CT and 18FDG-PET/CT findings in progressive mediastinal idiopathic fibrosis as a benign mimicker of esophageal carcinoma: a case report

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 esoph...

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Published in:Journal of international medical research 2023-12, Vol.51 (12), p.3000605231213212-3000605231213212
Main Authors: Mitrovic-Jovanovic, Milica, Skrobic, Ognjan, Odalovic, Strahinja, Djikic Rom, Aleksandra, Plavsic, Aleksandra, Jankovic, Aleksandra, Kostadinovic, Milena, Ivanovic, Nenad, Simic, Aleksandar, Djuric-Stefanovic, Aleksandra, Kovac, Jelena Djokic
Format: Article
Language:English
Subjects:
Case Reports
Esophageal cancer
Tomography
Online Access:Get full text
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Summary: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.
ISSN:0300-0605
1473-2300
DOI:10.1177/03000605231213212