Malignant pleural mesothelioma presenting as achalasia

Our plain-English summary of Malignant pleural mesothelioma presenting as achalasia, by H. Seki, K. Matsumoto, K. Ohmura, et al (Internal Medicine, 1994).

The study

• Authors: H. Seki, K. Matsumoto, K. Ohmura, Y. Fukushi, T. Fujita, H. Kiriyama, H. Takada, K. Kamii, H. Terada, Y. Mori
• Journal: Internal Medicine
• Published: 1994;33(10):624-7
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A 65-year-old man with an occupational history of asbestos exposure developed dysphagia and vomiting. Clinical examinations at onset revealed a dilated esophagus with smooth narrowing at the gastroesophageal junction and no apparent tumor in and around the esophagus. Achalasia was suspected. Dysphagia progressed gradually and examinations performed three months after the onset disclosed a tumor in the pleural and the peritoneal cavities. At laparotomy, the tumor extended from the pleural cavity into the peritoneal cavity. Histological examination of the biopsied specimen demonstrated malignant mesothelioma. We report the first case of malignant pleural mesothelioma presenting as achalasia.

In plain English

This case report described a 65-year-old man in Japan with an occupational history of asbestos exposure. He had been treated for asbestosis since 1958. The article did not state his job or the type of asbestos. He was admitted to hospital in April 1992 with difficulty swallowing, vomiting and weight loss. X-rays and endoscopy showed a widened esophagus that narrowed smoothly where it meets the stomach, and no tumor was seen. Achalasia, a condition in which the lower esophagus does not open properly, was suspected, although pressure testing did not fully meet its criteria. His swallowing worsened. About three months after symptoms began, scans showed a mass that had not been seen earlier. At abdominal surgery the tumor had invaded the diaphragm, spread into the abdominal cavity and involved the lower esophagus. It could not be completely removed. Biopsy showed malignant mesothelioma, and he died six months after symptoms began. The authors concluded, in retrospect, that his widened esophagus was secondary achalasia caused by malignant pleural mesothelioma. They described it as the first reported case.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One 65-year-old man with an occupational history of asbestos exposure, admitted in April 1992 to Koshigaya Hospital, Dokkyo University School of Medicine, Japan, with dysphagia (difficulty swallowing), vomiting and weight loss
• Exposure: Occupational asbestos exposure; the job and fiber type are not stated. He had been treated for asbestosis since 1958. The authors put the latent period at about 35 years.
• Main results:
  • At onset, examinations showed a dilated esophagus with smooth narrowing at the junction with the stomach and no apparent tumor in or around the esophagus; achalasia was suspected
  • Pressure testing showed the lower esophageal sphincter pressure was more than 60 mmHg, but the findings did not completely satisfy the criteria for achalasia
  • A later CT scan showed a mass that had not been seen on the CT taken about three months earlier at another hospital or on the CT taken on admission; the lower esophagus and descending aorta were involved in the tumor
  • Cytology of the pleural fluid was negative. Hyaluronic acid in the pleural fluid was more than 15 micrograms/ml (normal range 2.5 to 5.5 micrograms/ml).
  • Of the tumor markers tested, only CA-125 was abnormal, at 118 U/ml (normal less than 35)
  • At laparotomy the tumor invaded the diaphragm and extended into the peritoneal cavity, including the back of the pancreas and the left lobe of the liver, and involved the lower esophagus
  • Complete resection of the tumor was impossible, so some palliative procedures were carried out and biopsy specimens were taken
  • Biopsy showed epithelial tumor cells forming glandular structures resembling adenocarcinoma. Staining indicated hyaluronic acid in the tumor cells, and the PAS stain with diastase was negative. The authors stated these findings were consistent with malignant mesothelioma.
  • A pathological diagnosis of malignant mesothelioma was made; the patient died six months after symptoms began
• The authors' conclusion: The authors concluded in retrospect that the esophageal dilatation at onset resulted from secondary achalasia due to malignant pleural mesothelioma. They stated that, to their knowledge, this had not been reported before, and described this as the first reported case.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Occupational History, Asbestos Exposure, Dysphagia, Laparotomy, Pleural Cavity, Peritoneal Cavity, Malignant Mesothelioma.

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