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When a Late Metastasis Is Hard to Swallow
Catarina Negrão1, Rita Sismeiro1, Margarida Monteiro1
1Internal Medicine, Hospital Professor Doutor Fernando Fonseca EPE, Amadora, PRT.
Cureus
|January 20, 2022
Summary
Pseudoachalasia, mimicking achalasia, can be a rare sign of malignancy. This case shows late breast cancer metastasis presenting as pseudoachalasia, emphasizing the importance of patient history in diagnosis.
Area of Science:
- Gastroenterology
- Oncology
- Internal Medicine
Background:
- Pseudoachalasia presents similarly to idiopathic achalasia, with esophageal aperistalsis and lower esophageal sphincter dysfunction.
- Malignancy is the most frequent cause of pseudoachalasia, necessitating thorough investigation.
Observation:
- A 70-year-old female with a 16-year history of breast cancer in remission presented with dysphagia and weight loss.
- Initial diagnostics suggested achalasia, but subsequent CT revealed metastatic breast cancer with mediastinal adenopathy and pulmonary nodules.
Findings:
- Endobronchial ultrasound-guided transbronchial needle aspiration confirmed metastatic breast carcinoma.
- Treatment with chemotherapy led to complete resolution of pseudoachalasia symptoms and normalization of tumor markers.
Implications:
- This case underscores pseudoachalasia as a potential first indicator of late-stage cancer recurrence.
- Maintaining awareness of prior medical history is crucial for diagnosing complex cases and guiding treatment decisions.
