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A 45-year-old man presented with odynophagia, felt in the region of the upper chest. Upper GI endoscopy was normal and proton pump inhibitor therapy ineffective. Oesophageal function tests showed no reflux on 24 h pH monitoring; manometry revealed ineffective oesophageal motility (low-amplitude peristalsis) thought to explain his symptoms. He re-presented 6 years later with worsening odynophagia; repeat endoscopy showed a 1 cm nodule in the proximal oesophagus at 24 cm from the incisor teeth. Endoscopic biopsies showed features of low-grade adenocarcinoma of mucinous/tubular type. He was referred to the network upper GI cancer multidisciplinary team and a decision was made for further endoscopic assessment, after staging CT and positron emission tomography scans did not identify the tumour or any metastases; endoscopic ultrasound (EUS) was not performed. …
Contributors CM, SB and JdC prepared the manuscript. CM and CJR prepared the histopathology images. JdC prepared the endoscopic images. CM, SB, CJR, SU and JdC reviewed the manuscript and contributed with their comments to the final version of the manuscript. SB and JdC conceived and finalised the manuscript. All authors approved the submitted manuscript.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.