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Cheng W, Zhou X, Lu M, Jin X, Ji F. Esophageal anthracosis occurred after treatment of esophageal tuberculosis secondary to mediastinal tuberculous lymphadenitis: a rare case report. BMC Infect Dis 2023; 23:172. [PMID: 36944925 PMCID: PMC10031953 DOI: 10.1186/s12879-023-08095-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/16/2023] [Indexed: 03/23/2023] Open
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.
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Affiliation(s)
- Weixin Cheng
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, China
| | - Xinxin Zhou
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, China
| | - Miaomiao Lu
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, China
| | - Xi Jin
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, China.
| | - Feng Ji
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, China.
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Lee DH, Kim JH, Cho SH, Yoon TM, Lee JK, Lim SC. Anthracofibrotic Lymph Node of Neck Mimicking Metastatic Malignant Melanoma in a Patient With Gastric Cancer. Int J Surg Pathol 2019; 27:778-780. [DOI: 10.1177/1066896919845060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Extrathoracic anthracofibrosis in head and neck region is of extremely rare occurrence and can be confused with malignancy. In this article, we report an unusual case of an anthracofibrotic lymph node of neck that was mistaken for metastatic malignant melanoma in a gastric cancer patient. Because the incidence of an anthracofibrotic lymph node of the neck is very low, it is important to distinguish it from other diseases, including malignancy or metastasis, especially in patients with a cancer history. Thus, pathological diagnosis of anthracofibrosis is necessary to make an accurate diagnosis and find appropriate treatment.
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Affiliation(s)
- Dong Hoon Lee
- Chonnam National University, Gwangju, South Korea
- Hwasun Hospital, Hwasun, South Korea
| | - Jo Heon Kim
- Chonnam National University, Gwangju, South Korea
- Hwasun Hospital, Hwasun, South Korea
| | - Sang Hee Cho
- Chonnam National University, Gwangju, South Korea
- Hwasun Hospital, Hwasun, South Korea
| | - Tae Mi Yoon
- Chonnam National University, Gwangju, South Korea
- Hwasun Hospital, Hwasun, South Korea
| | - Joon Kyoo Lee
- Chonnam National University, Gwangju, South Korea
- Hwasun Hospital, Hwasun, South Korea
| | - Sang Chul Lim
- Chonnam National University, Gwangju, South Korea
- Hwasun Hospital, Hwasun, South Korea
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Devarajan SR, Zarrin-Khameh N, Alapat P. Black lungs and big nodes: A case of airway anthracosis with bronchial anthracofibrosis. Respir Med Case Rep 2018; 25:9-11. [PMID: 29892540 PMCID: PMC5991906 DOI: 10.1016/j.rmcr.2018.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/17/2018] [Accepted: 05/18/2018] [Indexed: 12/25/2022] Open
Abstract
We present a case of a 76 year-old, non-smoking Honduran female who was referred to our clinic for years of persistent dry cough. Cardiac evaluation was unremarkable. She denied symptoms of heartburn, allergic rhinitis, and there was no personal or family history of asthma. Her physical exam demonstrated wheezing over the right mid-posterior chest. Spirometry was within normal limits. CT-imaging of the chest demonstrated right middle lobe bronchus and lingular segmental bronchus narrowing with bibasilar atelectasis and mild interlobular septal thickening with prominent mediastinal adenopathy. Bronchoscopy showed diffuse airway hyperpigmentation, right middle lobe medial segmental bronchial stenosis and lingular segmental bronchial stenosis. Endobronchial ultrasound demonstrated enlarged mediastinal lymph nodes, and transbronchial needle aspirates revealed necrotic tissue with black anthracotic pigment. Cultures were negative. Post-procedurally, the patient revealed regular use of a wood stove in an enclosed, poorly-ventilated kitchen. Anthracosis is the black discoloration of bronchial mucosa due to deposition of carbon-based particles in the airway, usually related to chronic environmental exposures. It can eventually result in endobronchial and parenchymal fibrosis and is mostly seen in non-smokers. Burning biomass fuel from wood smoke is a risk factor in the developing world. Symptoms include cough, dyspnea, and wheezing. Spirometry will usually demonstrate obstruction. CT-based imaging can show intraluminal narrowing, predominantly affecting the right middle and right upper lobe bronchi, resulting in distal segmental collapse. Extrapulmonary findings are rare, but usually are in the form of calcified mediastinal adenopathy on CT-based imaging, which allows for differentiation from lung cancer. There is no reliable treatment though bronchodilators can achieve clinical benefit.
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Affiliation(s)
- S R Devarajan
- Department of Pulmonary/Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | - N Zarrin-Khameh
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA
| | - P Alapat
- Department of Pulmonary/Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
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Lee YP, Chun EM, Kim YK, Kim KC. Benign superior vena cava syndrome with uncontrolled pleural effusion by calcified mediastinal lymphadenopathy: surgical management. J Thorac Dis 2017; 9:E660-E663. [PMID: 28932580 DOI: 10.21037/jtd.2017.06.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This report describes a rare case of benign superior vena cava syndrome (SVCS) accompanying recalcitrant pleural effusion developed secondary to extrinsic compression by anthracotic calcified mediastinal lymphadenopathy which was corrected by surgical bypass graft. An 81-year-old female presented with recalcitrant pleural effusion for several months despite of medical treatments. SVCS developed progressively without any other radiological evidence of malignancy or active infection on initial chest computed tomography (CT). A follow-up chest CT scan taken one month later revealed a poorly-defined mass-like lesion encasing the SVC. Near total collapse of the SVC due to circumferential compression by massive anthracotic calcified lymph nodes was noted in the surgical fields. A bypass graft was performed using an artificial vessel instead of endovascular treatment because of severe adhesion. The abrupt SVCS and uncontrolled pleural effusions completely disappeared after surgical correction.
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Affiliation(s)
- Yoon Pyo Lee
- Department of Internal Medicine, Division of Pulmonology and Critical Care Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Eun Mi Chun
- Department of Internal Medicine, Division of Pulmonology and Critical Care Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Yoo Kyung Kim
- Department of Radiology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kwan Chang Kim
- Department of Thoracic & Cardiovascular Surgery, Ewha Womans University College of Medicine, Seoul, Korea
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Aaronson NL, Toman JC, Lerner MZ, Baum ED. Fetal rhabdomyoma of the tongue in a newborn. EAR, NOSE & THROAT JOURNAL 2016. [PMID: 26214666 DOI: 10.1177/014556131509400708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Anthracotic pigmentation in the bronchial mucosa is a bronchoscopic finding of pneumoconiosis, or evidence of heavy atmospheric soot. This pigmentation in the tracheobronchial mucosa is surrounded by calcified or noncalcified lymph nodes. Anthracosis is not a previously known cause of left vocal fold paralysis. We present what we believe to be the first reported case of anthracosis-caused vocal fold paralysis.
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Affiliation(s)
- Nicole L Aaronson
- Section of Otolaryngology, Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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Kirchner J, Broll M, Müller P, Pomjanski N, Biesterfeld S, Liermann D, Kickuth R. CT differentiation of enlarged mediastinal lymph node due to anthracosis from metastatic lymphadenopathy: a comparative study proven by endobronchial US-guided transbronchial needle aspiration. Diagn Interv Radiol 2016; 21:128-33. [PMID: 25616268 DOI: 10.5152/dir.2014.14112] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Anthracosis often results in mediastinal nodal enlargement. The aim of this comparative study was to evaluate if it is possible to differentiate endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) proven anthracotic lymph nodes from malignant lymph node enlargement by means of multislice computed tomography (MSCT). METHODS We compared the MSCT findings of 89 enlarged lymph nodes due to anthracosis with 54 malignant lymph nodes (non-small cell lung cancer 75.9%, small cell lung cancer 18.5%, and non-Hodgkin lymphoma 5.6%). The lymph nodes were assessed for density (calcification, fat, and necrosis), shape (oval, round), contrast enhancement, and contour (sharp, ill-defined). RESULTS Malignant lymph nodes showed significantly greater axis diameters (P < 0.001). Both anthracotic and malignant nodes were most often oval (86.5% of all malignant nodes vs. 81.5% of all anthracotic nodes, P = 0.420) and showed confluence in a remarkable percentage (28.1% vs. 42.6%, P = 0.075). Anthracotic nodes showed calcifications more often (18% vs. 0%, P < 0.001). Malignant lymph nodes showed a significantly greater short and long axis diameter (P < 0.001), and they had a higher frequency of ill-defined contours (27.8% vs. 2.2%, P < 0.001) and contrast enhancement (27.8% vs. 5.6%, P < 0.001). Nodal necrosis, which appeared in one third of the malignant nodes, was not observed in anthracosis (35.2% vs. 0%, P < 0.001). Confluence of enlarged lymph nodes was seen in malignant lymph nodes (42.6%), as well as in lymph node enlargement due to anthracosis (28.1%, P = 0.075). CONCLUSION Our results show that there are significant differences in MSCT findings of malignant enlarged lymph nodes and benign lymph node enlargement due to anthracosis.
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Affiliation(s)
- Johannes Kirchner
- Department of Diagnostic and Interventional Radiology, Allgemeines Krankenhaus Hagen, Germany.
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Nishiyama N, Mori H, Kobara H, Rafiq K, Fujihara S, Katou K, Aritomo Y, Ono M, Kamada H, Oryu M, Kanaji N, Masaki T. Esophageal anthracosis with tuberculous lymphadenitis confirmed on transesophageal endoscopic ultrasound-guided fine-needle aspiration. Intern Med 2014; 53:577-80. [PMID: 24633027 DOI: 10.2169/internalmedicine.53.1562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
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.
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Affiliation(s)
- Noriko Nishiyama
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Japan
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Kim MA, Lee JC, Choi CM. Bronchial anthracofibrosis and macroscopic tissue pigmentation on EBUS-TBNA predict a low probability of metastatic lymphadenopathy in Korean lung cancer patients. J Korean Med Sci 2013; 28:383-7. [PMID: 23486741 PMCID: PMC3594601 DOI: 10.3346/jkms.2013.28.3.383] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Accepted: 01/04/2013] [Indexed: 02/02/2023] Open
Abstract
The identification of mediastinal lymph nodes (LNs) in lung cancer is an important step of treatment decision and prognosis prediction. The endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is widely used to assess the mediastinal LNs and tissue confirmation in lung cancer. As use of bronchoscopy or EBUS-TBNA has been increased, bronchial anthracofibrosis (BAF) has been detected frequently. Moreover, BAF is often accompanied by mediastinal lymphadenopathy and showed false-positive positron emission tomography uptake, which mimics metastatic lymphadenopathy in lung cancer patients. However, clinical implication of BAF during bronchoscopy is not well understood in lung cancer. We retrospectively reviewed 536 lung cancer patients who performed EBUS-TBNA and observed BAF in 55 patients. A total of 790 LNs were analyzed and macroscopic tissue pigmentation was observed in 228 patients. The adjusted odds ratio for predicting malignant LN was 0.46 for BAF, and 0.22 for macroscopic tissue pigmentation. The specificity of BAF and macroscopic tissue pigmentation for predicting a malignant LN was 75.7% and 42.2%, respectively, which was higher than the specificity of using LN size or standard uptake value on PET. In conclusion, BAF and macroscopic tissue pigmentation during EBUS-TBNA are less commonly found in malignant LNs than reactive LNs in Korean lung cancer patients.
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Affiliation(s)
- Mi-Ae Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Cheol Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Min Choi
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Primary nodal anthracosis identified by EBUS-TBNA as a cause of FDG PET/CT positive mediastinal lymphadenopathy. Respir Med Case Rep 2013; 10:48-52. [PMID: 26029513 PMCID: PMC3920429 DOI: 10.1016/j.rmcr.2013.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 08/25/2013] [Accepted: 09/18/2013] [Indexed: 02/01/2023] Open
Abstract
Isolated mediastinal lymphadenopathy can result from a number of potentially serious aetiologies. Traditionally those presenting with mediastinal lymphadenopathy would undergo mediastinoscopy to elucidate a final diagnosis or receive empirical treatment. There is now increased utilization of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), in this setting. Five cases of mediastinal lymphadenopathy are presented here in which lymph node anthracosis was identified as the primary diagnosis using EBUS-TBNA. They were female, non-smokers presenting with non-specific symptoms, who retrospectively reported cooking over wood fires. Four were from South Asia. Three were investigated by F-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) scanning and increased signal was identified in the anthracotic nodes sampled. With expansion of PET/CT and EBUS-TBNA services it is likely that primary nodal anthracosis will be encountered more frequently and should be considered in the differential diagnosis of those with PET/CT positive lymphadenopathy. It may mimic pathologies including tuberculosis and malignancy, thus accurate sampling and follow-up are essential.
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Onitilo AA, Engel JM, Tanimu SB, Nguyen TCT. Anthracosis and large mediastinal mass in a patient with healed pulmonary tuberculosis. Clin Med Res 2010; 8:99-103. [PMID: 20660934 PMCID: PMC2910103 DOI: 10.3121/cmr.2010.876] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A Mexican woman, aged 71 years, with life-long exposure to soot from a wood cook stove in a closed environment, who was treated for tuberculosis 4-years prior, presented with prominent mediastinal lymphadenopathy with anthracosis. Mediastinal lymphadenopathy is a common presentation of diverse granulomatous, malignant and infectious conditions like tuberculosis. Anthracotic pigment is found in different conditions such as tuberculosis or domestically acquired particulate lung disease. Accurate assessment of chronology and causative factors presents a challenge. Recognizing that pneumoconiosis can mimic or coexist with other granulomatous, infectious and malignant conditions presenting as mediastinal lymphadenopathy is important. Misdiagnosis may result in under- or over-treatment of potentially curable conditions such as tuberculosis, under-treatment of a lethal condition such as melanoma, or exposure of patients to inappropriate administration of costly therapy with potential untoward effects.
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Affiliation(s)
- Adedayo A Onitilo
- Department of Hematology/Oncology, Marshfield Clinic Weston Center, Weston, Wisconsin 54476, USA.
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Boonsarngsuk V, Suwatanapongched T, Rochanawutanon M. Bronchial anthracostenosis with mediastinal fibrosis associated with long-term wood-smoke exposure. Respirology 2009; 14:1060-3. [PMID: 19740268 DOI: 10.1111/j.1440-1843.2009.01604.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Bronchial anthracostenosis describes a disease entity consisting of bronchial destruction, deformity and stenosis related to dark pigmentation on bronchoscopy in patients with a history of coal workers' pneumoconiosis or chronic exposure to biomass smoke. The combined occurrence of bronchial anthracostenosis and mediastinal fibrosis in association with wood-smoke exposure has not been previously reported. This case report describes a non-cigarette smoking elderly woman who developed bronchial anthracostenosis and mediastinal fibrosis after long-term exposure to wood smoke. Clinical and radiological improvements were achieved after treatment with corticosteroid and tamoxifen. Awareness of this unusual entity will help to avoid misdiagnosis of malignancy or unnecessary thoracotomy.
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Affiliation(s)
- Viboon Boonsarngsuk
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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