Department of Medicine, Division of Cardiology, New York Medical College, Valhalla, NY 10595, USA.
Med Sci Monit. 2011 Jun;17(6):CS66-9. doi: 10.12659/msm.881797.
The mediastinum is an uncommon location for presentation of peripheral T cell lymphoma. Esophageal involvement by non-Hodgkin's lymphoma is extremely unusual. Although staging can be performed with routine imaging studies, surgical intervention is often required to ensure accurate histologic diagnosis of these lymphomas. Peripheral T cell lymphomas not otherwise specified are among the most aggressive non-Hodgkin lymphomas with often a poor response to conventional chemotherapy.
We report a case of a 63 year-old-man with an aggressive mediastinal T cell lymphoma presenting as esophageal obstruction and bronchoesophageal fistula. The patient was treated with a cyclophosphamide, vincristine, and prednisone (COP) regimen. Repeat computer tomography scan of the chest after chemotherapy noted a significant decrease in the cavitary lesion in the right paraesophageal region and right mediastinum. Bronchoscopy revealed a large opening in the posterior wall of the bronchus intermedius leading into the esophagus. A fistulogram was done which clearly demonstrated a fistulous tract between the lower esophagus and the right intermediate bronchus secondary to perforation from the lymphoma. The patient eventually underwent cervical esophagostomy and jejunostomy tube placement to correct the brochoesophageal fistula.
The mediastinum is an uncommon location for presentation of peripheral T cell lymphomas, and surgical intervention is often required to ensure accurate histological diagnosis of these lymphomas. In our patient, aggressive mediastinal T cell lymphoma presented as esophageal obstruction and bronchoesophageal fistula.
纵隔是外周 T 细胞淋巴瘤少见的发病部位。非霍奇金淋巴瘤累及食管极为罕见。尽管可以通过常规影像学研究进行分期，但为了确保这些淋巴瘤的准确组织学诊断，通常需要手术干预。未特指的外周 T 细胞淋巴瘤是最具侵袭性的非霍奇金淋巴瘤之一，对常规化疗的反应通常较差。
我们报告了一例 63 岁男性患有侵袭性纵隔 T 细胞淋巴瘤，表现为食管梗阻和支气管食管瘘。该患者接受了环磷酰胺、长春新碱和泼尼松（COP）方案治疗。化疗后胸部计算机断层扫描复查显示右侧食管旁区和右纵隔空洞病变明显减少。支气管镜检查显示中间支气管后壁有一个大开口，通向食管，提示存在瘘管。进行了瘘管造影，明确显示了由于淋巴瘤穿孔导致的下食管和右中间支气管之间的瘘管。患者最终接受了颈段食管造口术和空肠造口术，以纠正支气管食管瘘。
纵隔是外周 T 细胞淋巴瘤少见的发病部位，通常需要手术干预以确保这些淋巴瘤的准确组织学诊断。在我们的患者中，侵袭性纵隔 T 细胞淋巴瘤表现为食管梗阻和支气管食管瘘。
