J Thorac Cardiovasc Surg 1994;108:785-786
© 1994 Mosby, Inc.
Tracheobronchial remnants accidentally found in the esophagus and adenocarcinoma with Barrett's esophagus
Noriaki Tsubota, MD,
Masahiro Yosimura, MD,
Akihiro Murotani, MD,
Yosifumi Miyamoto, MD,
Maniwa Miyamoto, MD
Hyogo Medical Center
General Thoracic Department
Akashi 13-7 Kitaoji
Hyogo, Japan
To the Editor:
Barrett's esophagus 
1 is the term applied to the columnar-lined esophagus that is the result of a long history of gastroesophageal reflux 2 and also a prevalent site of adenocarcinoma. Tracheoesophageal fistula associated with Barrett's ulcer has been reported 3 as a result of an erosive process, but our case is different.
A 67-year-old woman was operated on for esophageal cancer. Esophagogastrectomy and reconstruction with the right hemicolon and ileum were done. The postoperative course was uneventful, but she died of a recurrence. An autopsy was not performed.
The patient had been treated for pneumonia at the ages of 10 and 34 years and also had a history of recurrent episodes of regurgitation on swallowing since childhood. She had had chest tube drainage for left-sided empyema but had no history of hiatal hernia. The macroscopic appearance of the specimen is shown in Fig. 1, with the probe in the blind fistula. Histologic examination of the fistula revealed the epithelium at the orifice lined by epidermoid cells switching over to columnar cells with cilia. The fistula then ended blindly. The small tumor (arrow)at the edge was found to be a bronchial cyst. Tracheobronchial remnants such as cartilage and gland were also found in thespecimen (Fig. 2). The lower part of the esophagus was invaded by the adenocarcinoma but the site of the fistula was not involved.
This case is typical with regard to the following points: The orifice of the blind fistula was lined with epidermoid cells. Remnants of the tracheobronchial element and the history of repeated regurgitation and vomiting in childhood are strongly suggestive of congenital abnormalities in tracheoesophageal development. The concept of bronchopulmonary foregut malformation is now established, 4and variable types of the disease have been reported. 5 Repeated coughing and vomiting in infancy are common symptoms. The degree of malformation was so mild that bronchopulmonary foregut malformation might not have been suspected when she was a girl. However, it is reasonable to conclude that the foregut malformation accompanied by repeated vomiting were responsible for the development of Barrett's esophagus, which later progressed to carcinoma.
References
-
Barrett NR. Chronic peptic ulcer of the oesophagus and "oesophagitis." Br J Surg 1950;38:175-82.
-
Gillen P, Keeling P, Byrne PJ, West AB, Hennessy TPJ. Experimental columnar metaplasia in the canine oesophagus. Br J Surg 1988;75:113-5.[Medline]
-
Diehl JM, Thomas L, Bloom MB, et al. Tracheoesophagial fistula associated with Barrett's ulcer: the importance of reflux control. Ann Thorac Surg 45:449-50.
-
Fowler CL, Pokorny WJ, Wagner ML, Kessler MS. Review of bronchopulmonary foregut malformation. J Pediatr Surg, 1988;23:793-7.[Medline]
-
Shoshany G, Bar-Maor JA. Congenital stenosis of the esophagus due to tracheobronchial remnants: a missed diagnosis. J Pediatr Gastroenterol Nutr 1986;5:977-9.[Medline]
