Esophageal cancer and trachea-esophageal fistula in Achalasia - A case report

Achalasia is an idiopathic motility disorder of esophagus which is characterised by an impaired relaxation of the lower esophageal sphincter and decreased motility of the esophageal body. It is considered as premalignant lesion for development of esophageal cancer. We present a case of 70 year old woman who had dysphagia for 30 years presented with worsening dysphagia for last 2 months, productive cough and significant weight loss. UGI scopy showed ulceroproliferative growth with tracheo-esophageal fistula in upper esophagus and dilated, aperistaltic lower esophagus. There was increased resistance at GE junction. Multiple Biopsies were taken from the growth and Histopathology showed moderately differentiated squamous cell carcinoma. CECT Thorax showed heterogenously enhancing thickening of upper esophagus with tracheo-esophageal fistula between right posterolateral wall of trachea and anterior wall of upper esophagus, dilated distal esophagus with fluid level, multiple mediastinal lymphadenopathy and consolidation with nodular parenchymal infiltrates in both lungs. Since patient has stage IV esophageal squamous cell carcinoma, she was treated with palliative chemotherapy. Malignancy of esophagus in Achalasia is rare but has to be anticipated in long standing Achalasia, for an early diagnosis curative treatment.