An Unusual Case of Submucosal Invasion of Esophageal Squamous Cell Carcinoma Mistaken as Primary Achalasia

Abstract

Secondary achalasia due to submucosal invasion of esophageal squamous cell carcinoma (SCC) is a very rare condition. Here, we report a case of secondary achalasia diagnosed after distal esophagectomy, initially mistaken as primary achalasia. A 51-year-old man presented with progressive dysphagia for 2 months and mild weight loss. A barium swallow study, endoscopy, and manometry showed typical findings of primary achalasia. Pneumatic dilatation was performed, but esophageal perforation occurred as a complication. During surgical repair, no abnormalities around distal esophagus were found, and intraoperative esophageal biopsy revealed only inflammatory cells. During the following 8 months, the patient suffered from dysphagia caused by recurrent esophageal obstruction several times although of repeated balloon dilatation and esophageal stent insertion. Finally, he received a distal esophagectomy. The postoperative pathology revealed SCC at the distal esophagus and esophagogastric junction.

Achalasia Secondary to Submucosal Invasion by Poorly Differentiated Adenocarcinoma of the Cardia, Siewert II: Consideration on Preoperative Workup

“…However, dysphagia in achalasia secondary to malignancy is relatively short in duration and usually develops in advanced phases of pathology. Although a secondary form of achalasia due to esophageal or gastric cancer involving the cardia could be easily diagnosed through upper gastrointestinal endoscopy, if the malignancy spreads into submucosal layer or is a very aggressive and poorly differentiated histological type, it can be very difficult to diagnose it until surgery [ 26 ].…”

Primary Squamous Cell Carcinoma of the Liver Initially Presenting with Pseudoachalasia

“…Moreover, due to the rarity of the disease, many patients with pseudoachalasia are initially diagnosed as primary achalasia. Unfortunately, if not promptly recognized, pseudoachalasia may be inappropriately treated with pneumatic dilation of the LES, which is both ineffective and dangerous, 8 and may delay proper treatment of the underlying malignancy. Thus, all patients with suspected achalasia should undergo EGD to exclude a diagnosis of tumor at the cardia or EGJ.…”

Is it necessary to perform a morphological assessment for an esophageal motility disorder? A retrospective descriptive study

“…The common form is primary EMD. Secondary forms are less common and have been little studied [7,8]. At yet, pseudoachalasia or "secondary achalasia" is the most studied secondary EMD.…”