대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesCases by Disease Category

Case No : 1183 Date 2020-06-22

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  • Courtesy of Lee Han Na, Jung Im Kim / Kyung Hee University Hospital at Gangdong
  • Age/Sex 71 / M
  • Chief ComplaintIncidental found mass in EGD
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Esophageal lymphoma
Radiologic Findings
Chest CT scans (Figure 1-5) show elongated intraluminal protruding mass with homogeneous attenuation in the upper to lower esophagus. PET-CT scan (Figure 6) shows uptake of esophageal mass. Differential diagnosis include esophageal leiomyoma, esophageal cancer.

Endoscopic examination revealed esophageal protruding mass with smooth-surface. Endoscopic biopsy was done and histologic and immunohistochemical features diagnosed marginal zone B cell lymphoma.
Brief Review
Primary esophageal lymphoma is an extremely rare occurrence with fewer than 30 cases reported in the literature. The pathogenesis is not clear due to the rarity of this disease. Normal esophageal mucosa lacks structured lymphatic tissue, but due to persistent chronic inflammation, lymphatic follicles may appear and accumulate in the esophageal mucosa for MALT development. Moreover, autoimmune disorders such as Sjogren disease, Hashimoto disease, are also believed to cause MALT lymphoma as established in previous studies.

Chest CT findings of esophageal lymphoma are nonspecific, with features such as thickening of the wall, mimicking other common tumors such as esophageal carcinoma. CT, however, is valuable for the evaluation of the extraluminal component of an esophageal mass, its mediastinal extension, any fistula formation, and status of lymph nodes.

No standard treatment has been established for patients with localized primary esophageal lymphoma. Chemotherapy, radiotherapy, endoscopic and surgical resection have been used with similar prognoses.
References
1. World J Radiol. 2010 Aug 28;2(8):334-8. doi: 10.4329/wjr.v2.i8.334
2. Leuk Res Rep. 2016 Dec 20;7:2-5. doi: 10.1016/j.lrr.2016.12.001. eCollection 2017
3. Medicine (Baltimore). 2017 Mar;96(13):e6478. doi: 10.1097/MD.0000000000006478
Keywords
esophagus, lymphoma,

No. of Applicants : 76

▶ Correct Answer : 8/76,  10.5%
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - Other , Korea (South) MINSU KIM
  • - National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
  • - Osaka City General Hospital , Japan SHU MATSUSHITA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - , Korea (South) CHAEHUN LIM
▶ Correct Answer as Differential Diagnosis : 31/76,  40.8%
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - CH de la Cote Basque , France PAUL ARDILOUZE
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Jiangsu province hospital , China WANGJIAN ZHA
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Chungbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - McGill University Health Center , Canada Alexandre Semionov
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Gifu University Hospital , Japan KEITA FUJIMOTO
  • - , Korea (South) CHOI SOOYOUNG
  • - Chonbuk National University Hospital , Korea (South) SOL KI KIM
  • - SRI SATHYA SAI INSTITUTE OF HIGHER MEDICAL SCIENCES, WHITEFIELD , India SHAIK ISMAIL
  • - Sikkim Manipal Institute of Medical Sciences, Gangtok , India HARIPRASAD SUDARSAN
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Hamamatsu University Hospital , Japan HAYATO NOZAWA
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Gifu University Hospital , Japan Yo Kaneko
  • - , Japan YUMI MAEHARA
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Private sector , Greece VASILIOS TZILAS
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - The University of Tokyo Hospital , Japan MOTO NAKAYA
  • - TWMU Medical Center East , Japan MASAFUMI KAIUME
  • - The University of Kyoto Hospital , Japan TOMOAKI OTANI
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