The differential d w o s i s of odynophagia h patients with malignant disorders usually includes esophagitis due to herpes, Cmdidu, or gastroemphageal reflux. Two cases and a review of the literature are presented that illustrate that leukemic iafiltration of the esophagus and necrosis of the esophageal m u c m following chemotberapy should be considered in addition to tbe more cornonly mcognhd causes. Esophagoscopy with biopsy and brushing for fungal stains is esseotial for the correct diyprosis since the various causes for odynopafsia may be clinically and radmphicrrlly iadisdogaishable.
Cancer 5528774879,1985.
DYNOPHAGIA, or painful swallowing, is a symptom 0 that always demands careful attention. In immunocompromised patients, it is especially important to determine the cause of the odynophagia so that specific therapy may be given. A major textbook of gastroenterology states that the differential diagnosis of odynophagia in such patients is esophagitis, either due to Cundidu or herpes. and gastroesophageal reflux.' Radiation-induced esophagitis may also be a cause of odynophagia. Recently, at the Medical College of Ohio, we have seen two patients with malignant disease and odynophagia. Our expcriencc with these patients has expanded this differential diagnosis. and serves as the basis for this report.
Case Reports il.SlJ I
A 7 I -year-old woman was referred to the Medical College 01' Ohio for evaluation of odynophagia. She was diagnosed as having chronic lymphosarcoma cell leukemia 3 months previously when she presented to her local physician with spleno-mLwly and lymphocytosis. The diagnosis of lymphosarcoma cell leukemia was made based on bone marrow biopsy findings. ('hcmotherdpy was begun with cyclophosphamide and prednisonc. The patient's medical condition was stable until she dcvelopcd painful swallowing 3 months after the diagnosis of leukemia was made. Physical examination revealed no evidence of oropharyngeal candidiasis. There was no lymphadenopathy.
The spleen was palpable 9 cm below the left costal border.
An csophagogram was performed and showed nodular mucowl folds and a shaggy mucosal contour in the distal one