Abstract
We present a case of secondary achalasia due to an adenocarcinoma of the stomach with no tumor infiltration of the esophagus. Immunohistochemical staining revealed a massive infiltration of activated eosinophils in the muscularis of the esophagus with secretion of the highly cytotoxic and neurotoxic eosinophil cationic protein (ECP). Immunohistochemical staining for the neuropeptides VIP and substance P, as well as the histochemical demonstration of AChE, revealed a nearly total absence of all three neurotransmitters/modulators compared to control. The hypothesis is advanced that eosinophil neurotoxicity is the cause of secondary achalasia.
Publication types
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Case Reports
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Research Support, Non-U.S. Gov't
MeSH terms
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Adenocarcinoma / complications
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Adenocarcinoma / pathology
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Aged
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Blood Proteins / analysis
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Eosinophil Granule Proteins
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Esophageal Achalasia / etiology*
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Esophageal Achalasia / metabolism
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Esophageal Achalasia / pathology
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Esophagus / analysis
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Esophagus / innervation*
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Esophagus / pathology
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Humans
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Immunohistochemistry
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Male
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Nerve Fibers / pathology*
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Ribonucleases*
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Stomach Neoplasms / complications*
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Stomach Neoplasms / pathology
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Substance P / analysis
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Vasoactive Intestinal Peptide / analysis
Substances
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Blood Proteins
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Eosinophil Granule Proteins
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Substance P
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Vasoactive Intestinal Peptide
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Ribonucleases