title: A case of pseudoachalasia hiding a malignant pleural mesothelioma.
abstract: OBJECTIVE
  Malignant pleural mesothelioma (MPM) is a rare cancer with a poor prognosis. We describe a case of MPM with an uncommon onset, characterized by pseudoachalasia as demonstrated with high-resolution manometry (HRM).
  
  
  METHODS
  A 56-year-old man was referred to our hospital reporting worsening dysphagia. On the hypothesis of an esophageal motor disorder, the patient was referred for an HRM examination, which revealed features consistent with a diagnosis of type II achalasia.
  
  
  RESULTS
  At the time of the first pneumatic dilation the endoscopist stopped the procedure in order to prevent perforation when he noticed only partial expansion of the pneumatic balloon. A CT scan and subsequent CT-guided excisional biopsy revealed an epithelioid pleural mesothelioma infiltrating the muscle wall. Given his good clinical condition, the patient was eligible for chemotherapy with cisplatin 75 mg/m2 and pemetrexed 500 mg/m2, resulting in a good response with partial remission of the disease and resolution of the dysphagia symptoms.
  
  
  CONCLUSIONS
  Pseudoachalasia as the first or only manifestation of mesothelioma is a rare occurrence that may expose patients to the risk of diagnostic delay. Close attention should be paid whenever a patient with symptoms and signs consistent with achalasia shows unusual features.
authors.affiliation:  Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan - Italy.| Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan - Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Branchi
authors.affiliation:  Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan - Italy.| Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan - Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Tenca
authors.affiliation:  Oncology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan - Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Bareggi
authors.affiliation:  Epidemiology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan - Italy.
authors.forename: Carolina
authors.initials: C
authors.lastname: Mensi
authors.affiliation:  Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan - Italy.| Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan - Italy.
authors.forename: Aurelio
authors.initials: A
authors.lastname: Mauro
authors.affiliation:  Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan - Italy.| Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan - Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Conte
authors.affiliation:  Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan - Italy.| Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan - Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Penagini
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004931:Esophageal Achalasia / Q000175:diagnosis*; D006801:Humans; D061705:Image-Guided Biopsy; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D008365:Manometry; D008654:Mesothelioma / Q000175:diagnosis*; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D010997:Pleural Neoplasms / Q000175:diagnosis*; D000072078:Positron Emission Tomography Computed Tomography; D011859:Radiography; D016896:Treatment Outcome