Stenosing tumors of the esophagus occasionally pose a diagnostic challenge to digestive endoscopists due to the difficulty of access through the esophageal lumen. We describe a case of stenosing esophageal carcinoma diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).

The patient was a 71-year-old man, smoker, with an alcohol intake of 30g/day, who presented with a 2-month history of dysphagia associated with constitutional syndrome. Physical examination was normal. Laboratory tests were unremarkable, apart from a total bilirubin of 1.3mg/dl. Computed tomography (CT) detected a 33mm×26mm×48mm mass in the upper third of the esophagus (Fig. 1A). Gastroscopy showed stenosis of the cervical esophagus, apparently extrinsic, that prevented advancement of the endoscope. During the transesophageal endoscopic ultrasound (EUS), stenosis of the esophageal lumen made it difficult to introduce the endoscope, and sampling by fine needle aspiration was not optimal. Aspiration performed in the area most proximal to the lesion showed only atypical cells.

Fig. 1.

(A) Chest CT image in which a mass situated in the upper third of the esophagus can be seen (indicated with an arrow). (B) Endoscopic ultrasound image of the esophageal mass needle aspiration.

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Since a diagnosis could not be made through the digestive tract, the possibility of a diagnostic approach using transtracheal ultrasound-guided fine needle aspiration (EBUS-FNA) was studied. Following endoscopic examination, we detected a protrusion of the pars membranacea in the upper third of the trachea. Using ultrasound, a 25mm×32mm retrotracheal mass was identified 2cm from the vocal cords (Fig. 1B), which was aspirated twice. After histopathological study of the samples, including immunohistochemistry studies (positive for cytokeratin 5 and p63 and negative for cytokeratin 7 and TTF1), esophageal squamous cell carcinoma was diagnosed.

Stenosing cancer of the esophagus has a poor prognosis and sometimes poses a diagnostic challenge. Interventionist endoscopy and surgery have been proposed in the literature.

EBUS-TBNA is a useful, safe tool for the diagnosis of hilo-mediastinal lymphadenopathies. It is essential in the diagnosis and staging of lung cancer. However, there is less data in the literature on its usefulness in the diagnosis of pulmonary or middle mediastinal masses.1 Anantham et al. published 2 cases in which bronchogenic cysts were diagnosed,2 and Chalhoub and Harris described the first case in which a thyroid nodule was sampled,3 both using EBUS-FNA. Thus, EBUS-FNA can be used to diagnose other, non-adenopathic, mediastinal disease, thereby obviating the need for more invasive procedures.

In addition, EBUS-TBNA can be performed by the bronchoscopist during endobronchial ultrasound. Turner et al. reported a case of a stenosing esophageal tumor diagnosed by EUS-FNA.4 In the patient described, the lesion, being stenotic, could not be properly accessed via the esophageal tract. Recently, Liberman et al. demonstrated the usefulness of EBUS-FNAB in the staging of esophageal carcinoma.5

EBUS and EUS are therefore complementary, minimally invasive techniques for the study of mediastinal disease, hence the importance of close collaboration between both specialties.