Inflammatory myofibroblastic tumor (IMT) of the lung is a rare entity considered to be a benign neoplastic lesion. It often mimics spindle cell sarcoma, fibrous histiocytoma, or fibrosarcoma in histologic appearance. Because of its variable cellular composition, it seldom allows diagnosis preoperatively either through transthoracic fine-needle aspiration or bronchoscopic biopsy. In this report we describe a unique occurrence of a rarely described large inflammatory myofibroblastic tumor of the lung that mimics a posterior mediastinal tumor in a 45-year-old female, detailing clinical presentation, imaging, and management.
Mediastinal lymphadenopathy is usually a sign of serious underlying disease. A patient who had nodular patchy opacity of the right hilum from a routine screening chest radiograph was referred for the whole-body PET/CT scan with FDG. The initial PET/CT scan demonstrated mediastinal lymphadenopathy and a 2-month follow-up PET/CT revealed the progression of lymphadenopathy with several newly developed FDG-avid nodes. Biopsy demonstrated chronic noncaseating granulomatous process, which was consistent with sarcoidosis. This report may suggest the possibility that rapid progression in size and FDG uptake of mediastinal nodes could be sarcoidosis and not malignancy.
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