Long-term evolution of squamous-cell cancer in Plummer-Vinson syndrome

Plummer-Vinson syndrome (PVS, Paterson-Kelly) is a clinical condition that is frequently seen in middle-aged women, and is characterised by iron deficiency anaemia, proximal oesophageal web, and dysphagia [1].
Today the progress seen in the amount and variety of foods as well as the more frequent iron replacement practices for women has decreased the prevalence of PVS. It has been stated that there was an increase in the prevalence of cancer in the upper digestive system in patients with PVS [2, 3]. Endoscopic follow-up is recommended because there is an increase in the risk of cancer development in the oral cavity, pharynx, squamous-cell cancer (SCC) of the oesophagus, and gastric adenocarcinoma in long-term follow-ups [3, 4]. The cause of the dysphagia, which was seen 6 years later in our 38-year-old male patient, who had received endoscopic treatment of the oesophageal web and started on iron replacement because of PVS, was advanced-stage local oesophageal SCC.
The 38-year-old male patient had presented to our outpatient clinic 9 years earlier because of dysphagia, fatigue, and weight loss. His evaluation had not revealed any history of chronic illness, smoking, or alcohol consumption. According to his laboratory results his haemoglobin level was 10.5 g/dl (normal range: 12.2–18.1), haematocrit level was 35.0% (normal range: 37.7–53.7), iron level was 12 µg/dl (normal range: 25–156), and mean corpuscular volume (MCV) 64.5 fl, which were in line with iron deficiency anaemia. The peripheral blood smear conducted within the scope of the initial evaluation for anaemia showed an outlook concordant with iron deficiency anaemia (Figure 1, upper left corner). The barium swallow performed for dysphagia demonstrated narrowness in the proximal oesophagus (Figure 2). Endoscopic evaluation revealed a web causing narrowness in the proximal (Figure 3), and it was dilated by bougie. While the other parts of the oesophagus and stomach were normal, duodenal bulbus was oedematous, and a biopsy was performed. Duodenal biopsy revealed signs of chronic inflammation. The colonoscopic evaluation for anaemia showed no pathological signs. The patient was diagnosed with PVS, started on oral iron preparation, and taken into the follow-up program.
The patient’s third-month follow-up showed that his dysphagia had regressed. His laboratory results at this stage were: haemoglobin 14.8 g/dl, haematocrit 43.2%, mean corpuscular volume (MCV) 81.6 fl, and iron level 104...


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