SHM Converge Scientific Abstract ePoster Gallery-A Rare Cause of Tracheoesophageal Fistula: Direct Invasion by Diffuse Large B Cell Lymphoma

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This case report describes a rare tracheoesophageal fistula (TEF) caused by direct invasion from diffuse large B-cell lymphoma (DLBCL). TEFs are abnormal connections between the trachea and esophagus that can lead to aspiration, infections, and malnutrition. In adults, they are usually linked to malignancy, most often esophageal or lung cancer, while association with hematologic cancers is uncommon.<br /><br />An 83-year-old man with rheumatoid arthritis on methotrexate and heart failure with reduced ejection fraction presented with six weeks of worsening shortness of breath and dry cough. Chest CT showed multiple pulmonary nodules and a large left hilar mass causing obstruction of the left main bronchus and pulmonary artery. PET-CT demonstrated a hypermetabolic hilar mass with concern for TEF. Endobronchial ultrasound-guided biopsy confirmed DLBCL invading the esophagus, and the fistula was directly visualized. Notably, the patient had no dysphagia, regurgitation, aspiration, or recurrent infections.<br /><br />Management options included endoscopic evaluation with dual stenting versus systemic chemotherapy. The patient declined procedural intervention and chose chemotherapy, starting R-CEOP. At five months, he had marked improvement in respiratory symptoms.<br /><br />The authors emphasize that TEF as an initial manifestation of DLBCL is exceedingly rare and that, in lymphoma, TEFs are more commonly treatment-related than due to direct invasion. Because lymphoma is chemosensitive, conservative management with chemotherapy and close monitoring may be appropriate for small or minimally symptomatic fistulas. Endoscopic or surgical intervention is generally reserved for patients with significant symptoms, aspiration risk, or recurrent infections.<br /><br />Overall, this case highlights the importance of early recognition, multidisciplinary assessment, and individualized treatment in lymphoma-associated TEFs.

Asset Subtitle

Shannon R. Menezes

Meta Tag

Author List Ibironke Oduyebo, Oghuz Anwar, Shannon R. Menezes

Category Clinical Vignettes

Concept Tracheoesophageal Fistula

Concept Aspiration

Concept Diffuse Large B-Cell Lymphoma

Concept Esophageal Invasion

Concept Malignancy

Distinguished Non-Finalist

Presenter Organization Kaiser Permanente Mid-Atlantic States Residency Program

Presenting Author Shannon R. Menezes

Track Adult

Keywords

tracheoesophageal fistula

diffuse large B-cell lymphoma

DLBCL

direct invasion

hilar mass

endobronchial ultrasound

PET-CT

R-CEOP chemotherapy

lymphoma-associated fistula

case report

Tracheoesophageal Fistula

Aspiration

Diffuse Large B-Cell Lymphoma

Esophageal Invasion

Malignancy