Combined tracheal and esophageal stenting for palliation of tracheoesophageal symptoms from mediastinal lymphoma

Diffuse Large B-Cell Lymphoma With Tracheoesophageal Fistula Healed Using Chemotherapy: A Case Report and Review of the Literature

Malignant lymphomas are rarely associated with tracheoesophageal or bronchoesophageal fistulas (TEFs/BEFs). Lymphomas accompanied by TEFs/BEFs have a more favorable prognosis than solid tumors. Here, we present a unique case of a 74-year-old patient with diffuse large B-cell lymphoma (DLBCL). Contrast-enhanced computed tomography (CT) revealed TEF, aspiration pneumonia, and multiple lymphadenopathy. Histopathology helped confirm DLBCL, leading to a Lugano IIE staging. Complete DLBCL remission could be achieved by adjusting chemotherapy dosages for complications, which also resulted in spontaneous TEF resolution without requiring interventions such as stent insertion or surgical correction. No instances of lymphoma recurrence or tracheoesophageal fistula were observed 46 months post-chemotherapy. Among 33 documented cases, this is the first instance of DLBCL-associated TEF resolution through chemotherapy. Notably, in patients initially presenting with a fistula prior to treatment initiation, a favorable response to chemotherapy and/or radiotherapy coupled with controlled aspiration could potentially lead to the resolution of the fistula. Collectively, our case highlights the potential for conservative fistula management and the possibility of spontaneous resolution with chemotherapy. Our report provides valuable insights into lymphoma-associated fistulas and their management.

Recurrent oesophageal cancer complicated by tracheo-oesophageal fistula: improved palliation by means of parallel tracheal and oesophageal stenting

OBJECTIVES

Recurrent oesophageal carcinoma complicated by the development of a tracheo-oesophageal fistula is a crushing condition. In this situation, endoscopic double stenting may provide a quick and safe option for palliation.

METHODS

The outcomes of patients who received endoscopic parallel stent implantation for tracheo-oesophageal fistula due to recurrent oesophageal cancer at a German tertiary referral hospital between 2006 and 2013 were reviewed in a retrospective case study.

RESULTS

A total of 9 patients were identified (mean age 59.9 years). Tumour entity was squamous cell carcinoma, adenocarcinoma and neuroendocrine cancer of the oesophagus in 5, 3 and 1 case, respectively. The mean interval between primary treatment and recurrence was 19.2 months. Successful double-stent placement was always feasible. Complete closure of the communication between oesophagus and respiratory system was accomplished in all cases by stent implantation. There were no stent-associated complications. The mean survival following stent insertion was 64 days (6-121 days). After successful double stenting, 5 patients were fit enough to receive palliative chemo- or radiotherapy. Seven patients were finally discharged home after adequate oral intake had been achieved. Fatal aspiration pneumonia with respiratory failure occurred in 2 cases.

CONCLUSIONS

Endoscopic parallel stent implantation provides an easy and ubiquitous available technique for closure and palliation of tracheo-oesophageal fistula caused by recurrent oesophageal cancer. Immediate sealing of the fistula and relief of symptoms related to aspiration is achieved while hazardous operations are avoided. Therefore, we recommend endoscopic parallel stent insertion as the treatment of choice in case of tracheo-oesophageal fistula caused by recurrent oesophageal cancer.