Occult bronchogenic carcinoma masquerading as esophageal cancer. Case reports with recommendations for a change in reporting esophageal cytology.

We describe two patients with benign esophageal stricture in whom exfoliative esophageal cytologic features positive for squamous cell carcinoma is attributed to roentgenographically occult lung cancer. The discovery of alveolar macrophages within the esophageal washings of these patients prompted a retrospective analysis assessing the prevalence of esophageal washings contaminated by cellular material from the lower respiratory tract. Alveolar macrophages were observed in 11 of 28 patients (39%) and in 12 of 33 specimens (36%). Alveolar macrophages were noted in half of patients with benign esophageal disease, but in only one of eight cases with proved esophageal cancer. Criteria alerting physicians to the coexistence of benign esophageal stricture and occult respiratory neoplasm are given, and recommendations for a change in reporting esophageal cytologic features are proposed.