PMC9365934_01
Case progress timeline, EEG, and PET-CT. (A) Case progress timeline and vital treatment records. (B) EEG demonstrated epileptiform discharge. (C) PET-CT suggested that the metabolism of para mid-esophageal was increased. The lesion was about 1.7 cm*0.6 cm, the maximum value of SUV was 4.4, and the lesion was poorly demarcated from the adjacent esophageal wall. EEG, electroencephalogram; PET-CT, positron emission tomography-computed tomography; SUV, standard uptake value.
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There were no abnormalities in the cranial nerves, muscle tone, muscle power, deep tendon reflex, or coordination (timeline in Figure 1A). Electroencephalogram (EEG) demonstrated epileptiform discharge (Figure 1B). Positron emission tomography-computed tomography (PET-CT) scan revealed hypermetabolic foci in the para mid-esophagus, which was poorly demarcated from the adjacent esophageal wall and measured 1.7 cm*0.6 cm (Figure 1C).
Images from the MRI after the second admission. (A, B) T1-weighted sequences showed slight hypointensity in the hippocampus (yellow arrow). (C, D) T2-weighted sequences showed hyperintensity in the hippocampus (yellow arrow). (E, F) FLAIR showed hyperintensity in the hippocampus (yellow arrow). magnetic resonance imaging; FLAIR, fluid-attenuated inversion recovery.
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T2-weighted sequences and a slightly high signal shadow in fluid-attenuated inversion recovery (FLAIR) (Figure 2). The chest CT scan showed paraesophageal space-occupying lesion, considering the possibility of malignant lesions in the patient's mediastinum (Figure 3).
Paraesophageal space-occupying lesion visible on chest CT. nodular thickening of the horizontal tube wall of the esophagus from the tracheal carina was 2.7 cm*2.0 cm*4.0 cm (yellow square). (A) CT plain scan. (B) Arterial phase. (C) Venous phase. CT, computed tomography.
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T2-weighted sequences and a slightly high signal shadow in fluid-attenuated inversion recovery (FLAIR) (Figure 2). The chest CT scan showed paraesophageal space-occupying lesion, considering the possibility of malignant lesions in the patient's mediastinum (Figure 3).
Pathological examination and immunohistochemistry. (A) Biopsy of paraesophageal lesion (hematoxylin-eosin staining, magnification x40). (B) Biopsy of paraesophageal lesion (hematoxylin-eosin staining, magnification x100). (C) The immunohistochemistry demonstrated positive results for synaptophysin. (D) The immunohistochemistry demonstrated positive results for CD56.
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CK, synaptophysin, villin, CgA, E-cad, and CD56. CK7 and CEA scattered positively and showed a 70% ki67 nuclei-positive staining (Figure 4).