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Mitrovic-Jovanovic M, Skrobic O, Odalovic S, Djikic Rom A, Plavsic A, Jankovic A, Kostadinovic M, Ivanovic N, Simic A, Djuric-Stefanovic A, Kovac JD. CT and 18FDG-PET/CT findings in progressive mediastinal idiopathic fibrosis as a benign mimicker of esophageal carcinoma: a case report. J Int Med Res 2023; 51:3000605231213212. [PMID: 38041832 PMCID: PMC10693803 DOI: 10.1177/03000605231213212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/23/2023] [Indexed: 12/04/2023] Open
Abstract
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.
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Affiliation(s)
- Milica Mitrovic-Jovanovic
- Department of Digestive Radiology, Clinic for Digestive Surgery, University Clinical Centre of Serbia, No. 6 Dr. Koste Todorovica Street, Belgrade, Serbia
- Department of Radiology, Faculty of Medicine, University of Belgrade, No. 8 Dr. Subotica Street, Belgrade, Serbia
| | - Ognjan Skrobic
- Department of Esophageal and Gastric Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, No. 6 Koste Todorovica Street, Belgrade, Serbia
- Department of Surgery and Anesthesiology, Faculty of Medicine, University of Belgrade, No. 8 Dr. Subotica Street, Belgrade, Serbia
| | - Strahinja Odalovic
- Department of Radiology, Faculty of Medicine, University of Belgrade, No. 8 Dr. Subotica Street, Belgrade, Serbia
- Center for Nuclear Medicine, University Clinical Centre of Serbia, No. 26 Višegradska street, Belgrade, Serbia
| | - Aleksandra Djikic Rom
- Department of Pathology, Clinic for Digestive Surgery, University Clinical Centre of Serbia, No. 6 Dr. Koste Todorovica Street, Belgrade, Serbia
| | - Aleksandra Plavsic
- Clinic of Allergy and Immunology, University Clinical Centre of Serbia, No. 2 Dr. Koste Todorovica Street, Belgrade, Serbia
- Department of Internal medicine, Faculty of Medicine, University of Belgrade, No. 8 Dr. Subotica street, Belgrade, Serbia
| | - Aleksandra Jankovic
- Department of Digestive Radiology, Clinic for Digestive Surgery, University Clinical Centre of Serbia, No. 6 Dr. Koste Todorovica Street, Belgrade, Serbia
- Department of Radiology, Faculty of Medicine, University of Belgrade, No. 8 Dr. Subotica Street, Belgrade, Serbia
| | - Milena Kostadinovic
- Center for Physical Medicine and Rehabilitation, University Clinical Centre of Serbia, No. 2 Pasterova Street, Belgrade, Serbia
| | - Nenad Ivanovic
- Department of Esophageal and Gastric Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, No. 6 Koste Todorovica Street, Belgrade, Serbia
- Department of Surgery and Anesthesiology, Faculty of Medicine, University of Belgrade, No. 8 Dr. Subotica Street, Belgrade, Serbia
| | - Aleksandar Simic
- Department of Esophageal and Gastric Surgery, Clinic for Digestive Surgery, University Clinical Centre of Serbia, No. 6 Koste Todorovica Street, Belgrade, Serbia
- Department of Surgery and Anesthesiology, Faculty of Medicine, University of Belgrade, No. 8 Dr. Subotica Street, Belgrade, Serbia
| | - Aleksandra Djuric-Stefanovic
- Department of Digestive Radiology, Clinic for Digestive Surgery, University Clinical Centre of Serbia, No. 6 Dr. Koste Todorovica Street, Belgrade, Serbia
- Department of Radiology, Faculty of Medicine, University of Belgrade, No. 8 Dr. Subotica Street, Belgrade, Serbia
| | - Jelena Djokic Kovac
- Department of Digestive Radiology, Clinic for Digestive Surgery, University Clinical Centre of Serbia, No. 6 Dr. Koste Todorovica Street, Belgrade, Serbia
- Department of Radiology, Faculty of Medicine, University of Belgrade, No. 8 Dr. Subotica Street, Belgrade, Serbia
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Kobayashi Y, Ishiguro T, Takaku Y, Kagiyama N, Shimizu Y, Takayanagi N. Clinical Features of Fibrosing Mediastinitis in Japanese Patients: Two Case Reports and a Literature Review. Intern Med 2021; 60:3765-3772. [PMID: 34024847 PMCID: PMC8710366 DOI: 10.2169/internalmedicine.5737-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/01/2020] [Indexed: 12/02/2022] Open
Abstract
Fibrosing mediastinitis (FM) is a rare fibroinflammatory disease of the mediastinum with an etiology and clinical features that vary by world region. The characteristics of FM in Japan are still unknown. We herein report two Japanese patients with FM who were treated with corticosteroids and responded well. We also reviewed the Japanese literature on PubMed® and summarized the characteristics of 27 Japanese FM patients, including our two patients. In Japan, the predominant cases were those without a specific cause, were diffusely distributed, and responded well to corticosteroid therapy.
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Affiliation(s)
- Yoichi Kobayashi
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan
| | - Takashi Ishiguro
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan
| | - Yotaro Takaku
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan
| | - Naho Kagiyama
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan
| | - Yoshihiko Shimizu
- Department of Pathology, Saitama Cardiovascular and Respiratory Center, Japan
| | - Noboru Takayanagi
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan
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Panagopoulos N, Leivaditis V, Kraniotis P, Ravazoula P, Koletsis E, Dougenis D. Sclerosing Mediastinitis Causing Unilateral Pulmonary Edema Due to Left Atrial and Pulmonary Venous Compression. A Case Report and Literature Review. Braz J Cardiovasc Surg 2019; 34:85-92. [PMID: 30810679 PMCID: PMC6385839 DOI: 10.21470/1678-9741-2018-0067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 05/08/2018] [Indexed: 12/01/2022] Open
Abstract
Sclerosing mediastinitis (SM), previously named chronic fibrosing mediastinitis,
is an inflammatory process that in its end-stage results to sclerosis around the
mediastinal structures. SM is quite rare and has been correlated with
inflammatory and autoimmune diseases, as well as malignancy. SM may either
present in a mild form, with minor symptoms and a benign course or in a more
aggressive form with severe pulmonary hypertension and subsequent higher
morbidity and mortality. The diagnosis of SM may be difficult and quite
challenging, as symptoms depend on the mediastinal structure that is mainly
involved; quite often the superior vena cava. However, practically any
mediastinal structure may be involved by the fibrotic process, such as the
central airways, as well as the pulmonary arteries and veins, leading to
obstruction or total occlusion. The latter may be impossible to undergo proper
surgical excision of the lesion, and is considered to be a real challenge to the
surgeon. We herein report a case of SM that presented with arterial and venous
compression. The imaging appearance was that of unilateral pulmonary edema,
associated with lung collapse. The case is supplemented by a non-systematic
review of the relevant literature.
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Affiliation(s)
| | - Vasileios Leivaditis
- Department of Cardiothoracic Surgery, University Hospital of Patras, Patras, Greece.,Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, Kaiserslautern, Germany
| | | | | | - Efstratios Koletsis
- Department of Cardiothoracic Surgery, University Hospital of Patras, Patras, Greece
| | - Dimitrios Dougenis
- Department of Cardiothoracic Surgery, University Hospital of Patras, Patras, Greece
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Giorgadze T, Koizumi JH, Ronen S, Chaump M, Magro CM. Postradiation-associated sclerosing mediastinitis diagnosed in fine needle aspiration specimen: A cytological-pathological correlation. Ann Diagn Pathol 2017; 27:43-47. [PMID: 28325360 DOI: 10.1016/j.anndiagpath.2017.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 01/18/2017] [Indexed: 10/20/2022]
Abstract
Sclerosing mediastinitis (SM) is an aggressive fibroproliferative process in the mediastinum that may lead to encasement of mediastinal structures within a dense fibrotic mass. This disease may cause significant clinical complications, morbidity, and even mortality. The etiology and pathogenesis of SM is unclear and in more than one third of cases remains idiopathic. Among the known causes of SM, granulomatous infection is the commonest. Association of SM with radiation therapy has been rarely reported. Herein, we are reporting a case of postradiation sclerosing mediastinitis diagnosed in fine needle aspiration (FNA) specimen. To our knowledge, this is the first reported case of postradiation sclerosing mediastinitis with unusual striking intracytoplasmic glycogen accumulation. Having high index of suspicion and awareness of the fact that this entity may be also associated with radiation therapy, will be helpful in avoiding diagnostic pitfalls in FNA specimens and guiding proper clinical management.
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Affiliation(s)
- Tamar Giorgadze
- Weill Cornell Medical College, Department of Pathology and Laboratory Medicine, 1300 York Ave, New York, NY 10065, United States.
| | - June H Koizumi
- Weill Cornell Medical College, Department of Pathology and Laboratory Medicine, 1300 York Ave, New York, NY 10065, United States.
| | - Shira Ronen
- Medical College of Wisconsin, Department of Pathology, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226, United States.
| | - Michael Chaump
- Weill Cornell Medical College, Department of Pathology and Laboratory Medicine, 1300 York Ave, New York, NY 10065, United States.
| | - Cynthia M Magro
- Weill Cornell Medical College, Department of Pathology and Laboratory Medicine, 1300 York Ave, New York, NY 10065, United States.
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