Esophageal actinomycosis mimicking a carcinoma

A 75-year-old male was referred due to dysphagia and iron-deficiency anemia. An upper endoscopy was performed which revealed a friable mass at 30 to 37 cm from the incisors, consistent with esophageal malignancy. However, the pathology only demonstrated granulation inflammatory tissue. An endoscopic ultrasound exam showed a 2-3 cm esophageal wall thickening with a 1.5 cm lymph node, which was staged as a T2-3 N1 esophageal tumor. A CT-scan also identified a 7.5 cm esophageal malignancy surrounded by several large pathological lymph nodes.