2022 Volume 64 Issue 8 Pages 1462-1468
A 79-year-old man was referred to our hospital for evaluation of a depressed lesion detected on esophageal radiography. EGD revealed a deep depressed well-marginated lesion containing multiple coarse granules on the left wall of the upper thoracic esophagus. Additionally, narrow-band imaging revealed a distended intra-papillary capillary loop within the depression. However, findings were not suggestive of an epithelial tumor, and the lesion remained undiagnosed based on the initial biopsy findings. Subsequent contrast-enhanced CT performed for systemic evaluation revealed enlarged mediastinal and celiac lymph nodes and multiple hepatic lesions, suggestive of multiple lymph node and liver metastases of a malignant tumor. However, EUS performed to evaluate the esophageal lesion revealed a hypoechoic mass that appeared to be a lymph node continuous with the esophageal depression, which indicated secondary esophageal tuberculosis with concomitant mediastinal lymphadenitis. Furthermore, EUS-FNA biopsy of the enlarged lymph nodes revealed a granuloma with caseous necrosis. Subsequent endoscopic re-examination and liver tumor biopsies revealed granulomas and Langhans giant cells. Therefore, the patient was clinically diagnosed with secondary esophageal tuberculosis associated with tuberculous lymphadenitis and hepatic tuberculosis and received antituberculosis therapy. Endoscopy performed 6 months later showed flattening of the depressed lesion and disappearance of the coarse granules, and CT revealed reduction in the size of the lymph nodes with disappearance of the liver lesions.
