Spontaneous healing of fistula formed after EBUS-TBNA in monomorphic epitheliotropic T-cell lymphoma
WK. Ryua (Dr), JS. Kimb (Prof), J. Parkc (Prof), SH. Yong*a (Prof)
a Division of Pulmonology and Critical Care, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, KOREA, REPUBLIC OF ; b Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, KOREA, REPUBLIC OF ; c Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, KOREA, REPUBLIC OF
Tracheal or bronchial fistulas after endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) are rarely reported as a procedure-related complication, but are sometimes fatal. There were few reports of spontaneous closure of fistulas formed after EBUS-TBNA. Here, we report a case of spontaneous healing of fistula formed after EBUS-TBNA in a patient with monomorphic epitheliotropic T-cell lymphoma.
A 72-year-old man was referred to a pulmonologist for evaluation of mediastinal lymphadenopathy. He was a current smoker and had a history of cerebral infarction, prostate cancer treated with radical prostatectomy. He was admitted, underwent EBUS-TBNA of the subcarinal lymph node, and was discharged without complications.
Two weeks after discharge, he developed a severe cough and foul-smelling sputum. Chest computed tomography (CT) revealed a fistula from the main carina to the subcarinal lymph node. However, the pathological result of EBUS-TBNA showed non-specific inflamed tissue. Another clue to the underlying condition was that the patient had hematochezia. Upper and lower gastrointestinal endoscopies were performed, and there were several shallow oval ulcers in the sigmoid colon. Ulcer biopsy revealed chronic active inflammation with granulation tissue and dense lymphocyte infiltration, involvement of intestinal T-cell lymphoma, most likely monomorphic epitheliotropic T-cell lymphoma (METL). Considering all diagnostic tests and clinical course, the subcarinal lymph node was assumed to be metastasis of METL.
He received CHOP chemotherapy and considered inserting a rigid silicone stent to close the fistula, but he refused. On follow-up CT after 3 months, the previous subcarinal fistula healed spontaneously. He is scheduled to receive the next chemotherapy and is planning a bronchoscopy after his condition improves.
Fistula formation after EBUS-TBNA is a rare complication. However, diseases with severe inflammatory characteristics can more easily cause fistula formation. Also, fistula may heal spontaneously if disease activity is controlled.
Disclosure of funding source(s): none