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A Case of Mediastinal Tuberculous Lymphadenitis Mimicking a Submucosal Tumor of the Esophagus  

Kim, Se-Jin (Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine)
Jung, Seok-Won (Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine)
Hwang, Se-Jin (Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine)
Yi, Young-Arm (Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine)
Kim, Jong-Min (Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine)
Sung, Shi-Jung (Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine)
Jeong, In-Du (Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine)
Publication Information
The Korean Journal of Medicine / v.80, no.3, 2011 , pp. 328-332 More about this Journal
Abstract
Esophageal involvement in tuberculosis is rare, and the clinical presentation may mimic an esophageal submucosal tumor. A 30-year-old woman presented with dysphagia for 1 month. At esophagoscopy, a 3-cm subepithelial mass with normal covering mucosa was found 28~25 cm from the upper incisors. We diagnosed the lesion as a submucosal tumor of the esophagus and performed endoscopic ultrasonography 1 week after the first examination. The second endoscopy showed a large, linear ulceration on the same subepithelial mass. The histologic examination obtained following an endoscopic biopsy revealed chronic granulomatous inflammation, and a molecular nested PCR study for Mycobacterium tuberculosis was positive. The final diagnosis was mediastinal tuberculous lymphadenitis with invasion into the esophagus. We suggest the use of molecular biology techniques when there is a strong clinical suspicion of tuberculosis and difficulty in arriving at a definite diagnosis.
Keywords
Tuberculosis; Esophagus; Mediastinum; Submucosal tumor;
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1 류우진. 한국의 결핵 실태. 대한결핵 및 호흡기학회 1999;46:301-310.
2 Geldmacher H, Taube C, Kroeger C, Magnussen H, Kirsten DK. Assessment of lymph node tuberculosis in northern Germany: a clinical review. Chest 2002;121:1177-1182.   DOI   ScienceOn
3 Popli MB. Dysphagia: a rare presentation of tuberculous mediastinal lymphadenitis. Australas Radiol 1998;42:143-145.   DOI   ScienceOn
4 Rafay MA. Tuberculous lymphadenopathy of superior mediastinum causing vocal cord paralysis. Ann Thorac Surg 2000;70:2142-2143.   DOI   ScienceOn
5 Drake WM, Elkin SL, al-Kutoubi A, Mitchell DM, Shaw RJ. Pulmonary artery occlusion by tuberculous mediastinal lymphadenopathy. Thorax 1997;52:301-302.   DOI   ScienceOn
6 Ohtake M, Saito H, Okuno M, Yamamoto S, Ohgimi T. Esophagomediastinal fistula as a complication of tuberculous mediastinal lymphadenitis. Intern Med 1996;35:984-986.   DOI   ScienceOn
7 Hadlich E, Galperim B, Rizzon CF. Esophageal ulcers caused by reactivation of ganglionary tuberculosis: a case report. Braz J Infect Dis 2007;11:293-296.   DOI
8 Jain SK, Jain S, Jain M, Yaduvanshi A. Esophageal tuberculosis: is it so rare? Report of 12 cases and review of the literature. Am J Gastroenterol 2002;97:287-291.   DOI   ScienceOn
9 Alatas F, Ozdemir N, Isiksoy S, et al. An unusual case of esophageal tuberculosis in an adult. Respiration 1999;66:88-90.   DOI   ScienceOn
10 Fahmy AR, Guindi R, Farid A. Tuberculosis of the oesophagus. Thorax 1969;24:254-256.   DOI   ScienceOn
11 Gordon AH, Marshall JB. Esophageal tuberculosis: definitive diagnosis by endoscopy. Am J Gastroenterol 1990;85:174-177.
12 Savage PE, Grundy A. Oesophageal tuberculosis: an unusual cause of dysphagia. Br J Radiol 1984;57:1153-1155.   DOI   ScienceOn
13 Monig SP, Schmidt R, Wolters U, Krug B. Esophageal tuberculosis: a differential diagnostic challenge. Am J Gastroenterol 1995;90: 153-154.
14 Tassios P, Ladas S, Giannopoulos G, et al. Tuberculous esophagitis: report of a case and review of modern approaches to diagnosis and treatment. Hepatogastroenterology 1995;42:185-188.
15 Van Dam J. Endosonographic evaluation of the patient with esophageal carcinoma. Chest Surg Clin N Am 1994;4:269-284.
16 Im JG, Song KS, Kang HS, et al. Mediastinal tuberculous lymphadenitis: CT manifestations. Radiology 1987;164:115-119.
17 Gupta NM, Goenka MK, Vaiphei K, Bhardwaj A, Singh R. Isolated oesophageal tuberculosis: a rare cause of oesophageal stricture. Eur J Surg 1995;161:523-525.
18 Dow CJ. Oesophageal tuberculosis: four cases. Gut 1981;22:234-236.   DOI   ScienceOn
19 Ramo OJ, Salo JA, Isolauri J, Luostarinen M, Mattila SP. Tuberculous fistula of the esophagus. Ann Thorac Surg 1996; 62:1030-1032.   DOI   ScienceOn