Esophageal Rupture: Insights Gained from 9 Cytology Cases

Summary: Introduction: Esophageal perforation (EP) is a rare condition that is most often iatrogenic (>50%) but can also be spontaneous, malignant, or traumatic. Mortality rates are estimated to be 50%. Diagnosis is often delayed, which leads to worse outcomes. Cytologic examination of fluid specimens can be prepared rapidly and can be diagnostic for EP if food/foreign material, oropharyngeal contents (e.g. squamous cells and Candida species) are present. We describe our institutional experience with 9 cytology cases from patients with EP. Materials and Methods: We queried our institutional database for all fluid cytology specimens of EP patients in the last 25 years. Patient demographics, clinical history, and follow-up microbiological culture data were collected. The slides were evaluated for the presence of squamous cells, food or foreign material, and infectious organisms. Results: We retrieved 9 specimens from 8 patients (5 males and 3 females), with a median age of 61 years. Seven were pleural fluid specimens and 2 were bronchial lavages. One was positive for malignant cells, 4 were atypical, and 4 were negative. Five (63%) patients died, with a median interval of 1.8 months after presentation. Five cases were iatrogenic, and 4 had a history of malignancy. Squamous cells were present in 5 (55%) of specimens, while food/foreign material and fungi were present in 2 (22%) and 1 (11%) specimen, respectively (Figure 2). Cultures were positive in 7 (77%) specimens with 6 (66%) positive for bacteria and 5 (55%) positive for Candida species. Conclusions: EP is associated with high mortality, and thus early recognition and rapid diagnosis are critical. While diagnostic, Candida species and food/foreign material were only present in 20% and 10% of cases, respectively. The presence of squamous cells can be suggestive in patients with recent manipulation or malignancy. The prognosis of patients with EP in our series was poor.