Wang Jian-Bo, Gao Yang, Liu Jun-Wei, Dai Mu-Gen, Yang Shang-Wen, Ye Bin
Department of Gastroenterology, Lishui Hospital of Zhejiang University, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui 323000, Zhejiang Province, China.
Department of Radiology, Lishui Hospital of Zhejiang University, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui 323000, Zhejiang Province, China.
World J Clin Cases. 2021 Mar 16;9(8):1871-1876. doi: 10.12998/wjcc.v9.i8.1871.
Gastroesophageal varices are a rare complication of essential thrombocythemia (ET). ET is a chronic myeloproliferative neoplasm (MPN) characterized by an increased number of blood platelets.
A 46-year-old woman, who denied a history of liver disease, was admitted to our hospital on presentation of hematemesis. Laboratory examination revealed a hemoglobin level of 83 g/L, and a platelet count of 397 × 10/L. The appearance of gastric and esophageal varices with red colored signs as displayed by an urgent endoscopy was followed by endoscopic variceal ligation and endoscopic tissue adhesive. Abdominal computed tomography revealed cirrhosis, marked splenomegaly, portal vein thrombosis and portal hypertension. In addition, bone marrow biopsy and evidence of mutated Janus kinase 2, substantiated the onset of ET. The patient was asymptomatic with regular routine blood testing during the 6-mo follow-up period. Therefore, in this case, gastroesophageal varices were induced by ET.
MPN should be given considerable attention when performing differential diagnoses in patients with gastroesophageal varices. An integrated approach such as laboratory tests, radiological examination, and pathological biopsy, should be included to allow optimal decisions and management.
胃食管静脉曲张是原发性血小板增多症（ET）的一种罕见并发症。ET是一种慢性骨髓增殖性肿瘤（MPN），其特征是血小板数量增加。
一名46岁女性，否认有肝脏疾病史，因呕血入院。实验室检查显示血红蛋白水平为83 g/L，血小板计数为397×10⁹/L。紧急内镜检查显示胃和食管静脉曲张并有红色征，随后进行了内镜下静脉曲张结扎术和内镜组织黏合剂治疗。腹部计算机断层扫描显示肝硬化、明显脾肿大、门静脉血栓形成和门静脉高压。此外，骨髓活检及Janus激酶2突变的证据证实了ET的发病。在6个月的随访期内，患者通过定期血常规检查未出现症状。因此，在该病例中，胃食管静脉曲张由ET引起。
在对胃食管静脉曲张患者进行鉴别诊断时，应高度重视MPN。应采用实验室检查、放射学检查和病理活检等综合方法，以便做出最佳决策和管理。
