A case of esophageal and endobronchial anthracosis

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

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.

Scary black nodes

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.