A Case of Esophagolymphnodal Fistula due to Tuberculous Cervical Lymphadenitis

Abstract

A 79-year-old woman complaining of discomfort in swallowing was referred to our hospital, because an endoscopic examination had revealed a deep ulcerative lesion in the cervical esophagus. Biopsy specimens disclosed subepithelial epithelioid granulomas with non-specific granulation tissue without central necrosis and no histological evidence of malignancy. A barium study showed a deep ulcerative lesion, which appeared to be a Type 3 lesion, located from the cervical esophagus to the upper thoracic esophagus. CT scan revealed a cervical esophageal tumor adjacent to the right cervical paraesophageal lymph node with suspicious formation of an esophagolymphnodal fistula. The patient underwent cervicotomy under general anesthesia because malignancy of the lesion was not be able to be ruled out. Intraoperative biopsy from the bottom of the lesion was performed after opening the cervical esophagus. Intraoperative frozen sections demonstrated subepithelial granulomatous inflammation, which was suspected to be a tuberculosis epithelioid granuloma. Acid fast bacilli were seem in Ziehl-Neelsen staining, and this led to the find positive diagnosis of an esophagolymphnodal fistula due to tuberculous cervical lymphadenitis. In the differential diagnosis of tumors of the esophagus, tuberculous lesions must be included.