Mediastinal Tuberculous Lymphadenitis after Esophagectomy for Esophageal Cancer

Satoru Matono, Toshiaki Tanaka, Yuichi Tanaka, Susumu Sueyoshi*, Tatsuji Tsubuku, Kohei Nishimura, Kazutaka Murata, Hiroko Sasahara*, Kazuo Shirouzu and Hiromasa Fujita

Department of Surgery, Kurume University School of Medicine
Department of Surgery, Omuta City General Hospital*

A 45-year-old woman undergoing distal esophagectomy through a left thoracoabdominal incision for abdominal esophageal cancer with a postoperative diagnosis of pT3N0M0 Stage II was found in computed tomography (CT) one year after surgery to have mediastinal lymph node swelling anterior to the trachea. For a definitive diagnosis, we conducted mediastinal lymphadenectomy with video-associated thoracic surgery. Histologically, we found epithelioid cell granuloma with strong central caseous necrosis and Langhans' giant cells, indicating lymph node tuberculosis. We could not confirm the tubercle bacillus, so she was diagnosed with tuberculosis lymphadenitis because the tuberculin reaction was very strong and pathology findings were typical of tuberculosis. She was administered antituberculous drugs for six months and her later course was good. Three years since esophageal cancer surgery and the two years since the diagnosis of the tuberculosis. No recurrence has been seen to date in the upper mediastinum lymph node lesions following trachea lymph node recurrence are rare in abdominal esophageal cancer. We should therefore consider diseases other than cancer, particularly tuberculosis lymphadenitis, if findings suggest upper mediastinum lymph node swelling anterior to tracheal lymph nodes.

Key words
mediastinal tuberculous lymphadenitis, postesophagectomy for esophageal cancer

Reprint requests
Satoru Matono Department of Surgery, Kurume University School of Medicine
67 Asahimachi, Kurume, 830-0011 JAPAN

Accepted
December 17, 2008

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