title: Laparoscopic diagnosis of pleural mesothelioma presenting with pseudoachalasia.
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.
authors.affiliation: Department of Surgery, University of Milano School of Medicine, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese (Milano), Italy.
authors.forename: Greta
authors.initials: G
authors.lastname: Saino
authors.forename: Davide
authors.initials: D
authors.lastname: Bona
authors.forename: Marco
authors.initials: M
authors.lastname: Nencioni
authors.forename: Barbara
authors.initials: B
authors.lastname: Rubino
authors.forename: Luigi
authors.initials: L
authors.lastname: Bonavina
mesh_terms: D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology* / Q000473:pathology; D004931:Esophageal Achalasia / Q000209:etiology* / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008654:Mesothelioma / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D010997:Pleural Neoplasms / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D015607:Stents