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一例通过消化内镜检查发现的下咽淀粉样变性病例。

A case of hypopharyngeal amyloidosis by digestive endoscopy.

作者信息

He Ling, Su Wei, Li Lingli, Zhou Qiao, Zhao Qiuling, Li Hongping

机构信息

Gastroenterology Hospital, Affiliated Hospital of Zunyi Medical University; Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou 563000, China.

出版信息

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2024 Apr 28;49(4):643-648. doi: 10.11817/j.issn.1672-7347.2024.230483.

Abstract

Amyloidosis is a rare disease. This paper reports a case of localized secondary hypopharyngeal amyloidosis presenting with pulmonary tuberculosis as the initial symptom. The patient lacked specific clinical manifestations and primarily exhibited symptoms such as cough, sputum production, acid reflux, belching, and abdominal pain. Chest CT indicated bronchiectasis with infection and pulmonary tuberculosis. Digestive endoscopy revealed a white mucosal elevation at the right pyriform sinus of the hypopharynx. Pathological diagnosis confirmed amyloid deposits in the hypopharyngeal mucosal tissue. The patient tested positive for anti-amyloid A antibodies, Congo red staining (+), and periodate Schiff staining (+). Amyloidosis commonly affects the digestive system and may have various etiologies, often presenting with symptoms that overlap with other digestive system diseases, leading to frequent misdiagnosis and missed optimal treatment opportunities. The hypopharynx, a highly folded and narrow chamber that serves as a common passage for the digestive and respiratory tracts, can be effectively evaluated for amyloidosis using digestive endoscopy.

摘要

淀粉样变性是一种罕见疾病。本文报告一例以肺结核为首发症状的局限性继发性下咽淀粉样变性病例。该患者缺乏特异性临床表现,主要表现为咳嗽、咳痰、反酸、嗳气及腹痛等症状。胸部CT显示支气管扩张伴感染及肺结核。消化内镜检查发现下咽右侧梨状窝有白色黏膜隆起。病理诊断证实下咽黏膜组织中有淀粉样沉积物。患者抗淀粉样蛋白A抗体检测呈阳性,刚果红染色(+),过碘酸希夫染色(+)。淀粉样变性常累及消化系统,病因多样,症状常与其他消化系统疾病重叠,易导致误诊及错过最佳治疗时机。下咽是一个高度折叠且狭窄的腔隙,是消化和呼吸道的共同通道,利用消化内镜可有效评估下咽淀粉样变性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a345/11255184/bf5845ca0824/ZhongNanDaXueXueBaoYiXueBan-49-4-643-g001.jpg

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