Clinical and therapeutic features of Plummer-Vinson syndrome in a Tunisian population: a case series.

Plummer Vinson syndrome (PVS) is a rare entity and most publications are case or series of cases. Thus, we report a series from southern Tunisia. Our aim was to analyse the epidemiological and clinical characteristics, the therapeutic modalities as well as the evolution of this pathology. Thus we carried out a retrospective study from 2009 until 2019. For each patient with PVS, we collected the epidemiological, clinical, paraclinical data and therapeutic modalities. A total of 23 patients were enrolled with a median age of 49.52 years [18-82 years] and a clear female predominance (M/F=2/21). The median duration of dysphagia was 42 months [4-92 months]. Moderate microcytic hypochromic anemia was noted in 16 patients. The anemia was without obvious cause in 60.8% (n=14) of cases. The main endoscopic finding was a diaphragm in the cervical area. Treatment was based on iron supplementation followed by endoscopic dilatation with Savary dilators in 90.9% (n=20) and balloons for 9.1% of patients (n=2). Dysphagia recurred in 5 patients after a median of 26.6 months [2-60 months]. Three cases of PVS were complicated by esophageal squamous cell carcinoma. In conclusion, our series confirms that PVS affects mostly women. Anemia is frequently noted in these patients. Treatment is based on endoscopic dilatation which is often an easy and risk-free procedure and iron supplementation.

Plummer-Vinson syndrome.

Plummer-Vinson or Paterson-Kelly syndrome presents as a classical triad of dysphagia, iron-deficiency anemia and esophageal webs. Exact data about epidemiology of the syndrome are not available; the syndrome is extremely rare. Most of the patients are white middle-aged women, in the fourth to seventh decade of life but the syndrome has also been described in children and adolescents. The dysphagia is usually painless and intermittent or progressive over years, limited to solids and sometimes associated with weight loss. Symptoms resulting from anemia (weakness, pallor, fatigue, tachycardia) may dominate the clinical picture. Additional features are glossitis, angular cheilitis and koilonychia. Enlargement of the spleen and thyroid may also be observed. One of the most important clinical aspects of Plummer-Vinson syndrome is the association with upper alimentary tract cancers. Etiopathogenesis of Plummer-Vinson syndrome is unknown. The most important possible etiological factor is iron deficiency. Other possible factors include malnutrition, genetic predisposition or autoimmune processes. Plummer-Vinson syndrome can be treated effectively with iron supplementation and mechanical dilation. In case of significant obstruction of the esophageal lumen by esophageal web and persistent dysphagia despite iron supplementation, rupture and dilation of the web are necessary. Since Plummer-Vinson syndrome is associated with an increased risk of squamous cell carcinoma of the pharynx and the esophagus, the patients should be followed closely.

[The frequency and development of tissue iron deficiency in 6 iron deficiency anemia patients with plummer-vinson syndrome].

The physical signs of tissue iron deficiency include smooth and red tongue, angular stomatitis, koilonychia, and pica. The incidence of these conditions is unknown in Japan. We evaluated the frequency and development of tissue iron deficiency in 353 patients with iron deficiency anemia. The frequency of tissue iron deficiency was 6.8%; papillary atrophy of the tongue, 5.4%; abnormal nails, 5.4%; angular stomatitis, 1.1%; Plummer-Vinson syndrome, 1.7%; and pica, 0.06%. These findings were compared with the date collected by Wintrobe and Beveridge. The development and incidence of tissue iron deficiency correlated significantly with the severity of iron deficiency anemia.

Plummer-Vinson syndrome. A case report and literature review.

The Plummer-Vinson syndrome is characterized by dysphagia, iron-deficiency anemia, and esophageal webs. The webs are best diagnosed by cineradiography. Iron repletion often improves the dysphagia, although some patients require esophageal dilatation or bougienage. The syndrome is associated with an increased incidence of postcricoid carcinoma, and surveillance endoscopy is recommended.

Estudo anatomopatológico de 794 peças cirúrgicas da tireóide / Anatomopathologic study of 794 surgical specimens of the thyroid gland

Com a finalidade de se conhecer a frequência das doenças da tireóide em peças cirúrgicas, fez-se estudo retrospectivo de 11 anos (1981/1991) nos arquivos do Serviço de Patologia Cirúrgica da Faculdade de Medicina da UFMG, Belo Horizonte - MG. A casuística compreendeu 794 espécimes, sendo 710 (89,4 por cento) de pacientes do sexo feminino e 84 (10,6 por cento) do masculino. Em 80 casos (10,1 por cento), havia associaçäo de duas doenças. As doenças isoladas mais frequentes foram: bócio colóide nodular (399 casos, 50,3 por cento), adenoma folicular (119 casos, 15,0 por cento), bócio hiperplásico difuso (Doença de Graves, 55 casos, 6,9 por cento), carcinoma papilífero (33 casos, 4,1 por cento), doença de Plummer (19 casos, 2,4 por cento), cisto da tireóide (15 casos, 1,9 por cento), tireoidite de Hashimoto (14 casos, 1,8 por cento), carcinoma folicular (11 casos, 1,4 por cento), carcinoma indiferenciado (5 casos, 0,6 por cento), carcinoma medular (4 casos, 0,5 por cento). As associaçöes de doenças mais comuns foram bócio colóide nodular + adenoma folicular (50 casos, 6,3 por cento) e carcinoma papilífero + bócio colóide nodular (8 casos, 1,0 por cento). Lesöes neoplásicas estiveram presentes em 252 pacientes (31,7 por cento), isoladamente ou associadas a outras doenças. Ao todo, foram encontrados 70 casos (8,8 por cento) de neoplasias malignas.

Rise and fall of the Plummer-Vinson syndrome.

Three hypotheses have been proposed for the decreased incidence of Plummer-Vinson disease: non-existence, identity with inlet gastric mucosa of the oesophagus and disappearance of the predisposing condition(s). We examined these possibilities by reviewing our understanding of the syndrome. The early framers disagreed on the cause, but many thought it was a precursor for upper oesophageal carcinoma. Four explanations arose to account for the pathogenesis: iron deficiency; nutritional deficits; autoimmunity; and gastric lesion. We believe the decline in recognition paralleled the improve of dietary status and the treatment of sideropenic anaemia with inorganic iron salts.

[Sideropenic dysphagia]. / La dysphagie sidéropénique.

Ten typical cases of sideropenic dysphagia over four years reported and clinical, biological, endoscopic and radiological signs are studied. The authors stress the value of oesophagal opacification for diagnosis. The particularities of our study are the relative high frequency of the disease in Tunisia and the unusual attack in two black patients.

[Mucoid webs of the cervical esophagus. Apropos of 38 cases discovered during upper endoscopy at the Hôpital Principal of Dakar. Relationship to Plummer-Vinson syndrome]. / Diaphragmes muqueux de l'oesophage cervical. A propos de 38 cas découverts au cours d'endoscopies hautes à l'Hôpital Principal de Dakar. Relation avec le syndrome de Plummer-Vinson.

Thirty-eight cervical esophageal mucous diaphragms were discovered in the course of 15,000 high endoscopies carried out over the past 5 years at Dakar General Hospital. Thirty-six of the sufferers were Black Senegalese. The 29 women and 9 men had an average age of 37 years. Dysphagia was diagnosed 29 times, and anemia 22 times. Endoscopic diagnosis readily shows the mucous diaphragm at the level of, or immediately below, KILLIAN's mouth. PLUMMER-VINSON's syndrome affected 16 of these patients. Treatment consists in collapsing the mucous diaphragm by putting the endoscope through it: this happened to 30 of the patients. Endoscopic surveillance is indispensable because of the risk of cancer, but is difficult to perform.

[A Polynesian case of sideropenic dysphagia]. / A propos d'un cas polynésien de dysphagie sidéropénique.

This first case has been found in a polynesian woman, a casual finding of the above condition during a whole heart decompensation. Clinical, biological, endoscopic and therapeutic aspects of Plummer-Vinson syndrome are reviewed.

Relationship of Plummer-Vinson disease to cancer of the upper alimentary tract in Sweden.

Sideropenic anemia with epithelial lesions (Plummer-Vinson syndrome) was previously very common among women in northern Sweden. The incidence of this condition is decreasing, however, because of better nutrition and improved health care. Plummer-Vinson syndrome as a sequela of previous sideropenic anemia still influences the pattern of hypopharyngeal and oral cancer in northern Sweden where the female/male ratio in these diseases is remarkably high and where cancer in the postcricoid part of the hypopharynx is relatively common. In Sweden as a whole, a decreasing trend in the incidence of hypopharyngeal cancer in women can be demonstrated, which is probably due to diminished prevalence of Plummer-Vinson syndrome.