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 3. Characteristics of 4 reported cases and present patient’s case of hematologic malignancies masquerading as fibrosing mediastinitis.
| Case | Age/Sex | Main symptoms | Duration between symptom onset and consultation | CRP (mg/dL) | LDH (U/L) | sIL-2R (U/mL) | LA at first presentation |
|---|---|---|---|---|---|---|---|
| 1 | 36F | Fatigue, myalgia, fever | 6 wks | n.a. | 256 | n.a. | None |
| 2 | 36M | Mass on anterior thoracic wall | 24 wks | n.a. | n.a. | n.a. | None |
| 3 | 43F | Cough | 4 wks | 7.6 | n.a. | 311 | None |
| 4 | 44M | Facial swelling, dyspnea, neck distention | 2 wks | 0.38 | n.a. | 575 | None |
| PC | 32M | Headache, facial swelling, dyspnea, orthopnea | 27 days10 days10 days5 days | 0.15 | 167 | 431 | None |
| ALCL – anaplastic large cell lymphoma; App. – appearance; B-ALL/LBL – B-acute lymphoblastic leukemia/lymphoblastic lymphoma; CLA – cervical lymphadenopathy; CRP – C-reactive protein; CT-GNB – computed tomography-guided needle biopsy; EBUS-TBNA – endobronchial ultrasound-guided transbronchial needle aspiration; HD – Hodgkin disease; HM – hematologic malignancy; LA – lymphadenopathy; LDH – lactate dehydrogenase; LNB – lymph node biopsy; mos. – months; n.a. – not available; PC – present case; PB – peripheral blood; PNB – percutaneous needle biopsy; PTCL-NOS – peripheral T-cell lymphoma not otherwise specified; Ref – reference; SB – surgical biopsy; sIL-2R – soluble interleukin-2 receptor; wks – weeks. | |||||||
| Case | Procedure of biopsy | Response to corticosteroids | Clues that a HM has been identified | Final diagnosis | Duration between onset and diagnosis | Response to chemo-therapy of FM lesions | Ref. |
| 1 | CT-GNB, SB, LNB | Not used | App. of new tumor | HD | n.a. | Reduction | 13 |
| 2 | SB, SR | Not used | None (SR) | HD | n.a. | n.a. | 14 |
| 3 | TBB, SB, LNB | Slightly, relapsed | CLA | ALCL | 6 mos. | Reduction | 15 |
| 4 | CT-GNB, SB, PNB, PNB | Slightly, relapsed | High sIL-2R level (1623) | PTCL-NOS | 12.5 mos. | Reduction | 16 |
| PC | EBUS- TBNA, CT-GNB, SB, LNB | Slightly, relapsed | Blasts in the PB | B-ALL/LBL | 18 mos. | Reduction | |
| ALCL – anaplastic large cell lymphoma; App. – appearance; B-ALL/LBL – B-acute lymphoblastic leukemia/lymphoblastic lymphoma; CLA – cervical lymphadenopathy; CRP – C-reactive protein; CT-GNB – computed tomography-guided needle biopsy; EBUS-TBNA – endobronchial ultrasound-guided transbronchial needle aspiration; HD – Hodgkin disease; HM – hematologic malignancy; LA – lymphadenopathy; LDH – lactate dehydrogenase; LNB – lymph node biopsy; mos. – months; n.a. – not available; PC – present case; PB – peripheral blood; PNB – percutaneous needle biopsy; PTCL-NOS – peripheral T-cell lymphoma not otherwise specified; Ref – reference; SB – surgical biopsy; sIL-2R – soluble interleukin-2 receptor; wks – weeks. | |||||||