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Rare chemotherapy-related tracheoesophageal fistula secondary to lymphoma

1 Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
2 Department of Otorhinolaryngology, University Malaya Medical Centre, Kuala Lumpur, Malaysia

Date of Submission15-Dec-2020
Date of Decision12-Jun-2021
Date of Acceptance18-Jun-2021
Date of Web Publication29-Jun-2022

Correspondence Address:
Liew Yew Toong,
Department of Otorhinolaryngology, University Malaya Medical Centre, Kuala Lumpur
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijc.IJC_1350_20

How to cite this URL:
Xuan AQ, Ghauth S, Toong LY. Rare chemotherapy-related tracheoesophageal fistula secondary to lymphoma. Indian J Cancer [Epub ahead of print] [cited 2022 Dec 4]. Available from:

Tracheoesophageal fistula (TEF) is a rapidly fatal condition where patients usually succumb to death from intractable aspiration pneumonia.[1] Acquired TEF due to neoplastic processes are commonly associated with primary esophageal or pulmonary carcinoma.[2] Here, we report a rare case of postchemotherapy TEF secondary to Hodgkin lymphoma.

A 27-year-old lady without any underlying medical condition presented with diffuse painless neck swelling for 3 months. The mass was progressively increasing in size, associated with low-grade fever, progressive dysphagia, and shortness of breath. Clinical examination revealed diffuse cervical lymphadenopathy, which was confirmed by a contrasted computed tomography (CT) of the neck. There was also diffuse mediastinal lymphadenopathy. The diagnosis of Stage 3 Hodgkin lymphoma was established from the core needle biopsy of the cervical lymph node. She was started on a chemotherapy regime consisting of Adriamycin, bleomycin, vinblastine, and dacarbazine. After the second cycle of chemotherapy, she developed multiple episodes of aspiration pneumonia with choking, and needed intubation to protect the airway. A massive TEF of 2 cm in length, 1.2 cm in diameter, was detected at the level of C7 from endoscopic esophagoscopy [Figure 1] and [Figure 2] and CT of the neck [Figure 3]. After intubation, she was managed conservatively with intravenous antibiotics, feeding gastrostomy and antisialagogue but to no avail. Endoscopic insertion of dual stentings – both esophagus and trachea – was performed to provide structural support to maintain luminal patency and to seal the fistula. [Figure 4] We used the tracheal stent as well due to the mass effect on the trachea from mediastinal nodes. She recovered from pneumonia gradually and remained asymptomatic with normal oral intake after the completion of chemotherapy and is currently under remission. TEF usually develops during or after the completion of radiotherapy and/or chemotherapy.[3] The exact mechanism is still unclear. It is believed to be due to rapid tissue necrosis. The prognosis of TEF associated with lymphoma is generally better than those associated with primary esophagus or lung carcinoma.[4] Dual stenting with airway and esophageal stent insertion is proven to be safe[5] and effective in TEF closure.[6] It improves the quality of life as well as the survival of patients with malignant TEF.[1]
Figure 1: OGDS view: A fistula occluded by endotracheal tube balloon (pointed with an arrow)

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Figure 2: OGDS view: Another view showing the extent of the fistula (pointed with an arrow)

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Figure 3: Contrasted CT coronal view: The continuation between trachea and esophagus (pointed with an arrow)

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Figure 4: Esophageal stent in situ

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Declaration of patient consent

Informed consent has been obtained from the patient for the publication of this case report and any accompanying images.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Reed MF, Mathisen DJ. Tracheoesophageal fistula. Chest Surg Clin N Am 2003;13:271-89.  Back to cited text no. 1
Burt M, Diehl W, Martini N, Bains MS, Ginsberg RJ, McCormack PM, et al. Malignant esophagorespiratory fistula: Management options and survival. Ann Thorac Surg 1991;52:1222-8; discussion 1228-9.  Back to cited text no. 2
Balazs A, Kupcsulik PK, Galambos, Z. Esophagorespiratory fistulas of tumorous origin. Non-operative management of 264 cases in a 20-year period. Eur J Cardiothorac Surg 2008;34:1103-7.  Back to cited text no. 3
Perry RR, Rosenberg RK, Pass HI. Tracheoesophageal fistula in the patient with lymphoma: Case report and review of the literature. Surgery 1989;105:770-7.  Back to cited text no. 4
Bi Y, Ren J, Chen H, Bai L, Han X, Wu G. Combined airway and esophageal stents implantation for malignant tracheobronchial and esophageal disease. Medicine 2019;98:e14169.  Back to cited text no. 5
Paganin F, Schouler L, Cuissard L, Noel JB, Becquart JP, Besnard M, et al. Airway and esophageal stenting in patients with advanced esophageal cancer and pulmonary involvement. PLoS One 200;3:e3101.  Back to cited text no. 6


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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