Esophageal cancer diagnosed by high-resolution manometry of the esophagus: A case report

Abstract

A 48-year-old female who presented with a history of dysphagia for 5 months and regurgitation for 1 week was referred to the Sir Run Run Shaw Hospital (Hangzhou, China) for further evaluation, since the gastroscopy and endoscopic ultrasound performed in local hospitals did not reveal the presence of cancer. High-resolution manometry (HRM) of the esophagus was performed to determine the patient's condition, and revealed an abnormal high-pressure zone that was located 33 cm from the incisor and did not relax upon swallowing. Synchronous waves were observed, and the pressure of the esophageal lumen was found to increase with secondary synchronous peristaltic waves. The lower esophageal sphincter was 39 cm from the incisor and relaxed upon swallowing. The abnormal high-pressure zone could have been caused by an obstruction, and therefore an upper gastrointestinal series (barium swallow) test and gastroscopy were recommended to further pinpoint the cause. Following the two examinations, mid-esophageal cancer was considered as a possible diagnosis. A biopsy was performed and the final diagnosis was that of basaloid squamous cell carcinoma. The findings of the present study suggest that, for patients with evident symptoms of esophageal motor dysfunction without significant gastroscopy findings, HRM is recommended.

Keywords: basaloid squamous cell carcinoma of the esophagus; esophageal neoplasms; high-resolution manometry of the esophagus.

Figure 1.

High-resolution esophageal manometry recording showing an abnormal increase in the upper esophageal sphincter pressure (red arrow) and an abnormal high-pressure zone 33 cm from the incisor (yellow arrow), above the high-pressure zone. Synchronous waves were observed upon swallowing (black arrows), together with secondary peristaltic waves. The peristaltic waves were shown to remain even without swallowing, and pressure in the esophageal lumen was increased (rectangle), causing food to remain. Partial liquid flow from the esophagus into the stomach through the high-pressure zone was noted, and the lower esophageal sphincter was shown to relax upon swallowing (circle).

Figure 2.

Image from the upper gastrointestinal series (barium swallow) test showing a mucosal lesion, filling defect and wall stiffness along 56 mm of the esophagus below the arcus aortae. The barium had difficulty in passing through that region, indicating that the proximal esophagus was dilated.

Figure 3.

Gastroscopy imaging results revealing the presence of nodular irregular ulcers with thick fur on the surface and surrounding lip-like mucosa 25–30 cm from the incisor. These lesions resulted in the narrowing of the lumen, which made the advancement of the endoscope difficult.