title: 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.
authors.affiliation: Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi, Abeno, Osaka 545-8585, Japan.
authors.forename: Yushi
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Harushi
authors.initials: H
authors.lastname: Osugi
authors.forename: Nobuyasu
authors.initials: N
authors.lastname: Takada
authors.forename: Masashi
authors.initials: M
authors.lastname: Takemura
authors.forename: Shigeru
authors.initials: S
authors.lastname: Lee
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Ueno
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Fukuhara
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nishizawa
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kinoshita
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D019160:Endosonography; D004935:Esophageal Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D004938:Esophageal Neoplasms / Q000175:diagnosis*; D004947:Esophagus / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D014057:Tomography, X-Ray Computed; D014376:Tuberculosis / Q000175:diagnosis* / Q000000981:diagnostic imaging