CT and 18 FDG-PET/CT findings in progressive mediastinal idiopathic fibrosis as a benign mimicker of esophageal carcinoma: a case report.
Milica Mitrovic JovanovicOgnjan SkrobicStrahinja OdalovicAleksandra Djikic RomAleksandra PlavsicAleksandra JankovicMilena KostadinovicNenad IvanovicAleksandar SimicAleksandra Djuric-StefanovicJelena Djokic KovacPublished in: The Journal of international medical research (2023)
Idiopathic mediastinal fibrosis, also called sclerosing or fibrosing mediastinitis, is a very rare and aggressive fibroinflammatory process characterized by fibrous tissue proliferation in the mediastinal region. Herein, we present a rare case of idiopathic mediastinal fibrosis presenting with esophageal obstruction, most likely associated with immunoglobulin G (IgG4)-related disease, affecting the posterior mediastinum with intrapulmonary infiltration. Computed tomography revealed a narrowed lumen and thickened wall of the distal esophagus surrounded by a necrotic mass with infiltration into the nearby structures, suggesting a locally advanced malignant process. Positron emission tomography revealed intense accumulation of 18F-fluorodeoxyglucose, indicating an active inflammatory component, which complicates further differential diagnosis of mediastinal masses. Thoracoscopic biopsy and immunohistochemical analysis confirmed a fibroinflammatory process with perivascular lymphoid cell infiltration that was cluster of differentiation (CD)3 (++) and CD20 (++), with massive numbers of IgG4-immunoreactive plasma cells. Although a benign condition, sclerosing mediastinitis is a close mimicker of esophageal carcinoma, which cannot be differentiated by computed tomography or positron emission tomography and must be considered in a differential diagnosis.
Keyphrases
- positron emission tomography
- computed tomography
- ultrasound guided
- lymph node
- fine needle aspiration
- rare case
- single cell
- pet imaging
- contrast enhanced
- pet ct
- dual energy
- locally advanced
- magnetic resonance imaging
- image quality
- neoadjuvant chemotherapy
- squamous cell carcinoma
- multiple sclerosis
- induced apoptosis
- cell therapy
- rectal cancer
- rheumatoid arthritis
- mesenchymal stem cells
- liver fibrosis
- clinical trial
- nk cells
- endoplasmic reticulum stress
- robot assisted
- case report
- double blind
- contrast enhanced ultrasound