Esophageal diverticula are uncommon lesions that are usually classified according to location, layers of the wall, and underlying pathogenesis. A true traction esophageal diverticulum, which is commonly seen in the middle one-third of the thoracic esophagus, occurs secondary to mediastinal inflammatory lesions, such as those caused by tuberculosis. Esophageal tuberculosis usually develops secondary to tuberculous lymphadenitis or lung lesion; it manifests with various endoscopic findings such as single or multiple ulcers, elevated lesions with ulcers at the center, extrinsic compressions, fistulas, and rarely, anthracosis. Its shape can vary greatly depending on disease progression and treatment. Herein, we report sequential endoscopic findings of a tuberculous esophageal ulcer that turned into a depressed lesion with black-pigmentation, finally developing into a typical traction esophageal diverticulum in a patient with mediastinal lymphadenitis.

/pdf/sequential-endoscopic-findings-of-a-tuberculous-esophageal-1w33e2zubo.pdf

Sequential Endoscopic Findings of a Tuberculous Esophageal Ulcer that Developed into a Traction Diverticulum

Anthracosis is associated with smoking, air pollution, tuberculosis infection, and exposure to biomass Anthracosis commonly involves bronchial trees and rarely lymph nodes We report an unusual case of a 44-year-old female presented with painless supraclavicular swelling for 1 month A fine-needle aspiration cytology examination was done from the swelling The smears were markedly cellular and showed the presence of sheets, clusters, and singly scattered round to oval cells with mild anisonucleosis, fine to coarse chromatin, few with tiny nucleoli, and cytoplasm containing abundant black coarse pigment At many places, the fibroblasts and lymphocytes were admixed with histiocytes containing pigment The cell block made showed cell morphology similar to that described above for fine-needle aspiration smears The immunohistochemistry on the cell block and special stains helped to ascertain the nature of pigment and cell type The final diagnosis of the anthracofibrosis lymph node was made Due to its rarity, its awareness is a must; otherwise, it can be mistaken for metastatic deposits from malignant melanoma and can result in unnecessary surgical intervention and morbidity However, it shall be considered one of the differential diagnoses of neck nodes in nonsmoker females with a history of domestic wood smoke exposure

Scary black nodes.

Abstract Background Anthracosis is a disease generally considered to be in the lungs resulting from exposure to industrial dust in the workplace. Esophageal anthracosis is a fairly rare phenomenon and shows a strong correlation with tuberculosis. Moreover, esophageal involvement in tuberculosis is also rare. We here present an extremely rare case in which follow-up gastroesophageal endoscopy revealed a mass with a sunken, black area in the center and raised ring-like pattern in the surrounding mucosa resembling malignant melanoma. Uncovering the patient’s tuberculosis history finally avoided a misdiagnosis or overtreatment. Case presentation A 67-year-old male patient was admitted to the hospital due to “repeated chest pain for 1 month”. Endoscopic ultrasonography and contrast-enhanced CT scans revealed a mass adjacent to the esophageal wall with unclear boundaries. Aspiration biopsy confirmed that esophageal tuberculosis was caused by nearby mediastinal tuberculous lymphadenitis. After a standard anti-tuberculosis treatment regimen, the patient achieved a favorable prognosis. The follow-up gastroesophageal endoscopy showed a sunken black lesion with elevated peripheral mucosa replacing the original tuberculous mass, which was thought to be anthracosis, a disease that rarely occurs in the esophagus. Conclusion The diagnosis of tuberculosis should be taken into consideration when a submucosal mass appears in the middle part of the esophagus. Endoscopic ultrasonography can effectively contribute to a definite diagnosis. Moreover, this is the first case of esophageal anthracosis observed only 1 year after the treatment of tuberculosis, indicating esophageal anthracosis can be a short-term disease. The traction of the reduction of tubercular mediastinal lymph nodes after anti-tuberculosis treatment may create a circumstance for pigmentation or dust deposition. 

/pdf/esophageal-anthracosis-occurred-after-treatment-of-1aetmmkp.pdf

Esophageal anthracosis occurred after treatment of esophageal tuberculosis secondary to mediastinal tuberculous lymphadenitis: a rare case report

Esophageal anthracosis with tuberculous lymphadenitis is a very rare disease. Almost all reported cases are diagnosed using multiple endoscopic biopsies or thoracic esophagectomy. The present case report describes a case of esophageal anthracosis with tuberculous lymphadenitis that was diagnosed using transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) alone. After taking antituberculosis drugs, the patient's chest pain was relieved and she recovered. The patient achieved an excellent outcome following the use of less invasive methods than mediastinoscopy. If no esophageal anthracotic lesions are found on the mucous membrane layer of the esophagus, transesophageal endoscopic ultrasound-guided fine-needle aspiration is a suitable approach for diagnosing esophageal anthracosis.

Esophageal anthracosis with tuberculous lymphadenitis confirmed on transesophageal endoscopic ultrasound-guided fine-needle aspiration.

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Esophageal anthracosis with tuberculous lymphadenitis confirmed on transesophageal endoscopic ultrasound-guided fine-needle aspiration.