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. 2009:2009:bcr09.2008.0894.
doi: 10.1136/bcr.09.2008.0894. Epub 2009 Jun 1.

Benign endoscopic biopsies may be a red herring

Laith Alrubaiy  1 , Waqar Ahmed, Jonathan Sutton
Affiliations

Benign endoscopic biopsies may be a red herring

Laith Alrubaiy et al. BMJ Case Rep. 2009.

Abstract

A 64-year-old man presented with haematemesis and melena. Repeated endoscopies showed extensive candidiasis with an exophytic mass like a shelf of tumour. Biopsies showed chronic inflammatory changes with candidiasis without evidence of malignancy. His only complaint was feeling tired and loss of energy. There was no dysphagia but slight retrostenal discomfort on swallowing. Computed tomography scan reported an opacification in the right upper lobe adjacent to the mediastinum. This contained air bronchograms and several irregular air filled cavities. There was significant mediastinal adenopathy. Two endoscopies were done after that and both of them demonstrated a fistulous connection with the bronchial tree. Biopsies failed to show any neoplasm. The patient underwent a three stage oesophagectomy with removal of the adjacent lung lobe and a reconstructive procedure. The resected mass was sent for histopathology which showed a well differentiated squamous cell carcinoma of the oesophagus which locally invaded the lung.

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Figures

Figure 1
Figure 1
Endoscopy showing oesophageal candidiasis.
Figure 2
Figure 2
Histopathological examination showing ulcerative candidiasis with no evidence of neoplasia.
Figure 3
Figure 3
Histopathological examination showing ulcerative candidiasis with no evidence of neoplasia.
Figure 4
Figure 4
Oesophagogastroscopy demonstrating an exophytic mass like a shelf of tumour growing alongside the oesophagus. This mass gave the oesophagus a double barrel appearance.
Figure 5
Figure 5
Histopathological examination of chronic active inflammatory candidiasis with no evidence of neoplasia.
Figure 6
Figure 6
Histopathological examination of chronic active inflammatory candidiasis with no evidence of neoplasia.
Figure 7
Figure 7
Chest computed tomography scan. The oesophagus was notably dilated with a thickened wall and contained food and fluid residue. There was an approximately 7×4 cm area of opacification in the right upper lobe adjacent to the mediastinum. This contained air bronchograms and several irregular air filled cavities. There was significant mediastinal adenopathy.
Figure 8
Figure 8
Endoscopy demonstrating a fistulous connection with the bronchial tree.
Figure 9
Figure 9
Endoscopy demonstrating a fistulous connection with the bronchial tree.
Figure 10
Figure 10
Biopsies showing chronic inflammatory changes and no evidence of neoplasia.
See this image and copyright information in PMC

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