eMedicine Specialties > Gastroenterology > Esophagus

Esophageal Lymphoma: Follow-up

Author: Rebecca C Dunphy, MD, Consulting Staff, Centers for Gastroenterology
Coauthor(s): Manoop S Bhutani, MD, FACG, FACP, Professor, Department of Medicine, Division of Gastroenterology, Director, Center for Endoscopic Ultrasound, Co-Director, Center for Endoscopic Research, Training and Innovation, University of Texas Medical Branch at Galveston
Contributor Information and Disclosures

Updated: Jun 13, 2007

Follow-up

Further Outpatient Care

  • Carefully monitor adverse effects of chemotherapy or radiotherapy.
  • Carefully follow the patient's nutritional status. Consider placement of gastric or jejunal feeding tube if the patient cannot maintain his or her nutritional status because of dysphagia or odynophagia.

Transfer

  • Transfer to a specialized cancer center may be required for further treatment (eg, chemotherapy, radiotherapy, surgical intervention).

Complications

  • Hemorrhage
  • Vocal cord paralysis
  • Esophageal stricture formation
  • Esophageal obstruction
  • Perforation with esophagomediastinal or esophago-tracheobronchial fistula
  • Perforation with mediastinitis or massive hemorrhage due to invasion into the aorta or other large vessels

Prognosis

  • Patients who are not infected with HIV

    • The International Non-Hodgkin's Lymphoma Prognostic Factors Project found that age older than 60 years, tumor stage III or IV (Ann Arbor classification), Eastern Cooperative Oncology Group performance status of 2-4, serum lactate dehydrogenase (LDH) levels greater than normal, and extranodal involvement of more than 1 site are characteristic in higher-risk groups. The 5-year survival rate for patients with 0-1 of these risk factors was 73%; with 2 factors, 51%; with 3 factors, 43%; and with 4 factors, 26%.
    • The small number of cases of esophageal lymphoma makes predicting survival difficult. The longest reported period of disease-free survival in a person not infected with HIV is 13 years 5 months in a patient treated with combination chemotherapy and radiotherapy.
  • Patients who have HIV/AIDS

    • Esophageal lymphoma in patients with HIV/AIDS is commonly high grade, large cell or immunoblastic, aggressive, and poorly responsive to chemotherapy.
    • Survival rate averages have been poor (ie, 4-6 mo).
    • In HIV-positive patients in a low-risk category, including those with a CD4 count of greater than 100/µL and good performance status, response rates similar to those of HIV-negative patients may be achieved.

Miscellaneous

Medicolegal Pitfalls

  • Failure to initiate further evaluation of esophagitis unresponsive to adequate therapy in patients with HIV or AIDS is a possible pitfall.
    • In patients with HIV or AIDS, consider underlying esophageal lymphoma in a clinical presentation consistent with infectious esophagitis that is not responsive to adequate therapy. This is especially true when esophageal ulcerations are present.
    • Superinfection with Candida albicans is common and may lead to repeated treatment with antifungal medications rather than pursuit of alternative diagnoses for a nonhealing esophageal ulcer.
  • Failure to pursue further diagnostic workup when endoscopic biopsy findings are negative and suspicion for esophageal lymphoma remains high is a possible pitfall.
    • Endoscopic biopsies may demonstrate a false-negative rate of 30% or more.
    • If suspicion for esophageal lymphoma is high, consider other diagnostic modalities (eg, CT scans, surgical biopsy).
 


More on Esophageal Lymphoma

Overview: Esophageal Lymphoma
Differential Diagnoses & Workup: Esophageal Lymphoma
Treatment & Medication: Esophageal Lymphoma
Follow-up: Esophageal Lymphoma
References
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References

  1. Dawson IMP, Cornes JS, Morson BC. Primary malignant lymphoma of the intestinal tract. British Journal of Surgery. 1961;49:80-9.

  2. Gupta NM, Goenka MK, Jindal A, Behera A, Vaiphei K. Primary lymphoma of the esophagus. J Clin Gastroenterol. Oct 1996;23(3):203-6. [Medline].

  3. Agha FP, Schnitzer B. Esophageal involvement in lymphoma. Am J Gastroenterol. Jun 1985;80(6):412-6. [Medline].

  4. Bernal A, del Junco GW. Endoscopic and pathologic features of esophageal lymphoma: a report of four cases in patients with acquired immune deficiency syndrome. Gastrointest Endosc. Apr 1986;32(2):96-9. [Medline].

  5. Bolondi L, De Giorgio R, Santi V, Paparo GF, Pileri S, Di Febo G, et al. Primary non-Hodgkin's T-cell lymphoma of the esophagus. A case with peculiar endoscopic ultrasonographic pattern. Dig Dis Sci. Nov 1990;35(11):1426-30. [Medline].

  6. Brady LW, Asbell SO. Malignant lymphoma of the gastrointestinal tract. Erskine Memorial Lecture, 1979. Radiology. Nov 1980;137(2):291-8. [Medline].

  7. Cappell MS, Botros N. Predominantly gastrointestinal symptoms and signs in 11 consecutive AIDS patients with gastrointestinal lymphoma: a multicenter, multiyear study including 763 HIV-seropositive patients. Am J Gastroenterol. Apr 1994;89(4):545-9. [Medline].

  8. Chadha KS, Hernandez-Ilizaliturri FJ, Javle M. Primary esophageal lymphoma: case series and review of the literature. Dig Dis Sci. Jan 2006;51(1):77-83. [Medline].

  9. Chow DC, B1eikh SH, Eickhoff L, Soloway GN, Saul Z. Primary esophageal lymphoma in AIDS presenting as a nonhealing esophageal ulcer. Am J Gastroenterol. Mar 1996;91(3):602-3. [Medline].

  10. Field SP, Sachar DB, Childs CC, Rubin KP. Steroid-responsive dysphagia: a clue to the diagnosis of esophageal lymphoma. Mt Sinai J Med. Jul-Aug 1984;51(4):451-4. [Medline].

  11. Finn DG. Lymphoma of the head and neck and acquired immunodeficiency syndrome: clinical investigation and immunohistological study. Laryngoscope. Apr 1995;105(4 Pt 2 Suppl 68):1-18. [Medline].

  12. Gaskin CM, Low VH, Ho LM. Isolated primary non-hodgkin's lymphoma of the esophagus. AJR Am J Roentgenol. Feb 2001;176(2):551-2. [Medline].

  13. Gilman AG, Rall TW, Nies AS. The Pharmacological Basis of Therapeutics. 8th ed. New York: McGraw-Hill Inc; 1993.

  14. Herrmann R, Panahon AM, Barcos MP, Walsh D, Stutzman L. Gastrointestinal involvement in non-Hodgkin's lymphoma. Cancer. Jul 1 1980;46(1):215-22. [Medline].

  15. Hosaka S, Nakamura N, Akamatsu T, Fujisawa T, Ogiwara Y, Kiyosawa K, et al. A case of primary low grade mucosa associated lymphoid tissue (MALT) lymphoma of the oesophagus. Gut. Aug 2002;51(2):281-4. [Medline].

  16. Hricak H, Thoeni RF, Margulis AR, Eyler WR, Francis IR. Extension of gastric lymphoma into the esophagus and duodenum. Radiology. May 1980;135(2):309-12. [Medline].

  17. Kaplan KJ. Primary esophageal lymphoma: a diagnostic challenge. South Med J. Apr 2004;97(4):331-2. [Medline].

  18. Kirsch HL, Cronin DW, Stein GN, Latour F, Herrera AF. Esophageal perforation. An unusual presentation of esophageal lymphoma. Dig Dis Sci. Apr 1983;28(4):371-4. [Medline].

  19. Kurtin PJ, Pinkus GS. Leukocyte common antigen--a diagnostic discriminant between hematopoietic and nonhematopoietic neoplasms in paraffin sections using monoclonal antibodies: correlation with immunologic studies and ultrastructural localization. Hum Pathol. Apr 1985;16(4):353-65. [Medline].

  20. Levine AM. Acquired immunodeficiency syndrome related lymphoma. Blood. 1992;80:8-20.

  21. Maipang T, Panjapiyakul C, Sriplung H. Primary lymphoma of the esophagus: a case report. J Med Assoc Thai. May 1992;75(5):299-303. [Medline].

  22. Marnejon T, Scoccia V. The coexistence of primary esophageal lymphoma and Candida glabrata esophagitis presenting as dysphagia and odynophagia in a patient with acquired immunodeficiency syndrome. Am J Gastroenterol. Feb 1997;92(2):354-6. [Medline].

  23. Matsuura H, Saito R, Nakajima S, Yoshihara W, Enomoto T. Non-Hodgkin's lymphoma of the esophagus. Am J Gastroenterol. Dec 1985;80(12):941-6. [Medline].

  24. Mengoli M, Marchi M, Rota E, Bertolotti M, Gollini C, Signorelli S. Primary non-Hodgkin's lymphoma of the esophagus. Am J Gastroenterol. Jun 1990;85(6):737-41. [Medline].

  25. Moses AE, Rahav G, Bloom AI, Okon E, Polliack A, Maayan S, et al. Primary lymphoma of the esophagus in a patient with AIDS. J Clin Gastroenterol. Dec 1995;21(4):327-8. [Medline].

  26. Moss S, Valentine CB, Carey PB, Hind CR. Dysphagia in an HIV-positive man. Postgrad Med J. Apr 1995;71(834):247-8. [Medline].

  27. Nagrani M, Lavigne BC, Siskind BN, Knisley RE, Traube M. Primary non-Hodgkin's lymphoma of the esophagus. Arch Intern Med. Jan 1989;149(1):193-5. [Medline].

  28. Orvidas LJ, McCaffrey TV, Lewis JE, Kurtin PJ, Habermann TM. Lymphoma involving the esophagus. Ann Otol Rhinol Laryngol. Nov 1994;103(11):843-8. [Medline].

  29. Safai B, Diaz B, Schwartz J. Malignant neoplasms associated with human immunodeficiency virus infection. CA Cancer J Clin. Mar-Apr 1992;42(2):74-95. [Medline].

  30. Salerno CT, Kreykes NS, Rego A, Maddaus MA. Primary esophageal lymphoma: a diagnostic challenge. Ann Thorac Surg. Oct 1998;66(4):1418-20. [Medline].

  31. Soon MS, Yen HH, Soon A, Lin OS. Primary esophageal B-cell lymphoma: evaluation by EUS. Gastrointest Endosc. Jun 2005;61(7):901-3. [Medline].

  32. Weeratunge CN, Bolivar HH, Anstead GM, Lu DH. Primary esophageal lymphoma: a diagnostic challenge in acquired immunodeficiency syndrome--two case reports and review. South Med J. Apr 2004;97(4):383-7. [Medline].

  33. Wotherspoon AC. Extragastric MALT lymphoma. Gut. Aug 2002;51(2):148-9. [Medline].

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Further Reading

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Keywords

human immunodeficiency virus, acquired immunodeficiency syndrome, HIV, AIDS, Epstein-Barr virus, EBV, tracheoesophageal fistula, esophageal ulcerations, esophagitis

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Contributor Information and Disclosures

Author

Rebecca C Dunphy, MD, Consulting Staff, Centers for Gastroenterology
Rebecca C Dunphy, MD is a member of the following medical societies: American College of Gastroenterology and American Gastroenterological Association
Disclosure: Nothing to disclose.

Coauthor(s)

Manoop S Bhutani, MD, FACG, FACP, Professor, Department of Medicine, Division of Gastroenterology, Director, Center for Endoscopic Ultrasound, Co-Director, Center for Endoscopic Research, Training and Innovation, University of Texas Medical Branch at Galveston
Manoop S Bhutani, MD, FACG, FACP is a member of the following medical societies: American Association for the Advancement of Science, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Institute of Ultrasound in Medicine, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Medical Editor

Maurice A Cerulli, MD, FACG, Chief, Division of Gastroenterology and Hepatology, Associate Professor of Clinical Medicine, Department of Internal Medicine, Division of Gastroenterology, New York Methodist Hospital, Cornell University
Maurice A Cerulli, MD, FACG is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Medical Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Simmy Bank, MD, Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Assistant Dean for Medical Curriculum, Associate Professor of Medicine, Division of General Internal Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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