Sidana Varun, Lnu Rohan, Davenport Anna, Lekharaju Venkata
Internal Medicine, Wythenshawe Hospital, Manchester, GBR.
Trauma and Orthopaedics, Wythenshawe Hospital, Manchester, GBR.
Cureus. 2024 Nov 15;16(11):e73751. doi: 10.7759/cureus.73751. eCollection 2024 Nov.
Primary oesophageal lymphoma is an exceptionally rare cancer originating in the esophagus, distinct from more common oesophageal malignancies. Dawson's criteria has been the mainstay for diagnosis for such entities. However, recognizing primary oesophageal lymphoma is particularly challenging due to its rarity, diverse clinical presentations, and non-specific radiological and endoscopic features. These factors often lead to diagnostic delays, complicating timely treatment and resulting in poor patient outcomes. We hereby present a challenging case and literature review about this rare malignancy. A 78-year-old male was referred to Gastroenterology for evaluation of dysphagia. Initial esophagogastroduodenoscopy (OGD) revealed an oesophageal ulcer with features consistent with oesophageal candidiasis. A follow-up OGD identified an oesophageal stricture. Histopathology and immunohistochemistry of biopsy samples confirmed a diagnosis of diffuse large B-cell lymphoma (DLBCL). A staging CT was completed, and an oesophageal mass was shown extending into the mediastinum. The patient re-presented with worsening dysphagia, renal dysfunction, and hypercalcemia. Although lymphoma was confirmed, to ensure an appropriate regimen is commenced, a repeat OGD was recommended by the Hematology team. The patient's rapid deterioration necessitated pre-phase steroid treatment and management of tumor lysis syndrome. Before R-CHOP chemotherapy could begin, the patient deteriorated further. Following a multidisciplinary team (MDT) meeting and discussions with the patient and family, it was decided to manage the symptoms with palliative intent. This case highlights the diagnostic challenges posed by primary oesophageal lymphoma, emphasizing the importance of considering this rare malignancy in the differential diagnosis of oesophageal strictures, particularly in elderly patients. Aggressive disease progression complicates managing DLBCL in older patients. Moreover, this patient population has other co-morbidities that would preclude treatment options at the outset. Further studies are needed to establish optimal diagnostic and therapeutic strategies for this rare condition.
原发性食管淋巴瘤是一种起源于食管的极其罕见的癌症，与更常见的食管恶性肿瘤不同。道森标准一直是此类疾病诊断的主要依据。然而，由于原发性食管淋巴瘤罕见、临床表现多样以及放射学和内镜特征不具特异性，识别它极具挑战性。这些因素常常导致诊断延误，使及时治疗复杂化，并导致患者预后不良。我们在此呈现一例关于这种罕见恶性肿瘤的具有挑战性的病例及文献综述。一名78岁男性因吞咽困难被转诊至胃肠病科进行评估。初次食管胃十二指肠镜检查（OGD）显示一处食管溃疡，其特征与食管念珠菌病相符。后续的OGD检查发现了食管狭窄。活检样本的组织病理学和免疫组织化学检查确诊为弥漫性大B细胞淋巴瘤（DLBCL）。完成了分期CT检查，结果显示食管肿物延伸至纵隔。患者再次出现吞咽困难加重、肾功能不全和高钙血症。尽管淋巴瘤已确诊，但为确保开始合适的治疗方案，血液科团队建议再次进行OGD检查。患者病情迅速恶化，需要进行预阶段类固醇治疗并处理肿瘤溶解综合征。在R-CHOP化疗开始前，患者病情进一步恶化。经过多学科团队（MDT）会诊并与患者及其家属讨论后，决定以姑息治疗为目的处理症状。该病例突出了原发性食管淋巴瘤带来的诊断挑战，强调了在食管狭窄的鉴别诊断中，尤其是老年患者中，考虑这种罕见恶性肿瘤的重要性。侵袭性疾病进展使老年患者DLBCL 的管理复杂化。此外，这一患者群体还有其他合并症，一开始就会排除一些治疗选择。需要进一步研究来确立针对这种罕见疾病的最佳诊断和治疗策略。
