식도의 점막하 종양으로 오인된 종격동 결핵성 림프절염
A Case of Mediastinal Tuberculous Lymphadenitis Mimicking a Submucosal Tumor of the Esophagus
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초록
식도 결핵이 드문 질환이기는 하지만 우리나라가 결핵 유병률이 높은 지역임을 감안하면 식도에 달리 설명하기 어려운 궤양성 병변이나 종괴형 병변이 관찰될 때, 특히 식도 점막하 종양의 형태로 나타날 경우, 식도 결핵을 감별 진단의 하나로 고려해야 한다. 식도 결핵이 의심되면 상부 위장관 내시경검사에 의한 조직 생검 또는 수술 후 병리소견에 의해 최종적으로 진단될 수 있으나, 여러 차례의 내시경 조직검사에서 비특이성 만성 염증만 나타나는 경우가 많다. 조직검사에서 만족할 만한 소견이 나오지 않은 경우, 항산성균을 발견하거나 결핵 중합효소 연쇄반응을 시행하여 식도 결핵을 반드시 감별하여야 한다.
Abstract
Esophageal involvement in tuberculosis is rare, and the clinical presentation may mimic an esophageal submucosal tumor. A 30-year-old woman presented with dysphagia for 1 month. At esophagoscopy, a 3-cm subepithelial mass with normal covering mucosa was found 28~25 cm from the upper incisors. We diagnosed the lesion as a submucosal tumor of the esophagus and performed endoscopic ultrasonography 1 week after the first examination. The second endoscopy showed a large, linear ulceration on the same subepithelial mass. The histologic examination obtained following an endoscopic biopsy revealed chronic granulomatous inflammation, and a molecular nested PCR study for Mycobacterium tuberculosis was positive. The final diagnosis was mediastinal tuberculous lymphadenitis with invasion into the esophagus. We suggest the use of molecular biology techniques when there is a strong clinical suspicion of tuberculosis and difficulty in arriving at a definite diagnosis. (Korean J Med 2011;80:328-332)
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