined blood flow patterns and abundant flow signals. According to a previous study, after the administration of a contrast agent, the enhancement degree of the PV type is usually lower than that of the HV type[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The blood flow perfusion of UCD was consistent with our results, which is due to the proliferation and expansion of the capillary network around the lymphoid follicles in the HV subtype, while in PV subtype lesions, the diffuse plasma cell infiltration and fibrotic tissue compress or occupy normal vascular spaces, increasing vascular resistance and reducing blood flow. The mixed subtype is characterized by a pattern that may depend on whether hyaline vascular changes or plasma cell infiltration is more predominant in the pathological process[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe diagnosis of CD is often suspected initially owing to radiographic findings. In this study, we propose some imaging signs to provide auxiliary guidance for physicians during clinical procedures. In particular, the two characteristic patterns may be helpful for the diagnosis of CD. However, accurate preoperative diagnosis of CD is difficult based on radiologic features alone. The US findings can be manifestations of several diseases, including lymphoma, metastatic LN, and other diseases. Future research will therefore require considerably larger cohorts to investigate any difference.\u003c/p\u003e\u003cp\u003eOur study has some limitations. First, it is a single-center retrospective study; due to the low incidence of UCD, the number of cases included in this study was relatively limited. As our hospital is a comprehensive tertiary hospital for the rarity of CD, our study includes the largest UCD cohort to date. Second, for some deep-seated LNs, the richness of blood flow might be underestimated due to the application of a relatively low-frequency probe. Future prospective studies need to be conducted with a standardized diagnostic workup.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eUCD is typically manifested as a solitary enlarged lymph node with a thick cortex, absence of medullary structure, and an unclear cortico-medullary demarcation. These lesions showed macrocalcification or short linear hyperechoic patterns. They may indicate a diagnosis of UCD. Additionally, compared with PV, the HV group presented more often with abundant color flow signals on color Doppler flow imaging. Ultrasound is expected to play a significant role in the evaluation of UCD and guiding appropriate regions for biopsies.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eCD,\u0026nbsp;\u003c/strong\u003eCastleman disease\u003cstrong\u003e; UCD,\u0026nbsp;\u003c/strong\u003eUnicentric Castleman disease\u003cstrong\u003e; MCD,\u0026nbsp;\u003c/strong\u003eMulticentric Castleman disease\u003cstrong\u003e; HVV,\u0026nbsp;\u003c/strong\u003eHyaline vascular variant; \u003cstrong\u003ePCV,\u0026nbsp;\u003c/strong\u003ePlasma cell variant\u003cstrong\u003e; HVPC,\u0026nbsp;\u003c/strong\u003ehyaline-vascular plasma cell variant; \u003cstrong\u003eUS,\u0026nbsp;\u003c/strong\u003eUltrasound\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAll manuscripts must contain the following sections under the heading \u0026apos;Declarations\u0026apos;:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInstitutional Review Board approval was obtained. IRB#S-K1539\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from all patients in this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors consent to the publication of this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003cstrong\u003es\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated or analyzed during the study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has received funding from the National High-Level Hospital Clinical Research Funding (2022-PUMCH-B-066).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLZH analyzed the patient data and was a major contributor in writing the manuscript. NZH was a major contributor to collect the patient data and writing the manuscript. GYH substantially analyzed and interpreted the patient data. XMS was a major contributor to the investigation and data curation. WY Formal was a major contributor to analysis and data curation. ZQL was a major contributor to the conception of the project and writing of the manuscript. ZL was a major contributor to the writing and revision of the manuscript. All authors have read and approved the final version of the manuscript and agree with the order of presentation of the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eX. Zhang, H. Rao, X. Xu, et al. (2018). Clinical characteristics and outcomes of Castleman disease: A multicenter study of 185 Chinese patients. \u003cem\u003eCancer Sci, 109\u003c/em\u003e(1), 199-206.\u003c/li\u003e\n\u003cli\u003eB. Castleman, V.W. Towne. (1954). Case records of the Massachusetts General Hospital; weekly clinicopathological exercises; Case No. 40351. \u003cem\u003eN Engl J Med, 251\u003c/em\u003e(10), 396-400.\u003c/li\u003e\n\u003cli\u003eC. Hoffmann, E. Oksenhendler, S. Littler, L. Grant, K. Kanhai, D.C. Fajgenbaum. (2024). The clinical picture of Castleman disease: a systematic review and meta-analysis. \u003cem\u003eBlood Adv, 8\u003c/em\u003e(18), 4924-4935.\u003c/li\u003e\n\u003cli\u003eF. van Rhee, E. Oksenhendler, G. Srkalovic, et al. (2020). International evidence-based consensus diagnostic and treatment guidelines for unicentric Castleman disease. \u003cem\u003eBlood Adv, 4\u003c/em\u003e(23), 6039-6050.\u003c/li\u003e\n\u003cli\u003eN. Talat, A.P. Belgaumkar, K.M. Schulte. (2012). Surgery in Castleman\u0026apos;s disease: a systematic review of 404 published cases. \u003cem\u003eAnn Surg, 255\u003c/em\u003e(4), 677-84.\u003c/li\u003e\n\u003cli\u003eM.A. Pitot, A.D. Tahboub Amawi, L.F. Alexander, et al. (2023). Imaging of Castleman Disease. \u003cem\u003eRadiographics, 43\u003c/em\u003e(8), e220210.\u003c/li\u003e\n\u003cli\u003eM. Haap, J. Wiefels, M. Horger, A. Hoyer, K. M\u0026uuml;ssig. (2018). Clinical, laboratory and imaging findings in Castleman\u0026apos;s disease - The subtype decides. \u003cem\u003eBlood Rev, 32\u003c/em\u003e(3), 225-234.\u003c/li\u003e\n\u003cli\u003eY.J. Ho, C.C. Huang, C.H. Fan, H.L. Liu, C.K. Yeh. (2021). Ultrasonic technologies in imaging and drug delivery. \u003cem\u003eCell Mol Life Sci, 78\u003c/em\u003e(17-18), 6119-6141.\u003c/li\u003e\n\u003cli\u003eP. Wang, G. Hou, F. Li, X. Cheng. (2021). Hypermetabolic Unicentric Castleman Disease of Kidney on FDG PET/CT. \u003cem\u003eClin Nucl Med, 46\u003c/em\u003e(6), 510-511.\u003c/li\u003e\n\u003cli\u003eJ.W. Brubaker, R.P. Harrie, B.C. Patel, D.K. Davis, N. Mamalis. (2011). CT and orbital ultrasound findings in a case of Castleman disease. \u003cem\u003eOphthalmic Plast Reconstr Surg, 27\u003c/em\u003e(2), e37-9.\u003c/li\u003e\n\u003cli\u003eW.K. Moon, W.S. Kim, I.O. Kim, K.M. Yeon, M.C. Han. (1994). Castleman disease in the child: CT and ultrasound findings. \u003cem\u003ePediatr Radiol, 24\u003c/em\u003e(3), 182-4.\u003c/li\u003e\n\u003cli\u003eK. Lv, Y. Zhao, W. Xu, C. Zhang, P. Huang. (2020). Ultrasound and radiological features of abdominal unicentric castleman\u0026apos;s disease: A case series study. \u003cem\u003eMedicine (Baltimore), 99\u003c/em\u003e(18), e20102.\u003c/li\u003e\n\u003cli\u003eD. Fischerova, G. Garganese, H. Reina, et al. (2021). Terms, definitions and measurements to describe sonographic features of lymph nodes: consensus opinion from the Vulvar International Tumor Analysis (VITA) group. \u003cem\u003eUltrasound Obstet Gynecol, 57\u003c/em\u003e(6), 861-879.\u003c/li\u003e\n\u003cli\u003eA.T. Ahuja, M. Ying, S.Y. Ho, et al. (2008). Ultrasound of malignant cervical lymph nodes. \u003cem\u003eCancer Imaging, 8\u003c/em\u003e(1), 48-56.\u003c/li\u003e\n\u003cli\u003eD.D. Adler, P.L. Carson, J.M. Rubin, D. Quinn-Reid. (1990). Doppler ultrasound color flow imaging in the study of breast cancer: preliminary findings. \u003cem\u003eUltrasound Med Biol, 16\u003c/em\u003e(6), 553-9.\u003c/li\u003e\n\u003cli\u003eR. Alaggio, C. Amador, I. Anagnostopoulos, et al. (2022). The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Lymphoid Neoplasms. \u003cem\u003eLeukemia, 36\u003c/em\u003e(7), 1720-1748.\u003c/li\u003e\n\u003cli\u003eS. El Hussein, A.G. Evans, H. Fang, W. Wang, L.J. Medeiros. (2024). Unicentric Castleman Disease: Illustration of Its Morphologic Spectrum and Review of the Differential Diagnosis. \u003cem\u003eArch Pathol Lab Med, 148\u003c/em\u003e(1), 99-106.\u003c/li\u003e\n\u003cli\u003eD.M. Cronin, R.A. Warnke. (2009). Castleman disease: an update on classification and the spectrum of associated lesions. \u003cem\u003eAdv Anat Pathol, 16\u003c/em\u003e(4), 236-46.\u003c/li\u003e\n\u003cli\u003eD. Bonekamp, K.M. Horton, R.H. Hruban, E.K. Fishman. (2011). Castleman disease: the great mimic. \u003cem\u003eRadiographics, 31\u003c/em\u003e(6), 1793-807.\u003c/li\u003e\n\u003cli\u003eH.P. McAdams, M. Rosado-de-Christenson, N.F. Fishback, P.A. Templeton. (1998). Castleman disease of the thorax: radiologic features with clinical and histopathologic correlation. \u003cem\u003eRadiology, 209\u003c/em\u003e(1), 221-8.\u003c/li\u003e\n\u003cli\u003eS.-F. Ko, M.-J. Hsieh, S.-H. Ng, et al. (2004). Imaging Spectrum of Castleman\u0026apos;s Disease. \u003cem\u003eAmerican Journal of Roentgenology, 182\u003c/em\u003e(3), 769-775.\u003c/li\u003e\n\u003cli\u003eK. Lv, Y. Zhao, W. Xu, C. Zhang, P. Huang. (2020). Ultrasound and radiological features of abdominal unicentric castleman\u0026apos;s disease. \u003cem\u003eMedicine, 99\u003c/em\u003e(18).\u003c/li\u003e\n\u003cli\u003eA.J. Hill, S.H. Tirumani, M.H. Rosenthal, et al. (2015). Multimodality imaging and clinical features in Castleman disease: single institute experience in 30 patients. \u003cem\u003eBr J Radiol, 88\u003c/em\u003e(1049), 20140670.\u003c/li\u003e\n\u003cli\u003eS. Zhao, Y. Wan, Z. Huang, B. Song, J. Yu. (2019). Imaging and clinical features of Castleman Disease. \u003cem\u003eCancer Imaging, 19\u003c/em\u003e(1), 53.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"cancer-imaging","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"caig","sideBox":"Learn more about [Cancer Imaging](https://cancerimagingjournal.biomedcentral.com/)","snPcode":"40644","submissionUrl":"https://submission.nature.com/new-submission/40644/3","title":"Cancer Imaging","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Unicentric Castleman disease, Ultrasonography​​, Lymph node, ​​Diagnostic imaging, ​​​​Hyaline vascular subtype​​, Echo pattern","lastPublishedDoi":"10.21203/rs.3.rs-7334976/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7334976/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eUnicentric Castleman disease (UCD) is a rare group of non-neoplastic lymphoproliferative disorders. This study aims to summarize the specific ultrasonic manifestations of UCD.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis retrospective study included patients who underwent preoperative ultrasound for enlarged lymph nodes and were later diagnosed with UCD between January 2016 and March 2024. Ultrasound features, including lymph node size, cortical characteristics, corticomedullary interface, hyperechoic regions, and Doppler flow signals, were recorded. Pathological types were classified as hyaline vascular (HV), plasma cell (PC), or mixed. The ultrasonic features of each UCD subtype were systematically analyzed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 41 patients were enrolled, including 29 patients with HV-type, 4 with PC-type and 8 with mixed type. All patients exhibited enlarged LNs characterized by solitary mass, well-defined margins and increased cortical thickness. Among them, 95.12% (39/41) of cases had an indistinct corticomedullary interface. 41.46% (17/41) showed eccentric or asymmetrical cortical thickening, and 58.54% (24/41) demonstrated complete effacement of the fatty hilum. About 24.39% (10/41) of cases exhibited macrocalcification, and 56.10% (23/41) displayed short linear hyperechoic foci within the LNs. Additionally, HV-type and mixed-type patients had more abundant blood flow signals than PC-type patients (75.86% vs 25% vs 87.50%, P\u0026thinsp;=\u0026thinsp;0.018).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eUltrasound features of UCD typically include large, solitary masses with well-defined margins, a thickened cortex, and loss of the fatty hilum. Key imaging findings are micro-calcifications and short linear hyper echoes. Ultrasound is an effective and non-invasive tool for the early detection and diagnosis of UCD.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e\u003cp\u003eretrospectively registered.\u003c/p\u003e","manuscriptTitle":"The Sonographic Characteristics of Unicentric Castleman Disease - a single-center Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-21 10:26:25","doi":"10.21203/rs.3.rs-7334976/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-25T04:00:44+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-21T13:18:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"179852763114887362546648398550031906784","date":"2025-08-18T14:47:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"238511715650842768044114584326702661812","date":"2025-08-16T11:17:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-13T12:14:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-12T13:25:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-12T10:37:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"Cancer Imaging","date":"2025-08-09T15:59:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"cancer-imaging","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"caig","sideBox":"Learn more about [Cancer Imaging](https://cancerimagingjournal.biomedcentral.com/)","snPcode":"40644","submissionUrl":"https://submission.nature.com/new-submission/40644/3","title":"Cancer Imaging","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"59fddaa8-b693-4719-aeb6-6009a9b57bf4","owner":[],"postedDate":"August 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-06T16:02:52+00:00","versionOfRecord":{"articleIdentity":"rs-7334976","link":"https://doi.org/10.1186/s40644-025-00937-2","journal":{"identity":"cancer-imaging","isVorOnly":false,"title":"Cancer Imaging"},"publishedOn":"2025-09-29 15:57:43","publishedOnDateReadable":"September 29th, 2025"},"versionCreatedAt":"2025-08-21 10:26:25","video":"","vorDoi":"10.1186/s40644-025-00937-2","vorDoiUrl":"https://doi.org/10.1186/s40644-025-00937-2","workflowStages":[]},"version":"v1","identity":"rs-7334976","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7334976","identity":"rs-7334976","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}