Pseudoachalasia caused by pancreatic carcinoma

Abstract

Secondary achalasia or pseudoachalasia is mostly caused by gastric or oesophageal carcinoma. Here we report a case of pseudoachalasia caused by a pancreatic tumour invading the cardiac region. A 66-year-old man with a 2-month history of dysphagia and weight loss showed no abnormalities on upper gastrointestinal endoscopy and computed tomography scan, but had no swallow-induced relaxation on oesophageal manometry. Based on the patient's history and oesophageal manometry findings, further investigation was performed to exclude pseudoachalasia. Endoscopic ultrasonography showed abnormalities in the cardiac region, but large endoscopic biopsies showed no malignancy. A laparotomy was performed, which revealed a large, irresectable tumour originating from the pancreatic corpus region and expanding into the gastric cardia region. This case illustrates that a pancreatic tumour invading the cardiac region may present as pseudoachalasia.

Pseudoachalasia: not only esophago-gastric cancer

“…Benign causes of pseudoachalasia are extremely rare in Europe and North America, but in South America and in developing countries Chagas’ disease may mimic achalasia. Two cases of pseudoachalasia in patients with pancreatic carcinoma and two cases in patients with metastases from breast cancer have been described in the literature 4,9,14,17 . We have reported another case of pancreatic carcinoma and one of recurrence from breast cancer causing paseudoachalasia.…”

“…The prevalence of pseudoachalasia is considered to be in the 2–4% range among patients with manometric findings suggestive of achalasia, with less than 100 cases reported in the literature so far 2,3,17,18 . Primary gastric cancer is usually recognized as the most common malignancy causing pseudoachalasia, but also liver, lung, genital, colon, pancreas, breast cancer and metastases from unknown primaries have been reported in association with achalasia 1,3,4,7–15,18 . Benign causes of pseudoachalasia are extremely rare in Europe and North America, but in South America and in developing countries Chagas’ disease may mimic achalasia.…”

“…The difficulty of differentiating achalasia from pseudoachalasia is well known 2–17 . Older age, short clinical history and significant weight loss in a short period of time are usually considered suggestive of pseudoachalasia.…”

“…2,3,17,18 Primary gastric cancer is usually recognized as the most common malignancy causing pseudoachalasia, but also liver, lung, genital, colon, pancreas, breast cancer and metastases from unknown primaries have been reported in association with achalasia. 1,3,4,[7][8][9][10][11][12][13][14][15]18 Benign causes of pseudoachalasia are extremely rare in Europe and North America, but in South America and in developing countries Chagas' disease may mimic achalasia. Two cases of pseudoachalasia in patients with pancreatic carcinoma and two cases in patients with metastases from breast cancer have been described in the literature.…”

“…1,2,[4][5][6] However, it has been reported that processes other than esophagogastric cancers may lead to the development of pseudoachalasia, such as mediastinal masses or metastatic lesions located at the GEJ from carcinomas originating in the lung, pancreas and other organs ( Table 1). [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] We present three cases of pseudoachalasia in which the primary cause of the disease was not an esophagogastric cancer.…”