口咽癌误诊为原发性舌咽神经痛的原因分析及文献回顾OA

Objective To investigate the etiology of oropharyngeal cancer misdiagnosed as primary glossopharyngeal neuralgia(GPN)and to propose preventive strategies.Methods A retrospective analysis was conducted on the clinical data,including disease characteristics,clinical manifestations,differential diagnosis,and clinical management,of a patient admitted to the Second Hospital of Lanzhou University in November 2019,who presented with sore throat and tongue base ulcer as initial symptoms.Results The patient experienced pharyngalgia that was most pronounced during swallowing,accompanied by pain in the right retroauricular and mastoid regions,occasional headaches,acid regurgitation,belching,and a retrosternal burning sensation.Notably,there were no symptoms of dyspnea,cough,sputum production,or hemoptysis.Initial electronic laryngoscopy indicated an ulcer of unknown etiology in the laryngopharynx.The patient was subsequently referred to the Neurosurgery Department,where brain magnetic resonance imaging(MRI)led to a diagnosis of primary GPN.Microvascular decompression of the glossopharyngeal nerve and cranioplasty were performed,yielding only marginal symptomatic relief.Five months afterwards,the patient presented with aggravated right-sided pharyngalgia and hemoptysis.Follow-up electronic laryngoscopy revealed a neoplasm at the right tongue base,which was pathologically confirmed as oropharyngeal cancer.The patient was then transferred to a cancer hospital for comprehensive management,comprising three cycles of chemotherapy,eight sessions of targeted therapy,and 31 fractions of intensity-modulated radiotherapy(IMRT).The patient survived for eight months before ultimately succumbing to pulmonary infection and multiple organ failure.Conclusion Clinicians must maintain a high index of suspicion when evaluating common symptoms,ensuring comprehensive history taking and meticulous physical examinations.Organic pathologies must be definitively excluded before considering functional disorders.Multidisciplinary collaboration is pivotal in elucidating the differential diagnosis of complex pharyngalgia with multiple confounding factors,thereby minimizing the incidence of missed and misdiagnoses.