Paraneoplastic oesophageal dysmotility-renal cell carcinoma presenting as dysphagia: a case report

Mahesh D Bhalme,Scott E Levison,Gurvinder S Banait

doi:10.4076/1757-1626-2-8170

Mahesh D Bhalme, Scott E Levison + Show 1 more

Open Access

https://doi.org/10.4076/1757-1626-2-8170

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Abstract

IntroductionDysphagia and weight loss are alarming symptoms that warrant urgent assessment.Case presentationWe present a case report of dysphagia secondary to oesophageal dysmotility attributed to a paraneoplastic manifestation of an occult renal cell carcinoma.ConclusionWe believe this patient's dysphagia was a paraneoplastic manifestation of the renal cell tumour, an association that has never been previously reported. This case demonstrates the need to look for alternative causes for dysphagia if initial investigation and treatment are unhelpful. Importantly, this must include the consideration of a paraneoplastic process secondary to an occult neoplasm.

Highlights

Dysphagia and weight loss are alarming symptoms that warrant urgent assessment
Case presentation: We present a case report of dysphagia secondary to oesophageal dysmotility attributed to a paraneoplastic manifestation of an occult renal cell carcinoma
We believe this patient’s dysphagia was a paraneoplastic manifestation of the renal cell tumour, an association that has never been previously reported. This case demonstrates the need to look for alternative causes for dysphagia if initial investigation and treatment are unhelpful. This must include the consideration of a paraneoplastic process secondary to an occult neoplasm

Summary

Introduction

Dysphagia and weight loss are alarming symptoms that warrant urgent assessment to determine its cause and initiate appropriate treatment. Case presentation A previously well 55 year old Caucasian male presented to gastroenterology out patients clinic in November 2003, with a three week history of worsening dysphagia to solids and weight loss of 4 kilograms He described a sensation of food sticking at the level of the lower sternum. A liquid barium swallow showed no abnormality, a swallow with a solid medium (bread soaked in barium) detected a significantly abnormal non-specific dysmotility of the lower oesophagus (Figure 1a,b). The patient was given regular metoclopramide and dietary input to optimise his nutritional status He underwent a left radical nephrectomy for a poorly differentiated renal cell carcinoma (stage T3b, N0, Mx) at the end of December 2003. Repeat oesophageal manometry and pH study at 12 months after presentation was normal He remains well and annual CT scan surveillance has remained normal to date

Discussion

Conclusion

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