Lymphangioma of the esophagus presenting symptoms of achalasia —A case report

Abstract

A case of lymphangioma of the esophagus with symptoms of achalasia was presented. Compressible and folded intramural tumors were found from the middle to the lower part of the esophagus and the Mecholyl test was positive. After incisional biopsy at lower esophagus through full thickness of the wall, the opening was repaired with Thal-Hatafuku's fundic patch procedures to relieve achalasia. Postoperative course was uneventful and symptoms of achalasia completely disappeared.

Case report: Lymphangioma of the oesophagus endoscopically resected

“…The neck is the most common location of lymphangioma, but it also arises from other locations, including lip, cheek, tongue, oral cavity, limbs, mediastinum, omentum, liver, spleen, adrenal glands, kidney and the gastrointestinal ~y s t e m .~.~ In the gastrointestinal system, Gang1 et al reported that the colon was the most common location, followed by the duodenum and stomach; the oesophagus was the most unusual l o c a t i~n .~J~ Oesophageal lymphangioma is generally derived from the submucosal layer and is so rare that only nine cases have been reported in the world (Table 1). 1,6,7~10- 15 Wegner originally classified lymphangiomas into three types: simple, cavernous and cystic.I6 Our case was cavernous because of the highly In the diagnosis of oesophageal submucosal tumour, oesophagogram and endoscopy have been useful. However, EUS is the most useful in distinguishing lymphangioma from leiomyoma or other submucosal tumours because it shows clearly cystic formation and intact muscles.…”

Recurrent gastric carcinoma causing pseudoachalasia: case report

“…These findings can explain the controversial data of the literature as some authors 27 , 30 have found CT scan to be of great help in differentiating primary from secondary achalasia, whereas other authors 4 have not because of the low sensitivity of this diagnostic tool for malignancies with minimal local spread, low bulk or absent associated lymphadenopathy 31 . These data suggest that endoscopic ultrasonography (EU) may be helpful in diagnosing pseudoachalasia, detecting small, submucosal tumors missed with other diagnostic procedures 4 , 12 , 19 , 32 and supporting the theory of several authors 3 , 6 , 8 , 12 , 14 , 19 , 33 that malignancy– induced achalasia is caused by microscopic infiltration of the esophageal myenteric plexus by tumor cells, which disrupt post–ganglionic LES innervation and interfere with LES relaxation. Whatever the causes may be, if the diagnosis is still in doubt after an extensive diagnostic work‐up, it is mandatory to proceed with surgical exploration rather than to attempt palliation of dysphagia with non‐invasive treatments.…”

“…Pseudoachalasia or secondary achalasia is a rare motor abnormality of the esophagus mimicking idiopathic achalasia and associated with benign 1 or malignant diseases 2 . Metastases from unknown primaries, 3 , 4 multiple endocrine neoplasia (MEN) type 2b, 5 genital and urinary tumors, 6 colon cancer, 7 lung, 8 breast 3 , 9 and pancreatic carcinomas 10 and few primary lesions growing in the vicinity of the lower esophageal sphincter (LES) such as squamous cell carcinoma and lymphangioma of the esophagus, 11 –14 rhabdomyosarcoma of the diaphragm, 15 lymphoma, 8 , 16 pleural or peritoneal mesothelioma, 17 , 18 liver, 4 , 8 lung 19 –21 and pancreatic carcinomas 22 have been reported in association with pseudoachalasia. Even though primary gastric cancer is recognized to be the most frequent cause of pseudoachalasia, 3 , 4 , 8 , 11 , 12 , 19 , 23 –27 recurrent antral carcinoma showing the clinical picture of a secondary achalasia has not been previously described.…”

Endoscopic submucosal dissection of esophageal lymphangioma: a case report with a review of the literature

“…However, appropriate sampling may not be possible since normal surface epithelium usually covers the tumor [7,9]. Furthermore, biopsy is contraindicated when the lesion resembles esophageal varices [10].…”