Severe Dysphagia, Candidiasis, and an Oesophageal Mass, but Over 50 Biopsies Negative for Malignancy

Excerpt

A 52-year-old woman presented with progressive dysphagia over 6 months, a weight loss of 8 kg, and a persistent cough. Investigations performed at another hospital prior to referral included three endoscopies, all revealing oesophageal candidiasis and a papillomatous growth in the mid-oesophagus. Histology showed severely dysplastic squamous epithelium with no definitive stromal invasion. A barium swallow performed at this centre revealed an irregular filling defect in the mid- to distal oesophagus measuring 6 cm in length, with moderate holdup of contrast, in keeping with a partial obstruction (Fig. 1). An endoscopy demonstrated a fungating lesion 22–30 cm in length (Fig. 2), and histology revealed severely dysplastic squamous epithelium, without invasion (Fig. 3). Endoscopic ultrasound (EUS) showed a circumferential growth in the upper to mid-oesophagus, involving all the oesophageal layers to the adventitia with clear breach of the adventitia. A positron emission tomography-computed tomography (PET-CT) scan demonstrated a metabolically active large concentric thickening of the oesophagus from the level of the carina to the inferior pulmonary vein, with increased fluorodeoxyglucose (FDG) activity (Fig. 4). There were no distant nodal or visceral metastases. A bronchoscopy and endobronchial ultrasound revealed compression of the medial wall of the right main stem bronchus (Fig. 5). Biopsies revealed floridly inflamed bronchial mucosa with squamous metaplasia and numerous multinucleate giant cells, but no tumour. She underwent oral and systemic therapy for candidiasis.

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