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Lymphoma presented as dysphagia: a diagnosis hard to swallow
  1. Mafalda João1,2,
  2. Mário Bento-Miranda1,
  3. Elisa Gravito-Soares1,3,
  4. Marta Gravito-Soares1,3 and
  5. Pedro Figueiredo1,3
  1. 1Gastroenterology Department, Centro Hospitalar e Universitário Coimbra, Coimbra, Portugal
  2. 2Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
  3. 3University of Coimbra, Faculty of Medicine, Coimbra, Portugal
  1. Correspondence to Dr Mafalda João; mafaldacaine{at}gmail.com

Abstract

An 18-year-old woman presented with progressive oesophageal dysphagia, weight loss and night sweats over a 6-month period. Oesophagogastroduodenoscopy revealed a diffuse luminal narrowing with normal mucosa, whose biopsies were inconclusive. A cervical and thoracic CT scan showed a thickening of the upper oesophagus, densification of the mediastinal fat, several adenopathies and a 4.3×2.4 cm mass with infiltrative appearance and heterogeneous enhancement in right cervical paravertebral location. Positron emission tomography-CT showed marked increased fluorodeoxyglucose uptake in supradiaphragmatic lymph nodes, pleuropulmonary tissue, paraspinal musculature and bone marrow. Imaging-guided and surgical incisional biopsies of the paravertebral mass were inconclusive. During hospitalisation, she developed right cervicobrachial paraesthesia. Only excisional biopsy of the mass allowed the diagnosis of high-grade B-cell lymphoma not otherwise specified, Ann Arbor stage IV-B. The patient underwent chemotherapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone), followed by R-EPOCH (rituximab, etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin hydrochloride). Follow-up at 12 months revealed complete response.

  • endoscopy
  • malignant and benign haematology
  • oesophagus

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Footnotes

  • Contributors MJ wrote the manuscript and reviewed the literature. MJ is the article guarantor. MB-M, EG-S, MG-S and PF critically reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.