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Esophageal achalasia is a chronic neurogenic disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and absent or ineffective peristalsis in the distal esophagus. This leads to a functional obstruction without a physical blockage, despite significant disruption of esophageal motility.EtiologyAchalasia is caused by degeneration of the myenteric (Auerbach's) plexus, specifically the loss of inhibitory ganglion cells that produce vasoactive intestinal peptide...
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Pseudoachalasia: a diagnostic challenge.

Nader Roushan1, Abolfazl Zolfaghari2, Mehrnaz Asadi3

  • 11. Assistant Professor, Department of Internal Medicine, Division of Gastroenterology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. nroshan@tums.ac.ir.

Medical Journal of the Islamic Republic of Iran
|November 19, 2014
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A rare case of squamous cell carcinoma (SCC) caused difficult swallowing (dysphagia) and weight loss despite near-normal endoscopy results. This highlights the diagnostic challenges of esophageal malignancy.

Keywords:
AchalasiaDysphagia

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Area of Science:

  • Gastroenterology
  • Oncology
  • Diagnostic Imaging

Background:

  • Dysphagia and weight loss are common symptoms requiring investigation.
  • Esophageal stenosis can have various causes, including malignancy.
  • Near-normal endoscopic findings can complicate the diagnosis of esophageal cancer.

Purpose of the Study:

  • To report a challenging case of squamous cell carcinoma presenting with dysphagia and distal esophageal stenosis.
  • To highlight the importance of advanced imaging and biopsy techniques in diagnosing malignancy.
  • To contribute to the limited literature on esophageal SCC mimicking benign conditions.

Main Methods:

  • Gastrointestinal endoscopy with biopsies for a patient presenting with dysphagia.
  • Dilatation of distal esophageal stenosis.
  • Abdominopelvic computed tomography (CT) scan to identify potential masses.
  • Endosonography-guided fine needle aspiration (FNA) for tissue diagnosis.

Main Results:

  • Initial endoscopic biopsies of the stenosis showed normal esophageal tissue.
  • CT scan revealed a mass adjacent to the distal esophagus.
  • Endosonography-guided FNA confirmed the mass as squamous cell carcinoma (SCC).

Conclusions:

  • Squamous cell carcinoma can present insidiously with dysphagia and near-normal endoscopic findings.
  • Advanced imaging and targeted biopsies are crucial for diagnosing malignancy in such cases.
  • This case underscores the importance of considering malignancy even with initially non-diagnostic endoscopic results.