Primary non-Hodgkin lymphoma of the esophagus: case report

Abstract

Primary non-Hodgkin lymphoma of the esophagus is quite rare, representing less than 1% of all gastrointestinal neoplasms. We report the case of a 60-year-old male with 2-year progressive dysphagia and weight loss. The patient had no previous history of immunodeficiency, and laboratory work-up and chest radiography revealed no abnormalities. Endoscopy showed an ulcerated and vegetative lesion in the esophagus, 2 cm long, deeply invading the gastric cardia, with imprecise borders. Three esophagoscopies with biopsies were performed, all of which showed inconclusive results. Without a definitive histopathological diagnosis, the patient underwent one-stage distal transhiatal esophagectomy with lymphadenectomy and reconstruction using the stomach. Histological examination of tumor cell sheets revealed eosinophilic cytoplasm, and the nucleus showed marked hyperchromatism, pleomorphism, and increased mitotic activity. The tumor cells were infiltrating the muscularis propria. A diagnosis of non-Hodgkin's lymphoma was made and confirmed by immunohistochemistry using two markers: Ki67 and CD20. Surgery was followed by three cycles of chemotherapy. The patient now remains asymptomatic after 49 months of follow-up. In conclusion, although esophageal lymphoma is very rare, it should be considered as a differential diagnosis in situations like this. Furthermore, immunohistochemical analysis is a powerful tool for confirming the diagnosis.