Plummer-Vinson综合征并发下咽癌1例报告及文献复习

Plummer-Vinson syndrome complicated with hypopharyngeal carcinoma:A case report and literature review

目的:观察Plummer-Vinson综合征(PVS)患者中颈段食管蹼样狭窄的临床表现,分析其与下咽癌发病的关系,提高临床医生对该疾病的认识。方法:对临床上极为少见的1例PVS并发下咽癌患者的诊治过程进行总结,并结合相关文献分析其临床特点。结果:1例以“吞咽困难”为主诉的PVS患者,经电子喉镜检查和病理活检后诊断为下咽癌。经胃镜检查,患者下咽后壁及侧壁向下延伸至食管蹼上方的黏膜在窄带成像(NBI)中可见大量上皮内乳头样毛细血管襻(IPCL)。于IPCL密集处的下咽黏膜行病理活检,结果为中-重度不典型增生。入院后给予针对下咽癌的诱导化疗2个疗程后,患者症状消失,肿瘤体积明显缩小。结论:下咽癌的发生与PVS的黏膜改变有关。NBI技术有助于早期诊断PVS患者下咽及食管黏膜变性。

Objective: To observe the clinical manifestations of cervical esophageal webbed stenosis in the patients with Plummer-Vinson syndrome(PVS) and analyze its relationship with hypopharyngeal carcinoma,and to raise the clinicians’ awareness of the disease.Methods:The diagnosis and treatment process of one patient with PVS complicated with hypopharyngeal carcinoma was summarized,and its clinical characteristics were analyzed in combination with relevant literatures.Results:A 39-year-old patient with PVS as a complaint by “dysphagia” was diagnosed as hypopharyngeal carcinoma by electronic laryngoscope and pathological biopsy.A lot of intraepithelial papillary capillary loops (IPCL) were seen on narrow band imaging(NBI) of the mucosa extending downward from the posterior and lateral walls of the hypopharynx to the upper part of the esophageal web.The hypopharyngeal mucosa with dense IPCL was found to have moderate to severe dysplasia.After 2 courses of induction chemotherapy for hypopharyngeal carcinoma,the symptoms disappeared and the tumor volume was significantly decreased.Conclusion: The occurrence of hypopharyngeal carcinoma is related to the mucosal changes of PVS.NBI technique is helpful for early diagnosis of hypopharyngeal and esophageal mucosal degeneration in the PVS patients.