BRIEF REPORTS Esophageal anthracosis with endobronchial tuberculosis: case report Jeong Hoon Park, MD, Suck-Ho Lee, MD, Won-Yeop Bae, MD, Do Hyun Park, MD, Hyun Deuk Cho, MD, Sang-Heum Park, MD, Hong-Soo Kim, MD, Sun-Joo Kim, MD Cheonan, Korea Anthracosis is a very common disease of the lung and its related lymph nodes caused by the aspiration of particles of dust during inhalation. 1 Anthracosis is very rare in the GI organs. Furthermore, only a few case reports have de- scribed esophageal anthracosis. 2,3 There are currently no reports in the academic literature that explain the patho- genesis of esophageal anthracosis. Here, we report a case of anthracosis of the esophagus accompanied by endobronchial tuberculosis, confirmed by examination by gastroduodenoscopy, bronchoscopy, and radiography. CASE REPORT In a routine medical checkup, a healthy 68-year-old woman underwent EGD. She was a housewife, with no his- tory of smoking or occupational exposure to charcoal. Phys- ical examination disclosed no abnormalities, and laboratory values were within the normal limits. On EGD view (Fig. 1), a small, round (about 1 cm in diam- eter), black-pigmented flat lesion was noted 27 cm from the upper incisor. This well-demarcated lesion had a central dimpling, like a postinflammatory ulcerative scar or slightly external retraction. To rule out malignant neoplasm, Lugol’s solution was sprayed and multiple biopsy specimens were taken. A microscopic view (Fig. 2) showed black anthracotic pig- ment-laden macrophages located beneath the squamous- mucosal epithelial layer. Upon immunohistochemical examination, a positive finding was found on CD 68 and negative findings on S-100 protein, HMB 45. After a diagnosis of esophageal anthracosis, further stud- ies were performed to reveal a contributing disease. One chest CT showed a lymph node a pretracheal lesion and an- teroposterior (AP) window, 1 cm and 1.5 cm in size, respec- tively (Fig. 3). A cine esophagogram (Xenetix; Guerbet, Aulnay-Sous-Bois, France) showed a small diverticulum on the mid esophagus, without a fistula and mass (arrow) (Fig. 4). Bronchoscopic examination revealed a stricture on the orifice of the right upper lobe (arrow)(Fig. 5). Except for luminal narrowing, there were no other pathologic find- ings. A bronchioalveolar lavage (BAL) for cytologic and bacterial examination was done; an acid-fast bacilli stain (Ziehl-Neelsen) was positive. Based on the above-mentioned tests, esophageal anthra- cosis, accompanied with endobronchial tuberculosis, was diagnosed. Because there was no evidence of malignant change, medical observations were processed and antitu- berculosis agents were given simultaneously. Figure 1. EGD view. A black-pigmented flat lesion, 1 cm in diameter, is shown. This lesion has a central dimpling scarred lesion, like a small di- verticulum. A view with sprayed Lugol’s solution is demonstrated (right). Figure 2. Microscopic view, showing black, anthracotic pigment-laden macrophages located beneath the squamous-mucosal epithelial layer (H&E, orig. mag. Â160). 1022 GASTROINTESTINAL ENDOSCOPY Volume 64, No. 6 : 2006 www.giejournal.org