[Achalasia as a mask of cardial carcinoma]

Increasing dysphagia and weight loss between 3 and 30 kg developed in eight patients aged 27-70 years (mean age 53 years) within a period of 1.5 to 12 months. In five patients X-ray film showed the typical pattern of achalasia with dilatation of the tubular oesophagus and a smooth taper of the terminal part. Although in all patients the cardia became patent only after the endoscope had been advanced by pushing it forward to overcome stenosis or after bougienage, and although the malignoma had always been included in differential diagnostic considerations, a malignoma was identified only three times in 30 histological examinations. Oesophageal manometry demonstrated findings characteristic of achalasia in five patients, in three patients the examination could be performed only incompletely. In six patients computed tomography revealed pathological hypertrophy of the cardiac wall. Intraoperatively all cardiac tumours were in an advanced stage.