Pseudoachalasia Due to Malignant Pleural Mesothelioma Involving the Esophagus

Our plain-English summary of Pseudoachalasia Due to Malignant Pleural Mesothelioma Involving the Esophagus, by M. Honda, M. Iwamuro, K. Miyamoto, et al (Curēus, 2025).

The study

• Authors: M. Honda, M. Iwamuro, K. Miyamoto, T. Tanaka, M. Otsuka
• Journal: Curēus
• Published: 2025;17(5):e84161
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

We report a rare case of pseudoachalasia secondary to malignant pleural mesothelioma involving the esophagus. A 66-year-old man presented with progressive dysphagia, weight loss, and postprandial hiccups. Endoscopic examination showed esophageal dilation with luminal narrowing at the esophagogastric junction, but no mucosal abnormalities. Computed tomography revealed an irregular-shaped mass extending from the peri-esophagogastric junction to the retroperitoneum, accompanied by pleural effusion, right-sided hydronephrosis, and multiple hepatic lesions. Endoscopic ultrasound-guided fine-needle aspiration from the mass lesion through the esophageal lumen revealed epithelioid malignant mesothelioma. This case highlights the importance of considering malignant mesothelioma in the differential diagnosis of pseudoachalasia, particularly when imaging reveals extrinsic esophageal compression without mucosal lesions.

Copyright © 2025, Honda et al.

In plain English

This case report described one 66-year-old Japanese man with 8 kg of weight loss, difficulty swallowing, lower back pain and hiccups after meals. His condition, called pseudoachalasia, mimicked a disorder of the muscle where the esophagus meets the stomach. Endoscopy showed a widened esophagus holding food and a narrowing at that junction, but a normal lining, and biopsies there found no cancer cells. A CT scan showed an irregular mass running from around the junction into the back of the abdomen, with fluid around the lung, a swollen right kidney and multiple liver lesions. A needle sample taken through the esophagus under ultrasound guidance showed epithelioid malignant mesothelioma. Cells in the pleural fluid confirmed malignant pleural mesothelioma involving the esophagus. When asked again about his work, he reported piping construction at age 30, with a potential asbestos exposure. No fiber type was reported. Despite several lines of drug treatment and a stomach feeding tube, he died 22 months after diagnosis. The authors concluded that mesothelioma should be considered, though rare, in patients with progressive swallowing difficulty and significant weight loss.

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 66-year-old Japanese man with two months of unintentional weight loss (8 kg), then difficulty swallowing; treated at Okayama University, Japan
• Exposure: Work in piping construction at age 30, described by the authors as a potential asbestos exposure; no fiber type, product or dose was reported
• Main results:
  • Endoscopy showed a dilated esophagus and narrowing at the esophagogastric junction without mucosal abnormalities; biopsies from the junction showed no neoplastic cells
  • CT showed an irregular mass from the peri-esophagogastric junction to the retroperitoneum, with pleural effusion, right-sided hydronephrosis and multiple hepatic lesions
  • A sample of the mass taken by endoscopic ultrasound-guided fine-needle aspiration was diagnosed by immunohistochemistry as epithelioid malignant mesothelioma
  • Pleural effusion cytology showed similar tumor cells, confirming malignant pleural mesothelioma with esophageal involvement
  • The authors judged that the pseudoachalasia resulted from direct invasion or outside compression by the tumor, not distant spread
  • After pemetrexed and cisplatin, nivolumab, gemcitabine and other treatment, plus a gastrostomy, the patient died 22 months after diagnosis
• The authors' conclusion: The authors concluded that malignant mesothelioma should be considered as a possible, though rare, cause in patients with progressive dysphagia and significant weight loss, and that early, accurate diagnosis is essential given the poor prognosis.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Dysphagia, Retroperitoneum, Pleural Effusion, Ultrasound, Fine-Needle Aspiration, Epithelioid, Mesothelioma.

Related studies

• The pathogenesis of pseudoachalasia: a clinicopathologic study of 13 cases of a rare entity — W. Liu, W. Fackler, et al. (2002)
• The epidemiology of hypopharynx and cervical esophagus cancer — C.R. Popescu, S.V. Bertesteanu, et al. (2010)
• Cancer of the esophagus and asbestos exposure — B. Clin, I. Thaon, et al. (2017)
• Esophagus cancer and occupational exposure to asbestos: results from a meta-analysis of epidemiology studies — B. Li, S.P. Tang, et al. (2016)
• Occupational exposure and the risk of Barrett's esophagus: a case-control study — Z. Qureshi, D. Ramsey, et al. (2013)
• Myocardial metastasis from ZEB1- and TWIST-positive spindle cell carcinoma of the esophagus: A case report — Y. Shibata, H. Ohmura, et al. (2024)

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