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IMAGE IN EUS
Year : 2016  |  Volume : 5  |  Issue : 1  |  Page : 61-62

Primary esophageal tuberculosis mimicking esophageal cancer with vascular involvement


1 Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
2 Department of Cytology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India

Date of Submission28-Jul-2014
Date of Acceptance06-Aug-2014
Date of Web Publication8-Feb-2016

Correspondence Address:
Surinder Singh Rana
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2303-9027.175924

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How to cite this article:
Sharma V, Rana SS, Chhabra P, Sharma R, Gupta N, Bhasin DK. Primary esophageal tuberculosis mimicking esophageal cancer with vascular involvement. Endosc Ultrasound 2016;5:61-2

How to cite this URL:
Sharma V, Rana SS, Chhabra P, Sharma R, Gupta N, Bhasin DK. Primary esophageal tuberculosis mimicking esophageal cancer with vascular involvement. Endosc Ultrasound [serial online] 2016 [cited 2022 Sep 29];5:61-2. Available from: http://www.eusjournal.com/text.asp?2016/5/1/61/175924

A 30-year-old female presented with progressively increasing dysphagia associated with loss of appetite and weight. Upper gastrointestinal endoscopy revealed a polypoidal and ulcerated lesion in the mid esophagus with endoscopic biopsies being inconclusive [Figure 1]. An endoscopic ultrasound (EUS) revealed asymmetrical thickening of the esophageal wall with loss of the wall stratification [Figure 2] as well as loss of fat planes with right pulmonary artery [Figure 3]. No mediastinal lymphadenopathy was noted. EUS guided fine-needle aspiration (FNA) [Figure 4] yielded caseous material and cytology revealed epithelioid cell granuloma with a giant cell and caseation necrosis [Figure 5] with presence of acid-fast bacilli [Figure 6]. The patient was initiated on weight based four drug anti-tubercular therapy (rifampin, isoniazid, pyrazinamide, and ethambutol). At 1 month of follow-up the patient had gained 5 kg of weight with complete resolution of dysphagia.
Figure 1: Polypoidal and ulcerated lesion in mid esophagus

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Figure 2: Endoscopic ultrasound: Asymmetrical thickening of the mid esophagus

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Figure 3: Loss of fate planes with right pulmonary artery

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Figure 4: Endoscopic ultrasound fine-needle aspiration of the lesion

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Figure 5: Epithelioid cell granuloma with a giant cell and caseation necrosis (Pap, ×40)

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Figure 6: Ziehl– Neelsen stain showing acid-fast bacillus (×100)

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Esophageal tuberculosis is usually secondary to mediastinal lymphadenopathy causing extrinsic narrowing or secondarily due to infiltration of the esophageal wall. [1],[2] Primary esophageal tuberculosis, as in our case, is uncommon. Except a few, most such reports are from the pre-EUS era where the mediastinal lymphadenopathy may have been missed. [3] It is unusual for esophageal tuberculosis to result in vascular involvement although this has been described in relation to the pancreatic tuberculosis. [4] EUS-FNA has emerged as an important tool to diagnose the esophageal tuberculosis. [1],[2]

 
  References Top

1.
Rana SS, Bhasin DK, Rao C, et al. Tuberculosis presenting as dysphagia: Clinical, endoscopic, radiological and endosonographic features. Endosc Ultrasound 2013;2:92-5.  Back to cited text no. 1
    
2.
Rana SS, Bhasin DK, Sharma V, et al. Dysphagia as the first manifestation of tuberculosis. Endoscopy 2011;43 Suppl 2 UCTN:E300-1.  Back to cited text no. 2
    
3.
Huang YK, Wu YC, Liu YH, et al. Esophageal tuberculosis mimicking submucosal tumor. Interact Cardiovasc Thorac Surg 2004;3:274-6.  Back to cited text no. 3
    
4.
Rana SS, Sharma V, Sampath S, et al. Vascular invasion does not discriminate between pancreatic tuberculosis and pancreatic malignancy: A case series. Ann Gastroenterol 2014;27:395-8.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]


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