Retroperitoneal Diffuse Large B-Cell Lymphoma Presenting As Pseudoachalasia

Pastor, Danielle M.; Eggers, Ashley D.; Loughran, Thomas P.; Bayerl, Michael G.; Shope, Timothy

doi:10.1200/jco.2009.25.8715

Cited by 11 publications

(5 citation statements)

References 16 publications

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“…Agree: 94% [D + (0%); D (0%); U (6%); A (46%); A + (48%)] All series of pediatric achalasia treatments have in common that the treatment immediately improves the patients' QOL and reverses weight loss and failure to thrive. [285][286][287] Most patients will need repeat treatments over time, particularly patients having BTI or PD as an initial treatment. Smits et al, described the longitudinal experience in the Netherlands where 88% of PD treated patients had repeat treatment therapy required in 22% of patients after Heller myotomy.…”

Section: The Long-term Outcome Of Achalasia Treatment In Children Sho...mentioning

confidence: 99%

The 2018 ISDE achalasia guidelines

Zaninotto

Bennett

Boeckxstaens

et al. 2018

Diseases of the Esophagus

250

218

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Achalasia is a relatively rare primary motor esophageal disorder, characterized by absence of relaxations of the lower esophageal sphincter and of peristalsis along the esophageal body. As a result, patients typically present with dysphagia, regurgitation and occasionally chest pain, pulmonary complication and malnutrition. New diagnostic methodologies and therapeutic techniques have been recently added to the armamentarium for treating achalasia. With the aim to offer clinicians and patients an up-to-date framework for making informed decisions on the management of this disease, the International Society for Diseases of the Esophagus Guidelines proposed and endorsed the Esophageal Achalasia Guidelines (I-GOAL). The guidelines were prepared according the Appraisal of Guidelines for Research and Evaluation (AGREE-REX) tool, accredited for guideline production by NICE UK. A systematic literature search was performed and the quality of evidence and the strength of recommendations were graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Given the relative rarity of this disease and the paucity of high-level evidence in the literature, this process was integrated with a three-step process of anonymous voting on each statement (DELPHI). Only statements with an approval rate >80% were accepted in the guidelines. Fifty-one experts from 11 countries and 3 representatives from patient support associations participated to the preparations of the guidelines. These guidelines deal specifically with the following achalasia issues: Diagnostic workup, Definition of the disease, Severity of presentation, Medical treatment, Botulinum Toxin injection, Pneumatic dilatation, POEM, Other endoscopic treatments, Laparoscopic myotomy, Definition of recurrence, Follow up and risk of cancer, Management of end stage achalasia, Treatment options for failure, Achalasia in children, Achalasia secondary to Chagas' disease.

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Section: The Long-term Outcome Of Achalasia Treatment In Children Sho...mentioning

confidence: 99%

The 2018 ISDE achalasia guidelines

Zaninotto

Bennett

Boeckxstaens

et al. 2018

Diseases of the Esophagus

250

218

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“…Up to 70% of cases are secondary to malignancy, with primary malignancy accounting for 54%-70% [ 5 , 6 ] (mostly adenocarcinoma of the oesophagogastric junction or cardia) and secondary malignancy for only 6% [ 6 , 7 ]. Malignancy can cause pseudoachalasia either by direct invasion of the oesophageal neural plexuses (such as in adenocarcinoma of the oesophagogastric junction or cardia) or through the release of unspecified humoral factors that disturb the oesophageal function, especially in patients with small cell lung cancer [ 8 ], but this has also been reported in pancreatic cancer [ 9 ], pleural mesothelioma [ 10 ], multiple myeloma [ 11 ], diffuse large B-cell lymphoma [ 12 ], metastatic breast cancer [ 7 , 13 ] and cervical carcinomas [ 14 ]. Early recognition of malignancy-associated pseudoachalasia is necessary to avoid inappropriate treatment and delay of adequate therapy; however, the differential diagnosis between idiopathic achalasia and pseudoachalasia is very challenging since clinical and diagnostic features, such as radiographic studies, endoscopy and manometry, are often similar in both diseases.…”

Section: Discussionmentioning

confidence: 99%

When a Late Metastasis Is Hard to Swallow

Negrão¹,

Sismeiro²,

Monteiro³

et al. 2021

Cureus

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Pseudoachalasia is an uncommon disorder characterised by aperistalsis in the tubular oesophagus and impaired relaxation of the lower oesophageal sphincter (LES). It presents with symptoms and radiologic, endoscopic and manometric findings that mimic idiopathic achalasia. There is a huge spectrum of underlying causes for pseudoachalasia, although malignancy is the most common aetiology. We report the case of a 70-year-old Portuguese female with a history of breast cancer, submitted to tumourectomy, radiotherapy and hormonotherapy, in complete remission for 16 years, who presented in the emergency department with a two-month history of dysphagia, weight loss, heartburn and nausea. Blood work, body computed tomography (CT) scan, mammography, upper endoscopy, colonoscopy and skeletal scintigraphy did not show any alterations, but barium swallow scan and oesophageal manometry suggested achalasia. She was submitted to oesophageal dilatation with partial symptomatic improvement. Six months later, new onset of dysphonia and worsening of initial symptoms was noticed. A new CT scan revealed unilateral pleural effusion, large mediastinal adenopathy and multiple pulmonary nodules highly suggestive of a metastatic malignancy. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) from mediastinal adenopathies confirmed the tumoural invasion by a carcinoma, and immunohistochemistry suggested a breast origin. She underwent a nasoendoscopy that revealed bilateral vocal cord paralysis. After chemotherapy was started, symptoms of achalasia completely resolved, and tumour markers, which were increased, have normalised. The presented case highlights a pseudoachalasia as the first manifestation of a late breast metastasis. It is essential to always have in mind patients’ past history as a key that can help resolve clinical doubts.

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“…Subsequent reports have documented that pseudoachalasia is caused by malignancy in the majority of patients, usually esophageal or gastric carcinoma [2]. However, other malignancies such as breast carcinoma [3] or lymphoma [4] may also present in this manner. Benign causes of pseudoachalasia have also been reported, usually after surgical procedures in the gastroesophageal junction such as fundoplication [5] or gastric banding [6].…”

Section: Commentmentioning

confidence: 99%