Chapter  (1906–1982) Robert E. Scully

enjamin Castleman (fi gure 8.1) was born Dr. Mallory assigned two projects to his pupil: Bin Everett, Massachusetts, on May 17, 1906, the fi rst a study of carcinoid tumors in the ileo- the eldest of three sons, to religious Jewish par- cecal region, and the other the organization of ents who had emigrated from Russia and owned specimens that had been fi xed in jars in a confer- a small grocery store. Th e family soon moved ence room. Dr. Mallory was impressed with Dr. to Dorchester, Massachusetts, where, as a teen- Castleman’s work on his projects as well as his ager, he worked, contributing his income to sup- popularity with other personnel in the depart- port the education of his younger brothers, who ment. Upon graduation from Yale Medical became lawyers and moved to Detroit to join a relative in a legal fi rm. After high school, Castleman worked his way through Harvard College, gaining entrance despite the quota for Jews in existence at the time. He was unsuccessful, however, in his attempt to enter (HMS). Having a prosperous relative in New Haven with whom he could live, he applied to and was accepted by Yale Medical School, where he excelled. His idol and champion there was Dr. Milton C. Winternitz, Chairman of the Pathology Department and later Dean of the medical school. Eager to return to the area to practice medicine, Dr. Castleman volunteered to spend the summers of 1929 and 1930 as an unpaid assistant in the Pathology department at the Massachu- setts General Hospital (MGH). He was accepted by Dr. Tracy B. Mallory, Chief of Pathology at MGH (see chapter 5). During his second year as a volunteer, he had an attack of rheumatic fever; there was no evidence of residual cardiac damage, according to Dr. Paul Dudley White, to whom he had been referred for evaluation. Figure 8.1 Benjamin Castleman

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School, Dr. Castleman applied to the MGH research. (Subsequently, residents doing autopsies for an internship in pathology, and at the same were required to locate all four parathyroids and time to Peter Bent Brigham Hospital and Johns submit them for microscopical examination.) Hopkins Hospital for a medical internship. Two In 1935 Drs. Castleman and Mallory coau- months before he was to report to the MGH, thored the classic 73-page paper on the pathology he had a second attack of rheumatic fever, this of the parathyroid glands. Th is paper was the fi rst one with arthritis of the left elbow and an apical of many published throughout Dr. Castleman’s systolic murmur. He apologized to Dr. Mallory career that covered various areas of pathologic because of his illness and expressed his eagerness anatomy. to get back to work, but Dr. Mallory delayed his Th e most memorable of his publications were: return and convinced him that he should pursue • Th ose on parathyroid disorders, about which a career in pathology instead of medicine because he wrote many articles and two Armed of his heart disease. He trained at the MGH from Forces Institute of Pathology (AFIP) tumor 1931 to 1935. fascicles, the second with his coauthor San- In 1935, Dr. Castleman joined the MGH staff ford I. Roth (MGH). as an Assistant Pathologist. About that time he • Th ose on diseases of the thymus and medi- began to court his future wife, Anna Segal, who astinum, about which he wrote an AFIP was four years younger than he. She was also the tumor fascicle. daughter of Russian immigrants, who were pros- • perous friends of his parents; she had graduated A paper with V. Pardo (Cuba) and L. Iverson from Wellesley College in 1934. Ben and Anna (AFIP) on a newly recognized lymph node agreed to stop dating until he earned a salary disorder that led to the eponym “Castleman’s of $4,500, which he attained in July 1937. Th ey disease,” and a later paper senior-authored by were married in December of that year. Anna Albert R. Keller (MGH) reviewing 81 cases of was a charming, attractive woman who adored the disease and dividing them into hyaline- her husband; she was well known to his friends vascular and plasma cell types. (including his staff , residents, and fellows) as a • Coauthorship with S. H. Rosen (AFIP) and gracious hostess. Th e couple had three children, A. A. Liebow (Yale Medical School) of the a son, who graduated from Harvard and became initial description of alveolar proteinosis. a medical computer entrepreneur, and two well- • Coauthorship with David Korn (MGH) educated daughters, one of whom married a and others of a paper fi rst reporting multiple physician who became Professor of Medicine at minute chemodectomas of the lung. Jewish Hospital in St. Louis, and the other who • Coauthorship with A. A. Liebow (Yale Medi- married a space physicist in Florida. cal School) of a paper describing initially Preparation for Dr. Castleman’s fi rst major multiple clear cell (sugar) tumors of the lung. paper began when he was still a resident. Dr. • Edward D. Churchill, Professor of Surgery, asked Many articles on the clinicopathological Dr. Mallory to appoint a resident in pathol- features of pulmonary vascular disorders, ogy (Dr. Castleman was selected) to locate and some written with the renowned radiologists remove all four parathyroid glands for micro- Aubrey O. Hampton and Felix Fleischner scopical examination during 30 autopsies, in col- (both MGH). laboration with Dr. , the surgical res- • Coauthorship, mainly with R. H. Smithwick ident chosen by Dr. Churchill. Th e two residents (Boston University) of multiple articles on became close friends and later collaborators in essential hypertension, proving that renal

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arteriolosclerosis is secondary to, instead of another great pathologist, Dr. Lauren V. Acker- preceding and causing, the hypertension. man (Washington University, St. Louis). Th eir • A paper senior-authored by William M. opinion was eventually deemed incorrect by a Th urlbeck (MGH) reporting a high inci- great majority of pathologists and surgeons. dence of atheromatous emboli to the kid- Many of these papers were written in the 23 ney after aortic surgical operations, which years (1951–1974) during which Dr. Castleman resulted in improvements in surgical tech- was editing the Case Records of the MGH, which niques accompanied by a greatly improved were published in the New England Journal of survival. Medicine (NEJM). Being Editor usually included • A series of papers on diseases of the heart and presentation of the pathological fi ndings of the aorta, coauthored by P. D. White, Edward case in addition to presiding at the exercise and Bland, and other MGH cardiologists, review- editing the recorded version of the discussion. ing large numbers of cases of various disor- During his years as Editor, Dr. Castleman par- ders, mostly confi rming previous fi ndings ticipated in almost 1,200 cases. His feats as Edi- in the literature rather than presenting new tor were celebrated in an NEJM editorial entitled observations. “Ben Castleman—Champion of the CPC” (1). • After Dr. Mallory’s death in late 1951, Dr. Coauthorship with Richard R. Kelley and Castleman initially became Acting Chief of Fairfi eld Goodale (both MGH) of an article Pathology. In 1953 he became the offi cial Chief on the dynamics of rheumatic and calcifi c of Pathology at MGH (fi gure 8.2). As chief, Dr. (Th e article was based aortic valve disease. Castleman was responsible for naming the hos- on construction of a machine into which a pital’s pathology laboratories when they were human heart could be inserted and made moved into a newly constructed building facing to contract, simulating contraction of a the Charles River in 1956. Before the move, he heart in vivo). Motion pictures of normal had reviewed Dr. James Homer Wright’s great human hearts as well as those with valvular contributions to pathology and medicine and abnormalities were made. Th ese movies were suggested to the hospital Trustees that the entire widely used at HMS and elsewhere in teach- building be named in Dr. Wright’s honor, but ing cardiovascular pathophysiology. the Trustees preferred that the Warren family • Papers on medical education, mostly dealing receive that honor, and that the new laboratories with the use of clinicopathological confer- be named the James Homer Wright Pathology ences (CPCs) for teaching medical students, Laboratories. A spacious library on the second residents, and senior physicians. fl oor was named the Tracy Burr Mallory Memo- Dr. Castleman also authored the proceed- rial Library. ings of two prestigious slide seminars (the 50th Th e move to the new building also marked Dr. Anniversary of the American Society of Clini- Castleman’s establishment of two annual post- cal Pathologists Seminar and the Penrose Hos- sophomore fellowships, during which a student pital Slide Seminar). In these sessions he and spent half a year at MGH in diagnostic pathol- other experts discussed in detail 50 and 15 cases, ogy, and the other half in research. Th e program respectively. yielded many leaders in pathology, oncology, and Objectivity requires the admission that Dr. research, including one Nobel Prize–winner (J. Castleman coauthored four papers on large- Michael Bishop). intestinal adenomatous polyps, concluding that It is a testament to Dr. Castleman’s remarkable they were not premalignant, a view shared by drive and work ethic as chief of the department

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Figure 8.2 Benjamin Castleman in the chief’s offi ce, Warren Building (Photo courtesy of Fairfi eld Goodale)

that he was so productive a medical author and his wit was not as subtle as that of his audience. CPC Editor when he was also busy teaching at Once, while contemplating an appendiceal car- the MGH, HMS, and elsewhere in the world. cinoid tumor, he exclaimed: “What a beautiful Almost every workday he spent from 8:15 to 9:15 tumor. I’d like to have a necktie with that pat- a.m. reviewing gross specimens from the autop- tern.” An intern’s instant retort was “I’d rather sies of the previous day, along with the clinical have the tumor!” Occasionally, if a staff member, history and pertinent radiologic fi lms. His audi- having seen the slides directly under his micro- ence comprised the pathology residents and fel- scope, disagreed strongly with the conference lows and variable numbers of pathology staff diagnosis, the dispute was settled by joint use of members and clinicians. Th e emphasis was always a microscope after the conference. As soon as the on clinicopathological correlation and patient diagnoses were fi nalized, Dr. Castleman often care. From 2:00 to 3:00 p.m. the same day, he was telephoned one or more surgeons to guarantee the maestro who conducted the surgical sign-out that he would select the proper therapy. Predict- conference with verve and wit. After projecting ably, not all of them appreciated the advice. the most interesting surgical slides of the previ- Dr. Castleman’s busy schedule was also inter- ous day on a screen, he made the session exciting rupted almost daily by receipt of one or more by challenging the residents to make the correct challenging cases in the mail for his expert opin- diagnosis. He often joked about the patterns of ion. Finally, he continued Dr. Mallory’s practice the stained slides on the screen. Occasionally of spending time in the residents’ room to learn

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more about each of them and to help them with were yearly sessions with the staff to select incom- any problems they might have had profession- ing interns. Otherwise, the closest he came to a ally or personally. He considered his residents committee meeting was when he called Austin “my boys” and helped them with their careers Vickery and Robert Scully into his offi ce on one throughout their lives. occasion and asked their opinion about some Unlike Dr. Mallory, who left Boston for pro- thorny issue. Th ey agreed on a solution, where- fessional reasons infrequently, Dr. Castleman upon Dr. Castleman exclaimed: “Th at’s what I travelled extensively to deliver lectures, conduct thought you’d say, so I already did it.” slide seminars, and discuss CPCs modelled on When Dr. Castleman approached the custom- those given at the MGH. From 1951 to 1971 his ary retirement age of 65 in 1971, his staff organized destinations included many cities in the United a retirement dinner in his honor at the Harvard States, as well as cities in Central America, Cuba, Club on October 29, 1971, that was attended by other Caribbean Islands, South America, Japan, over 150 current and former colleagues and their India, Sri Lanka, Th ailand, and Hong Kong. He spouses, as well as special guests. was a dramatic speaker. He also made certain Finding a worthy successor was not an easy that the lay public as well as those in the medi- task. After rejecting several out-of-town candi- cal profession grasped the great importance of his dates, the search committee selected Dr. Rob- teachings. ert T. McCluskey, who was then Chairman of Another of Dr. Castleman’s accomplishments Pathology at Boston’s Children’s Hospital. Dr. was extending MGH pathology services to Castleman remained as Acting Chief until a new nonteaching hospitals that lacked an anatomic chief was appointed at Children’s Hospital in pathologist. Th ese included Memorial Hospital 1974. in Worcester, Brockton Hospital, and Emerson In January 1972, after Dr. John Knowles left Hospital in Concord. Th e MGH residents did his position as General Director of the hospital autopsies and the staff did frozen sections at these to become Director of the Rockefeller Founda- hospitals. Eventually, the hospitals acquired their tion, the hospital Trustees decided to appoint an own Chiefs of Anatomic Pathology, beginning Interim Acting General Director while search- with Dr. Ronald Sniff en, who became chief at the ing for a new one. Th e obvious candidate for the Memorial Hospital. temporary position was Dr. Castleman, who was Dr. Castleman’s remarkable quality was his admired throughout the hospital for his admin- self-confi dence. On one occasion he confessed istrative as well as medical skills. He exceeded to Dr. Scully, “I love solving problems.” Th at expectations in his new role (during which time proclivity was boundless in its extent and occa- he was still Acting Chief of Pathology) by reor- sionally comical—when, for example he directed ganizing physician rules and practices, beginning traffi c in a snowstorm (2). At a more consequen- the construction of new buildings, and, most tial level, Dr. Castleman led relentless and suc- important, obtaining a Certifi cate of Need and cessful battles against the sale of tobacco prod- starting construction of the new Cox Cancer ucts by the hospital’s gift shop, and later against Center. In August 1972 Dr. Charles A. Sanders the performance of radical mastectomy for breast replaced Dr. Castleman as General Director. cancer. Th e latter struggle had been inspired by During his career Dr. Castleman was showered his mother’s deformity and pain after that opera- with awards. He received honorary memberships tion many years earlier. in many South American and Central American Dr. Castleman also avoided committee meet- pathology and medical societies. He was given ings whenever possible. Th e ones he did conduct a travel award from the Rockefeller Foundation

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(1961) to improve medical education in coun- probably considered his greatest. He received tries in the Far East. (He did so energetically, as an honorary doctorate in medicine from the evidenced by the detailed reports of his activities University of Göteborg in Sweden because of that he submitted to the foundation.) In 1961 he his outstanding work in endocrine pathology also became President of the International Acad- in 1961 (fi gure 8.3). He was elected a Fellow of emy of Pathology (IAP). During his Far Eastern the American Academy of Arts and Sciences in trip he enlisted many new divisions in the IAP, 1960. Th e Benjamin Castleman Professorship in for which he received the FK Mostofi Award in Pathology at Harvard Medical School was estab- 1981. In 1972 he delivered the prestigious Maude lished in 1977. Finally, a Benjamin Castleman Abbott lecture of the IAP. He became Honor- Young Investigator Award was funded by his for- ary Member of two Alpha Omega Alpha Honor mer trainees and associates in 1980. Th e award Society chapters, one at Harvard and the other is given annually, at the meeting of the United at Princeton University. He was awarded the States–Canadian Division of the IAP, to a pathol- Shattuck Professorship in Pathology at Harvard ogist under the age of 40 who has published an Medical School in 1979 and became an Honor- outstanding article in the fi eld of human pathol- ary Fellow of the Royal College of Pathologists ogy in the previous year. of Australia and the Royal College of Physicians Dr. Castleman had two major diseases during and Surgeons of Canada. his lifetime, rheumatic heart disease and Walden- Th ere were four honors that Dr. Castleman ström’s macroglobulinemia. His heart disease,

Figure 8.3 Benjamin Castleman receiving an honorary doctorate in medicine from the University of Göteborg in Sweden

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accompanied by a mitral valve murmur, had been and then, still smiling, thanked them for the active suffi ciently recently for the Army to reject opportunity to serve so great an institution as the his application to join Dr. Mallory in Europe MGH. Two weeks later, still alert mentally, he during World War II. Greatly disappointed, Dr. died suddenly. Castleman successfully persuaded the U.S. gov- Ben Castleman was greatly appreciated by his ernment, the Rockefeller Foundation, and the Eli residents and associates because of his many fi ne Lilly Company to award him funds to mail CPCs qualities. He was generally a happy man, out- to all nine U.S. Army commands (see chapter 24) going, optimistic, and loyal. He had a lifelong and to travel throughout the world to improve interest in how “his boys” were doing and always medical education. attempted to place them in the best positions he Neither the rheumatic heart disease nor the could fi nd. Many of them had brilliant careers in Waldenström’s macroglobulinemia diminished research or teaching; almost all the rest had lead- the extent of Dr. Castleman’s achievements dur- ership roles in pathology throughout the world. ing his tenure as Chief of Pathology. Th e hema- Ben had strong convictions, and he did not hesi- tologic disorder ultimately led to his death, how- tate to express them to achieve his goals. He read ever, preventing completion of an investigation widely and was a stimulating conversationalist. he was pursuing in the Pathology Department He supported good causes and was a perpetual eight years after his retirement (a comparison of fund-raiser. He and Anna, who is still alive, often the results of large series of cases of breast cancer invited friends, colleagues, and the resident staff treated by radical mastectomy and those managed to their home. For all who worked with or under by more conservative surgery and irradiation). him or received his messages from one of his In early 1982 Dr. Castleman’s macroglobulin- lectures or publications, he propelled pathology emia evolved into a malignant anterior medias- from the laboratory into the clinic with his credo: tinal tumor. A biopsy gave him his last oppor- keep your mind on the patient’s care as you look tunity to solve a problem. Th e tumor was very through the microscope. His name is perpetu- malignant and had many giant cells. Th e staff ated in the hospital he loved by the bestowal on members who were responsible for the diagno- his successors as Chiefs of Pathology the title sis ordered immunohistochemical stains. Dr. Benjamin Castleman Professor of Pathology. Castleman could not wait, however, for them One would have to search far and wide to to be done. He left his hospital bed, hurried to fi nd a contemporary pathologist, if, indeed, the laboratory, looked briefl y at the routinely one existed, who did more for his department, stained slides, and exclaimed: “I don’t care what his hospital, and the medical world by elevating the ‘immuno’ shows. It’s a highly malignant lym- pathology to a vibrant clinical level than Benja- phoma.” As usual, he was right. min Castleman. Shortly after the diagnosis was made, Harvard Medical School and Massachusetts General Hos- pital decided to activate the Benjamin Castle- References man Professorship and award it to Dr. Robert 1. Scully RE. Ben Castleman—Champion of the T. McCluskey before their esteemed colleague CPC. N Engl J Med 307:370–371, 1982. died. Th e event, which took place in mid-June, 2. Scully RE, Vickery AL. Surgical pathology at the was for Dr. Castleman, Anna, his colleagues, and hospitals of Harvard Medical School. In Guiding his friends a mixture of celebration and deep sor- the Surgeon’s Hand: Th e History of American Sur- row. Dr. Castleman listened smilingly to speak- gical Pathology. Rosai J, ed. Washington, D.C.: ers praising him for all he had accomplished American Registry of Pathology, 1997.

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Selected paper of 14. Paul O, Castleman B, White PD. Chronic con- Benjamin Castleman, M.D. strictive pericarditis. A study of 53 cases. Am J 1. Albright F, Bloomberg E, Castleman B, Churchill Med Sci 216:361–377, 1948. ED. due to diff use hyper- 15. Castleman B, Smithwick RH. Th e relation of plasia of all parathyroid glands rather than ade- vascular disease to the hypertensive state. II. Th e noma of one. Arch Int Med 54:315–329, 1934. adequacy of the renal biopsy as determined from a 2. Castleman B, Mallory TB. Th e pathology of the study of 500 patients. N Engl J Med 239:729–732, parathyroid gland in hyperparathyroidism. Am J 1948. Pathol 11:1–72, 1935. 16. Castleman B, Norris EH. Th e pathology of the 3. Castleman B. Extension of gastric carcinoma into thymus in myasthenia gravis. A study of 35 cases. the duodenum. Ann Surg 103:348–352, 1936. Medicine 28:27–58, 1949. 4. Glendy RE, Castleman B. Dissecting aneurysm of 17. Castleman B, Cope O. Primary parathyroid the aorta. Am Heart J 13:129–165, 1937. hypertrophy and hyperplasia. A review of 11 cases 5. Castleman B, Mallory TB. Parathyroid hyper- at the Massachusetts General Hospital. Bull Hosp plasia in chronic renal insuffi ciency. Am J Pathol Joint Dis 12:368–378, 1951. 13:553–574, 1937. 18. Castleman B. Tracy Burr Mallory, 1896–1951. Har- 6. Palmer RS, Castleman B. Paraganglioma (chro- vard Med Alumni Bull 26:66–68, 1952. maffi noma, pheochromocytoma) of the adrenal 19. Castleman B. Tumors of the parathyroid glands. gland simulating malignant hypertension. N Engl In Atlas of Tumor Pathology. Washington, D.C.: J Med 211:793–796, 1938. Armed Forces Institute of Pathology, 1952. 7. Drake TG, Albright F, Bauer W, Castleman B. 20. Jones CM, Benson JA, Roque AL, Castleman B. Chronic idiopathic hypoparathyroidism. Report Whipple’s disease. Presentation of a case with spe- of six cases with autopsy fi ndings in one. Ann Int cial reference to histochemical studies of biopsy Med 12:1751–1765, 1939. material and therapeutic results following corti- 8. Hampton AO, Castleman B. Correlation of post- costeroid therapy. Tr Am Physicians 65:276–280, mortem chest teleroentgenograms with autopsy 1952. fi ndings. With special reference to pulmonary 21. Burt AS, Castleman B. Some histological eff ects of embolism and infarction. Am J Roentgenol and estrogens and castration on the anterior pituitary Rad Th erapy 43:305–325, 1940. in women with carcinoma of the breast. Cancer 9. Castleman B. Healed pulmonary infarcts. Arch 6:236–247, 1953. Pathol 43:305–318, 1940. 22. Morgan WS, Castleman B. A clinicopathologic 10. Palmer RS, Chute R, Crone NL, Castleman B. study of Mikulicz’s disease. Am J Pathol 29:471– Th e renal factor in continued arterial hyperten- 503, 1953. sion not due to a glomerulonephritis as revealed 23. Cope O, Nardi GL, Castleman B. Carcinoma of by intravenous pyelogram. A study of 212 cases the parathyroid glands. 4 cases among 148 patients with a report of the results of nephrectomy in nine with hyperparathyroidism. Ann Surg 138:661–671, cases. N Engl J Med 323:165–171, 1940. 1953. 11. Fleischner F, Hampton AO, Castleman B. Linear 24. Th omas WA, Averill JH, Castleman B, Bland EF. shadows in the lung. Am J Roentgenol 46:610– Th e signifi cance of Aschoff bodies in the left atrial 618, 1941. appendage. A comparison of 40 biopsies removed 12. Castleman B, Smithwick RH. Th e relationship during mitral commissurotomy with autopsy of vascular disease to the hypertensive state based material from 40 patients dying with fulminating upon a study of renal biopsies from 100 hyperten- rheumatic fever. N Engl J Med 249:761–765, 1953. sive patients. JAMA 121:1256–1261, 1943. 25. Owen WR, Th omas WA, Castleman B, Bland 13. Castleman B, Bland EF. Organized emboli of the EF. Unrecognized emboli to the lungs with subse- tertiary pulmonary arteries. An unusual cause of quent cor pulmonale. N Engl J Med 249:919–926, cor pulmonale. Arch Pathol 43:581–589, 1946. 1953.

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26. Castleman B. Th e Clinico-pathological Confer- 37. Korn D, Bensch K, Liebow AA, Castleman B. ence. In Proceedings of the First World Conference on Multiple minute pulmonary tumors resembling Medical Education, London, 1953. Clegg H, ed. St. chemodectomas. Am J Pathol 37:641–672, 1960. Albans, U.K.: Gainsborough Press, 1953. 38. Wilkins EW, Edmunds L, Castleman B. Cases of 27. Waldron BR, Fennell RH Jr., Castleman B, Bland thymoma at the Massachusetts General Hospital. EF. Myocardial rupture and hemopericardium J Th or Cardiovasc Surg 52:322–330, 1966. associated with anticoagulant therapy. A postmor- 39. Liebow AA, Castleman B. Benign clear cell tem study. N Engl J Med 251:892–894, 1954. (“sugar”) tumors of the lung. Yale J Biol Med 28. Fennell RH Jr., Castleman B. Carcinoma in-situ. 43:213–222, 1971. N Engl J Med 252:985–990, 1032–1037, 1955. 40. Keller AR, Hochholzer L, Castleman B. Hyaline- 29. Castleman B. Tumors of the thymus gland. In vascular and plasma-cell types of giant lymph Atlas of Tumor Pathology. Washington, D.C.: node hyperplasia of the mediastinum and other Armed Forces Institute of Pathology, 1955. locations. Cancer 29:670–683, 1974. 30. Castleman B, Iverson L, Pardo-Menendez V. 41. Schantz A, Sewall W, Castleman B. Mediastinal Localized mediastinal lymph node hyperplasia germinoma. A study of 21 cases with an excellent resembling thymoma. Cancer 9:822–830, 1956. prognosis. Cancer 30:1189–1194, 1972. 31. Th urlbeck W, Castleman B. Atheromatous emboli 42. Dawkins RL, Tashjian H Jr., Castleman B, Moore to the kidneys after aortic surgery. N Engl J Med EW. Hyperparathyroidism due to clear cell hyper- 257:442–447, 1957. plasia. Am J Med 54:119–125, 1973. 32. Rosen SH, Castleman B, Liebow A. Pulmonary 43. Schantz A, Castleman B. Parathyroid carcinoma. alveolar proteinosis. N Engl J Med 258:1123–1142, A study of 70 cases. Cancer 3:600–605, 1973. 1958. 44. Keller AR, Castleman B. Hodgkin’s disease of the 33. Cope O, Keynes W, Roth SI, Castleman B. Pri- thymus gland. Cancer 33:1615–1623, 1974. mary chief-cell hyperplasia of the parathyroid 45. Cope O, Wang CA, Chu A, Wang CC, Schulz M, glands. A new entity in the surgery of hyperpara- Castleman B, Long J, Sohier WD. Limited surgi- thyroidism. Ann Surg 148:375–388, 1958. cal excision as the basis of a comprehensive therapy 34. Cohen RB, Chapman WB, Castleman B. Hyper- for cancer of the breast. Am J Surg 131:400–407, adrenocorticism (Cushing’s disease). A study of 1976. surgically resected adrenal glands. Am J Pathol 46. Castleman B, Schantz A, Roth SI. Parathyroid 35:537–561, 1959. hyperplasia in primary hyperparathyroidism. A 35. Cohen RB, Toll GD, Castleman B. Bronchial ade- review of 85 cases. Cancer 38:1668–1675, 1976. nomas in Cushing’s syndrome. Th eir relation to 47. Castleman B, Roth SI. Tumors of the parathyroid thymomas and oat cell carcinomas associated with gland. In Atlas of Tumor Pathology. Washington, hyperadrenocorticism. Cancer 13:812–817, 1960. D.C.: Armed Forces Institute of Pathology, 1978. 36. Kelley RR, Goodale F, Castleman B. Th e dynam- 48. Wilkins EW, Castleman B. Th ymoma. A continu- ics of rheumatic and calcifi c aortic valve disease. ing survey at the Massachusetts General Hospital. Circulation 22:365–375, 1960. Ann Th orac Surg 28:252–256, 1979.

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