Esophageal tuberculosis presenting with an appearance similar to that of carcinoma of the esophagus

Abstract

A case of esophageal tuberculosis presenting with an appearance similar to that of esophageal cancer is reported. The patient was an 82-year-old man with progressive dysphagia. Barium swallow and esophagoscopy revealed an elevated lesion with deep ulceration in the middle thoracic esophagus. Esophageal carcinoma, in particular, an undermining type of undifferentiated carcinoma, was suspected fluoroscopically and endoscopically. Histological examination of biopsy specimens revealed no malignancy, but there were epithelioid granulomas and a few Langhans' type multinucleated giant cells. Endoscopic ultrasonography clearly demonstrated an extramural lesion with calcification and direct infiltration of enlarged subcarinal lymph nodes into the esophageal wall. Ultrasonographic and histological findings indicated the possibility of esophageal tuberculosis. Although no bacteriological evidence was obtained, a therapeutic trial for tuberculosis, using antituberculous drugs, was started. After 2 weeks, the enlarged subcarinal lymph nodes were markedly reduced in size. The patient's symptoms improved gradually and had disappeared 8 weeks after he started treatment, when tubercle bacilli were isolated from sputum. A connection between the esophageal wall and its adjacent structures was clearly demonstrated by endoscopic ultrasonography. For patients with findings indicative of esophageal tuberculosis on endoscopic ultrasonography, a therapeutic trial for tuberculosis should be considered, even if polymerase chain reaction assay or culture is negative.

Value of Endoscopic Ultrasonography for Diagnosis of Esophageal Tuberculosis: Report of Two Cases

“…To our knowledge, utility of EUS in diagnosis of ET has been reported in only one case previously. The EUS features of that case were very similar to those of our cases (7). In both of our cases, EUS evaluation showed multiple mediastinal LAPs which were round and oval shaped, hypoechoic, and heterogeneous with regular borders, and some of them had fine central calcification.…”

Esophageal tuberculosis: a microgranuloma visualized by narrow-band imaging magnifying endoscopy

“…The incidence of esophageal involvement is reported to be only 0.16 % of cases of TB in the gastrointestinal tract and peritoneum [2]. The common clinical symptoms of esophageal TB are reported to be dysphagia and odynophagia secondary to cancerlike ulcerations [6,7] that are associated with direct extension from adjacent lesions such as mediastinal lymphadenitis [3,4,5]. However, the present case revealed neither ulceration nor a fistula, but demonstrated only mucosal lesions in the esophagus.…”

Esophageal tuberculosis: role of endoscopic ultrasound in diagnosis

“…There is paucity of data about esophageal tuberculosis. The role of endoscopic ultrasound (EUS) to differentiate primary and secondary tuberculosis and its use in establishing the diagnosis is seen only in few case reports 4–7 . This study is done to evaluate the role of EUS in establishing the diagnosis of esophageal tuberculosis and to differentiate primary versus secondary tuberculosis.…”