Dynamic esophageal manometry reveals pseudoachalasia secondary to metastatic breast cancer: A case report

Abstract

BACKGROUND

Pseudoachalasia mimics primary achalasia in symptoms and diagnostic findings, as observed in gastroscopy and barium swallow studies. However, pseudoachalasia, often associated with malignancies like metastatic breast cancer, requires prompt differentiation to avoid misdiagnosis and inappropriate treatment. This report highlights a rare case of pseudoachalasia secondary to metastatic breast cancer and highlights the diagnostic value of esophageal motility changes.

CASE SUMMARY

A 52-year-old woman presented with a one-year history of intermittent dysphagia following breast cancer surgery. Initial examinations suggested achalasia, but the patient’s high-resolution manometry (HRM) results showed a rapid shift from ineffective esophageal motility to type II achalasia within four months. Further investigations revealed metastatic adenocarcinoma of the cardia, originating from the breast.

CONCLUSION

In patients with a history of malignancy, rapidly evolving esophageal motility abnormalities should raise suspicion of pseudoachalasia. HRM plays a crucial role in differentiating between primary and secondary achalasia. Early diagnosis through advanced imaging and pathology is essential for proper management.

Keywords: Pseudoachalasia; Metastatic breast cancer; Achalasia; Esophageal motility; High-resolution manometry; Case report

Core Tip: This case report presents a rare instance of pseudoachalasia secondary to metastatic breast cancer following surgery. Notably, high-resolution manometry (HRM) detected rapid changes in esophageal motility, progressing from normal motility to type II achalasia within a brief interval. This dynamic progression highlighted the diagnostic value of HRM in distinguishing pseudoachalasia from primary achalasia. The report emphasizes the importance of considering malignancy-related secondary achalasia in patients with a cancer history and unexplained dysphagia. It advocates for early HRM evaluation and pathological confirmation to guide timely treatment.