30 December 2024
: Case report 
B-Acute Lymphoblastic Leukemia/Lymphoblastic Lymphoma Mimicking Fibrosing Mediastinitis: A Case Report and Diagnostic Insight
Unknown etiology, Challenging differential diagnosis, Unusual or unexpected effect of treatment
Aya Kitamura ABCDEF 1, Shigehisa Yanagi ABCDEFG 1*, Kotaro Shide
ABCDEF 2, Yuichiro Sato ABCDE 3, Ayako Kamiunten BDE 2, Yasuhiro Yamanari BE 1, Akiko Kitamura E 1, Makoto Sumiyoshi E 1, Yasuharu Oda E 1, Hironobu Tsubouchi E 1, Kazuya Shimoda ADEF 2, Taiga Miyazaki ADEF 1
DOI: 10.12659/AJCR.945804
Am J Case Rep 2024; 25:e945804
Table 2. Differential diagnoses of the fibrosing mediastinitis-like lesion in the present patient’s case.
| Differential diagnosis | Findings that formed the basis for exclusion from diagnosis |
|---|---|
| IgG4-related disease | IgG4/IgG ratio in tissue not increased, IgG4 in serum not increased |
| Sarcoidosis | No granulomatous inflammation in the surgical biopsy specimen |
| Behcet’s disease | No aphthous ulcers of the oral mucosa, vulvar ulcers, skin symptoms, or eye symptoms |
| Systemic vasculitis | Antineutrophil cytoplasmic antibodies within the normal range |
| Systemic lupus erythematosus | Antinuclear antibody within the normal range |
| Histoplasmosis | No yeasts in the surgical biopsy specimen |
| Tuberculosis | No was found in the surgical biopsy specimen, Tb-IFNγ negative |
| Atypical mycobacterial infection | No acid-fast bacilli were found in the surgical biopsy specimen |
| Nocardiosis | No Nocardia species were found in the surgical biopsy specimen |
| Aspergillosis | No organisms in the surgical biopsy specimen, antigen negative |
| Cryptococcosis | No organisms in the surgical biopsy specimen, antigen negative |
| Mucormycosis | No Zygomycetes hyphae in the surgical biopsy specimen |
| Blastomycosis | No yeasts in the surgical biopsy specimen |
| Malignant lymphoma | No obvious TdT-positive cells in the surgical biopsy specimen |
| Desmoplastic malignant mesothelioma | No tumor cells in the surgical biopsy specimen |
| Metastatic carcinoma with fibrogenic Inflammatory response | No obvious neoplastic proliferations of cytokeratin AE1/AE3-positive cells in the surgical biopsy specimen |
| Solitary fibrous tumor | No obvious neoplastic proliferations of fibroblasts |
| Thymoma | No obvious neoplastic proliferations of cytokeratin AE1/AE3-positive cells in the surgical biopsy specimen |
| Thymic carcinoma | No obvious neoplastic proliferations of cytokeratin AE1/AE3-positive cells in the surgical biopsy specimen |
| Seminoma | No tumor cells in the surgical biopsy specimen, β-hCG within the normal range |
| Non-seminomatous germ cell tumors | No tumor cells in the surgical biopsy specimen, AFP within the normal range |
| SMARCA4-deficient thoracic tumor | No tumor cells in the surgical biopsy specimen |
| Primary lung cancer | No obvious neoplastic proliferations of cytokeratin AE1/AE3-positive cells in the surgical biopsy specimen |
| Radiation-induced | No history of radiation therapy before onset of the disease |
| Drug-induced | No history of taking medications before onset of the disease |
| Ectopic thyroid tissue | No thyroid tissue in the surgical biopsy specimen |
| AFP – alpha fetoprotein; IgG – immunoglobulin G; IgG4 – immunoglobulin G4; SMARCA4 – SWI/SNF-related, matrix-associated, actin-dependent regulator of chromatin, subfamily A, member 4; Tb-IFNγ – interferon gamma release assay; TdT – terminal deoxynucleotidyl transferasel β-hCG – beta-subunit of human chorionic gonadotropin. | |