A case report of lymphoma presenting initially with tracheoesophageal fistula and literature review.

RATIONALE

Extranodal involvement in non-Hodgkin lymphoma most commonly occurs in the gastrointestinal tract, whereas direct esophageal invasion by lymphoma is rare. The coexistence of a tracheoesophageal fistula (TEF) in such cases is even more exceptional, typically indicating a poor prognosis. This case report describes a female patient with advanced-age, large B-cell lymphoma involving both the lungs and esophagus, complicated by a TEF. Following treatment, the patient demonstrated improved physical strength and nutritional status, surviving more than 15 months post-diagnosis.

PATIENT CONCERNS

An 81-year-old female patient presented with a 2-month history of progressively worsening dysphagia, accompanied by cough and expectoration of white sticky sputum, along with marked weight loss and declining physical strength.

DIAGNOSES

The patient was definitively diagnosed with extranodal metastasis of large B-cell lymphoma involving the esophagus and complicated by TEF combined imaging studies and endoscopic biopsy. Concurrently, the patient presented with multiple comorbidities, including pulmonary fungal infection, viral hepatitis, moderate aortic valve regurgitation, and atrial fibrillation.

INTERVENTIONS

The patient received 2 cycles of standard chemotherapy, concurrently supported by aggressive nutritional intervention via a jejunal feeding tube. This approach led to improved physical strength, stabilization of body mass index, and elevated serum albumin levels compared to baseline. A 1-year follow-up plain computed tomography scan demonstrated no further tumor progression.

OUTCOMES

The patient's physical strength increased and nutritional status improved, with a post-diagnosis survival period exceeding 15 months.

LESSONS

This case underscores that individualized, effective symptomatic treatment can prolong survival and enhance quality of life in high-risk, frail oncology patients, while highlighting the critical role of nutritional support in comprehensive cancer care.

Copyright © 2025 the Author(s). Published by Wolters Kluwer Health, Inc.