Case Report
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Jul 28, 2009; 15(28): 3569-3572
Published online Jul 28, 2009. doi: 10.3748/wjg.15.3569
Laparoscopic diagnosis of pleural mesothelioma presenting with pseudoachalasia
Greta Saino, Davide Bona, Marco Nencioni, Barbara Rubino, Luigi Bonavina
Greta Saino, Davide Bona, Marco Nencioni, Barbara Rubino, Luigi Bonavina, Department of Surgery, University of Milano School of Medicine, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese (Milano), Italy
Author contributions: Saino G, Bona D and Nencioni M executed the study and wrote a draft; Rubino B examined the biopsy specimen; Bonavina L revised the manuscript.
Correspondence to: Luigi Bonavina, Professor, Department of Surgery, University of Milano School of Medicine, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese (Milano), Italy. luigi.bonavina@unimi.it
Telephone: +39-2-52774621
Fax: +39-2-52774622
Received: February 16, 2009
Revised: June 25, 2009
Accepted: July 2, 2009
Published online: July 28, 2009
Abstract

Pseudoachalasia due to pleural mesothelioma is an extremely rare condition. A 70-year-old woman presented with progressive dysphagia for solid and liquids and a mild weight loss. A barium swallow study revealed an esophageal dilatation and a smoothly narrowed esophagogastric junction. An esophageal manometry showed absence of peristalsis. Endoscopy demonstrated an extrinsic stenosis of the distal esophagus with negative biopsies. A marked thickening of the distal esophagus and a right-sided pleural effusion were evident at computed tomography (CT) scan, but cytological examination of the thoracic fluid was negative. Endoscopic ultrasound showed the disappearance of the distal esophageal wall stratification and thickening of the esophageal wall. The patient underwent an explorative laparoscopy. Biopsies of the esophageal muscle were consistent with the diagnosis of epithelioid type pleural mesothelioma. An esophageal stent was placed for palliation of dysphagia. The patient died four months after the diagnosis. This is the first reported case of pleural mesothelioma diagnosed through laparoscopy.

Keywords: Dysphagia; Achalasia; Pseudoachalasia; Mesothelioma; Laparoscopy