[Minimal deviation adenocarcinoma of the uterine cervix in a woman with Peutz-Jeghers syndrome. Report of a case]

We report a case of minimal deviation adenocarcinoma of the uterine cervix in a 32 year old women who present a Peutz Jeghers syndrome. This patient also had fibroadenoma of the breast and dystrophic mastopathy. This case represent an example of predisposition to developing tumors of the Peutz Jeghers syndrome.

Malignancy in Peutz-Jeghers syndrome? The pitfall of pseudo-invasion

Peutz-Jeghers syndrome is a malignancy-associated polyposis syndrome. We describe a histopathologic phenomenon easily encountered when examining the nature of Peutz-Jeghers polyps but that is underreported in the literature. This phenomenon of "pseudo-invasion" may mimic invasive carcinoma due to epithelial displacement and erroneously give the impression, both macroscopically and microscopically, that a malignancy is involved. This potential pitfall is illustrated by the case of a patient with Peutz-Jeghers syndrome who was thought to harbor a metastasizing adenocarcinoma in his small bowel with peritoneal metastasis as a perioperative finding. Histologic examination, however, revealed pseudo-invasion.

Gastrointestinal bleeding and gastric outlet obstruction from Peutz-Jeghers polyposis. Diagnosis and treatment

Images

Consecutive maintenance of human solitary and hereditary colorectal polyps in SCID mice

Recently, the sequential changes from adenoma to adenocarcinoma have been well studied in human colorectal carcinogenesis. To study the precise clonal changes from colorectal polyps to cancer, we have established an experimental system to maintain human colorectal polyps in severe combined immunodeficient (SCID) mice that have been improved by the selective inbreeding of C.B17-scid/scid homozygous male and female showing undetectable serum IgG and IgM (< 1 microgram/ml). Two of two solitary polyps from two nonhereditary colon polyp patients, four of five colon polyps from two Peutz-Jeghers' syndrome patients and one polypoid lesion from a familial polyposis coli (FAP) patient grew very slowly but steadily, at approximately one-tenth the rate of their malignant form, (i.e., adenocarcinoma), in the improved SCID mice and were maintained for a long period (more than 2 years), over several mouse generations. However, two polyps from FAP and Peutz-Jeghers' syndrome patients could not be transplanted further because of microinfection at the transplanted site due to incomplete sterilization of original human tumors prior to surgical operation (endoscopic polypectomy). Transplanted colon polyps had a semitransparent, soft and sticky appearance, with cells containing large amounts of mucin. Malignant transformation of human colon polyp to adenocarcinoma has not been observed during the maintenance period (about 2 years) in SCID mice. In the consecutively maintained human colon polyps, however, K-ras mutations were detected at codon 12, while these mutations were not found in their original polyps in the patients.

Peutz-Jeghers syndrome associated with primary malignant melanoma of the rectum

An 85-year-old Chinese woman was found to have mucocutaneous pigmentation involving the lips, buccal mucosa, hard palate and the buttocks when she presented with primary malignant melanoma of the rectum. Multiple brown-black pigmentation was also noted in the anal canal and the adjacent mucosa surrounding the tumour. This is the first report of Peutz-Jeghers syndrome associated with malignant melanoma of the rectum.

A solitary Peutz-Jeghers-type hamartomatous polyp of the rectum: report of a case and review of the literature

A solitary Peutz-Jeghers-type polyp of the rectum in a 64-year-old Japanese man is reported. Barium enema and endoscopic examination revealed a solitary polypoid lesion in the rectum. The polyp was pedunculated, and measured 2 x 1.5 x 1.5 cm. The patient had neither mucocutaneous pigmentation nor a family history of gastro-intestinal polyposis. Histopathologically, this polyp had an arborizing muscular network originating from the muscularis mucosa, and was covered by well organized mucosa with epithelial hyperplasia. The smooth muscle bundles in the polyp were thicker than those seen in Peutz-Jeghers syndrome, but their network was not as complex.

Solitary Peutz-Jeghers type polyp of the duodenum containing a focus of adenocarcinoma

The case of an 84-year-old woman with evidence of continuous gastrointestinal bleeding is presented. A barium study and endoscopy showed a 25 x 20 mm sized semipedunculated polyp in the second portion of the duodenum. No other lesion was found throughout the entire gastrointestinal tract, and endoscopic resection of the duodenal polyp was performed. The resected polyp showed typical histologic features of a Peutz-Jeghers type hamartomatous polyp, although the patient lacked any familial history and signs related to the Peutz-Jeghers syndrome. A focus of adenocarcinoma was also found within the polyp. The present case would appear to be the first demonstration of a solitary Peutz-Jeghers type hamartomatous polyp of the duodenum containing a focus of adenocarcinoma.

[Molecular changes in adenocarcinoma of the small intestine associated with Peutz-Jeghers syndrome]

The presence of molecular alterations in the c-K-ras and p53 genes in a small bowel adenocarcinoma arising in a case of Peutz-Jeghers syndrome is reported. The absence of mutations at codon 12 and 13 of the c-K-ras gene in the hamartoma and carcinoma indicates that this oncogene does not contribute to its development. On the other hand, p53 protein overexpression was detected in a small proportion (5-10%) of adenocarcinoma cells. Our findings suggest that p53 inactivation occur in late stages of tumour progression.

[Peutz-Jeghers syndrome. Apropos a familial case at Hospital Arzobispo Loayza]

The Peutz-Jeghers syndrome is a rare dominant autosomic, entity characterized by hyperpigmented lesions on the lips, hands and feet; with presence of gastrointestinal polyps producing acute or chronic anemia, intestinal obstruction, and/or abdominal pain. This polyps histologically are hamartomas; recent studies indicate a real risk for transformations in the malignant neoplasia. The high and low endoscopies and the intraoperative enteroscopy with polypectomy are the election treatment, improving prognosis quality on these patients. We describe a familiar case of a female patient 24 years old showing a repeated picture of intestinal subocclusion; her brother presented a similar clinical picture, and her mother presented the same syndrome, dying of carcinoma in the colon; also her child, at one and a half year old presented hyperpigmented lesions on the lips.

Polyposis: the Peutz-Jeghers syndrome

The classical pigmentation of Peutz-Jeghers syndrome distinguishes it immediately from the other polyposis syndromes. Less widely appreciated than this most obvious manifestation are the pitfalls in management presented by the risk of cancer and by the performance of multiple laparotomies that also characterize this condition. An outline of these risks and an approach that minimizes them is presented.

Appendiceal intussusception due to an appendiceal malignant polyp--an association in a patient with Peutz-Jeghers syndrome: report of a case

A 40-year-old woman with Peutz-Jeghers syndrome and an appendiceal intussusception is reported. In this patient, the lead point was a large sessile, appendiceal polyp. The invaginated and inverted portion of the appendix resembled the long stalk of a pedunculated polyp on roentgenography and endoscopic examination. Histologically, the appendiceal polyp was a villous adenoma with mild to severe atypia and focal carcinoma in situ. In patients with Peutz-Jeghers syndrome, hamartomatous polyps and colorectal adenomatous polyps with highly malignant potential can coexist and must be managed appropriately. Therefore, when evaluating a polypoid or a pedunculated lesion in the cecal lumen, the possibility of an appendiceal intussusception should also be investigated.

A case of Peutz-Jeghers syndrome with nasal polyposis, extreme iron deficiency anemia, and hamartoma-adenoma transformation: management by combined surgical and endoscopic approach

We report a rare variant of Peutz-Jeghers syndrome identified by the presence of nasal polyposis and extreme anemia. Multiple hamartomatous polyps were found throughout the upper and lower gastrointestinal tract. We conducted a combined surgical-endoscopic approach to prevent the development of a short-bowel syndrome. The polyps removed by snare and surgical polypectomy showed features typical of harmartomas. Three colonic polyps and two nasal polyps showed histological evidence of adenomatous change. This adenomatous change seems to fit into the pathogenic sequence of hamartoma-adenoma.

Peutz-Jeghers syndrome in a neonate

A 15-day-old girl was found to have generalized gastrointestinal polyposis resulting from Peutz-Jeghers syndrome. Her manifestations included abdominal distention, hematemesis, bloody diarrhea, and edema. She died at 1 year of age of multiple complications of her disease.

Peutz-Jeghers syndrome with osseous metaplasia of the intestinal polyps

A case of Peutz-Jeghers syndrome (PJS) with osseous metaplasia in three of 15 hamartomatous polyps of the small intestine is reported. At 35 years of age, the patient was diagnosed as having PJS by cutaneous pigmentation around the mouth and polyposis of the stomach, duodenum and intestine. Fifty-two polys of the large intestine were resected, which were characteristic of those of PJS. Three of them showed adenomatous and carcinomatous changes, but there was no osseous metaplasia in any of the resected polyps. At age 40, he had surgery under the diagnosis of intestinal obstruction. There were 15 polyps in the resected jejunum. These polyps were also characteristic of those of PJS. Additionally, three of these polyps were accompanied by osseous metaplasia. Histologically, mature bone formation and calcification were found close to the hyperplastic glands in the submucosa or in the propriate muscle. Malignant transformation was not observed. Osseous metaplasia is extremely rare in benign polyps, and it has not been reported in hamartomatous polyps of PJS to date. The knowledge of this association may be helpful in the clinical diagnosis of this benign lesion in PJS.

[Peutz-Jeghers syndrome. Cases at the Mannheim clinic over 25 years]

Observations in our clinic and others reviewed in the literature result in a new picture of the Peutz-Jeghers syndrome. It turns out to be a hereditary polypose syndrome which is hard to define. The tendency to malignant degeneration of polyps and development of associated neoplasms is almost impossible to forecast. In addition operations frequently involve complications and often need to be repeated more than once. Radical removal of all polyps must be the aim of treatment; the patients must then be closely followed up by clinical examination, endoscopy and radiology to avoid complications of regrowth and to make sure degeneration and associated neoplasms are detected at an early stage.

Peutz-Jeghers syndrome

Peutz-Jeghers syndrome is inherited as an autosomal dominant trait with variable incomplete penetrance. Patients with Peutz-Jeghers syndrome characteristically have hamartomatous polyps throughout their entire gastrointestinal tract, particularly in the small bowel, and mucocutaneous hyperpigmentation involving the lips, oral cavity, and skin. Although the intestinal hamartomatous polyps have a lower incidence of malignant change in the gastrointestinal tract than do adenomatous polyps, recent information suggests that the overall neoplastic transformation from Peutz-Jeghers syndrome is not a rare event.

Frequency, location, and age and sex distribution of various types of gastric polyp

Data on the frequency and location of the various types of gastric polyps are highly inconsistent. In a retrospective analysis of 5515 gastric polyps obtained from 4852 patients in the period between 1969 and 1989, including reexamination of 197 surgical, 1572 polypectomy, and 3746 biopsy specimens, the most frequent types found were Elster's glandular cysts (fundic gland polyps) (47.0%), followed by hyperplasiogenous polyp (28.3%), tubular adenoma (9.0%), adenocarcinoma (7.2%), inflammatory fibroid polyp (3.1%), carcinoid tumor (1.7%), Brunner's gland heterotopia (1.2%), and tubulopapillary adenoma (1.0%). Peutz-Jeghers polyps, juvenile polyps, and pancreatic heterotopia were found in younger patients (mean ages: 33.39 and 45 years, respectively), whereas the age of most patients (66%) with glandular cysts was between 40 and 69 years. Patients with any of the other types of gastric polyps were mostly (55-100%) over 60 years of age at the time of diagnosis. Glandular cysts, hyperplasiogenous polyps, inflammatory fibroid polyps, and carcinoid tumors were significantly more common in women, while all the other polyps were more or less equally distributed between the sexes. Glandular cysts and carcinoid tumors were relatively small (mean diameter 8 mm), and were mostly located in the corpus (100% and 83%, respectively). Medium-sized pancreatic heterotopias, Brunner's gland heterotopias, and inflammatory fibroid polyps (mean sizes 7-10 mm) were usually located in the antrum (100%, 81%, 80%, respectively), while the other polyps had an average size of between 10 and 16 mm and were distributed equally throughout the stomach.(ABSTRACT TRUNCATED AT 250 WORDS)

[Peutz-Jeghers syndrome and adenocarcinoma. Report of a case]

Peutz-Jeghers syndrome is a rare disease, characterized by autosomic inheritance, presenting skin stain and hamartomatous polyps. We report one case of Peutz-Jeghers syndrome and duodenal adenocarcinoma in a young male who presented with liver metastasis and pancreatic invasion. Such association is reported to be presented in 5% of patients with the syndrome. The reasons of such association are unknown, being possible that: 1) there is malignant degeneration of a adenomatous polyp; 2) malignant degeneration of a hamartomatous polyp, or 3) adenomatous portion of a hamartomatous polyp could undergo malignant transformation.

Progression toward malignancy of hamartomas in a patient with Peutz-Jeghers syndrome: case report and literature review

Peutz-Jeghers syndrome, inherited in an autosomal dominant fashion, is characterized by hamartomatous polyps of the gastrointestinal tract and by mucocutaneous pigmentation. The frequency of gastrointestinal malignant disease in this syndrome is estimated to be 2% to 3%. The authors review reports associating Peutz-Jeghers syndrome with malignant disease and present a patient who had advanced jejunal adenocarcinoma in association with Peutz-Jeghers syndrome. It has not been determined with certainty whether the malignant lesions arise from hamartomas, from associated adenomatous polyps or from the normal mucosa. Histologic examination of the excised specimen from the patient reported in this paper showed areas typical of a hamartoma as well as areas of hyperplasia, adenoma with mild to severe dysplasia and carcinoma in situ all in the same polyp. These findings suggest that the hamartomatous polyps found in Peutz-Jeghers syndrome have the potential to undergo malignant transformation.

[Overflow incontinence--a rare manifestation of Peutz-Jeghers syndrome]

We present the case of a 12-year-old girl with Peutz-Jeghers syndrome (PJS). Enormous polyps of the transverse colon intussuscepting into the rectum turned out to be the rate cause of overflow incontinence. Although she presented all the signs of PJS at infancy, diagnosis was made only after a period of nine years, implying a lack of follow-up. We emphasize that when polyps occur in children, a complete examination is required, and once the diagnosis of Peutz-Jeghers syndrome is established, frequent endoscopic follow-up and resection of polyps are necessary.

Pigmentation of Peutz-Jeghers syndrome occurring in psoriatic plaques

We report a patient with late-onset mucocutaneous pigmentation characteristic of Peutz-Jeghers syndrome, who also developed hyperpigmented macules within pre-existing psoriatic plaques. This has rarely been reported. Macular pigmentation of the forehead and dorsum of the fingers was also a prominent feature. It is important to consider other causes of mucocutaneous pigmentation including Addison's disease, the Laugier-Hunziker syndrome, chemotherapeutic agents and HIV disease.

Solitary hamartomatous duodenal polyp; a different entity: report of a case and review of the literature

Solitary hamartomatous duodenal polyps are a clinical entity considered until now to express an incomplete or initial form of Peutz-Jeghers syndrome (PJ syndrome). Following our experience of 1 case, we analyzed the clinical characteristics of the 12 previously reported cases of solitary hamartomatous duodenal polyps. In none of these cases did we find any documentation of mucocutaneous pigmentation, a family or personal history of intestinal polyps, or local neoplastic degeneration of the disease, and all cases presented during the fifth or sixth decade of life. Thus, we conclude that solitary hamartomatous duodenal polyps constitute a different entity to PJ syndrome, the most appropriate elective treatment for which is endoscopic electrosurgical polypectomy.

Neoplastic transformation arising in Peutz-Jeghers polyposis

PURPOSE AND METHODS

To clarify the potential for malignancy of Peutz-Jeghers polyposis, we investigated 75 gastrointestinal polyps resected surgically or endoscopically from seven patients with this syndrome.

RESULTS

There were 19 polyps in the stomach, 18 in the duodenum, 22 in the small intestine, and 16 in the large intestine, and these were histologically composed of 1 pyogenic granuloma, 1 cancer in adenoma, 2 adenomas, and 71 Peutz-Jeghers polyps. Nine of these Peutz-Jeghers polyps were accompanied by an adenomatous component, and, in addition, two of these showed a cancerous transformation with stalk invasion. A total of 12 neoplastic polyps (16 percent) were found in three relatively young patients (aged 20, 25, and 43 years), all of which were pedunculated and located either in the duodenum or in the jejunum. There was no statistical significance in size between the neoplastic polyps (mean +/- SD, 20.1 +/- 10.8 mm) and the completely hamartomatous polyps (mean +/- SD, 15.8 +/- 9.0 mm). Moreover, the configuration of these types of polyps seemed similar.

CONCLUSION

Neoplastic transformation is not a rare event, and our results may indicate evidence of a hamartoma-adenoma-carcinoma sequence in Peutz-Jeghers polyposis.

Adenoma malignum of uterine cervix in Peutz-Jeghers syndrome: CT and US features

We report CT and ultrasound (US) features of adenoma malignum of the uterine cervix in a patient with Peutz-Jeghers syndrome (PJS) in whom bilateral ovarian mucinous cystadenomas and sex cord tumors with annular tubules were associated. Adenoma malignum was shown as a hyperechoic mass mixed with multiple cysts on US and a low attenuated endocervical mass on CT. We think that imaging demonstration of an endocervical mass is important for the correct diagnosis of adenoma malignum in a female with PJS.

[Peutz-Jeghers syndrome with malignization of hamartomatous polyp]

Peutz-Jeghers syndrome is characterized by hamartomatous polyps in the gastrointestinal tract associated with mucocutaneous melanin spots; the condition is inherited in an autosomic dominant fashion. Although the hamartomatous polyps are not regarded as malignant, there is an association between the Peutz-Jeghers syndrome and the development of carcinomas of the gastrointestinal tract. Similarly, there is an increasing evidence suggesting that hamartomas can give rise to adenocarcinomas. We present a patient with Peutz-Jeghers syndrome who developed an adenocarcinoma in an hamartomatous jejunal polyp.

[Rare manifestation of nasal polyposis in the Peutz-Jeghers syndrome]

We are relating a case of the Peutz-Jeghers syndrome, a disease characterized by hamartomatous polyposis and by mucocutaneous melanic pigmentation, in a rare variant identified by the presence of nasal polyposis. At the objective E.N.T. examination, the patient's nasal fossae were completely obstructed by translucid masses of a polypoid appearance and, moreover, a melanic pigmentation of the cutis, of the perilabial mucosa and of the oral cavity was encountered. At the X-ray examination and, later, during the operation, also the right maxillary sinus appeared completely obstructed by polypoid masses. At the histologic examination, such polypoid neoformations were quite similar to common polyps of an inflammatory nature and, so, absolutely without any peculiar structural features. The nasal polyposis in patients suffering from the Peutz-Jeghers syndrome has been mentioned by Peutz since his first observation but it has been seldom described in the subsequent publications, even in relation to the presentation of rare causes to Congresses and Magazines of an exclusively gastroenterological interest, in which the main concern was that of identifying both the clinical and histological aspects of gastrointestinal hamartomatous polyposis and the correlation between the syndrome and the formation of malignant neoplasias in other organs to the prejudice of the secondary manifestations of the disease. Nevertheless, the nasal polyposis and, at any rate, the tendency to the formation of polyps in other districts (urinary tract, bronchi) are described among the less important features also in gastroenterological treatises of most recent publication. Clinical observations, even occasional, are completely missing in the E.N.T. ambit.(ABSTRACT TRUNCATED AT 250 WORDS)

Do dysplastic and adenomatous changes in large bowel hamartomas predispose to malignancy?--A report of two cases

Two patients, members of one family, with Peutz-Jeghers syndrome are described who underwent surgery for bowel obstruction. Both had multiple polyps in the gastrointestinal tract. Severe dysplasia and adenomatous change were present in two hamartomatous polyps adjacent to a stenosing colonic carcinoma in one patient and moderate dysplasia and adenomatous change were observed in two hamartomatous rectal polyps in his son. These changes support recent reports in the literature of progression towards neoplasia in these lesions.

[Peutz-Jeghers syndrome: report of two cases and review of the literature]

Two cases brothers of Peutz-Jeghers syndrome are reported, in which the gastrointestinal polyps were resected by laparotomy and enterotomy. One of the polyps was in the cecum and was found to have atypia cellular change, though no malignancy was found in the others, which were thought to be hamartomas. The hamartomatous polyps were initially thought to have little potential for malignancy, and the disease was believed to have a relatively benign course. However, reports in the literature have associated this syndrome with various kinds of malignancies, and the overall risk of cancer in this population is regarded as higher than normal. The analysis of our cases and a review of the literatures are presented for clarification of the predisposition of the development of malignancies in these patients.

Peutz-Jeghers syndrome

The Peutz-Jeghers polyp is an unusual type of hamartomatous polyp; its characteristic feature is a smooth muscle core arising from the muscularis mucosae and extending into the polyp. Peutz-Jeghers polyps vary in size and shape; are found in the stomach, small bowel, and colon; and are usually multiple. Peutz-Jeghers syndrome is an inherited condition that often remains undiagnosed until after the polyps are identified, despite mucocutaneous pigmented lesions on the lips and mouth of children or young adults. In the past, standard therapy involved removal of the polyps that produced intussusception, but now endoscopic removal of all polyps is recommended. The polyps are not premalignant, but a definite association exists between Peutz-Jeghers syndrome and gastrointestinal carcinoma. Evidence shows that the syndrome is associated with an increased risk of extraintestinal malignancy, especially carcinomas of the pancreas, breast, and reproductive organs.

Acquired pigmentation simulating Peutz-Jeghers syndrome: initial manifestation of diffuse uveal melanocytic proliferation

A 74-year-old man with an occult carcinoma of the colon developed pigmentation of the mouth and penis typical of the Peutz-Jeghers syndrome as the first manifestation of bilateral diffuse uveal melanocytic proliferation. The simultaneous appearance of extraocular pigmented lesion and those in the uveal tract of both eyes of this patient provides further evidence that bilateral diffuse uveal melanocytic proliferation may be caused by activation of occult melanocytic naevus cells in response to either a hormone-producing carcinoma or to some other common oncogenic stimulus.

Significance of the smooth muscle cell component in Peutz-Jeghers and juvenile polyps

We have previously reported the presence of smooth muscle cells (SMCs) in the lamina propria of both tubular and villous adenomatous polyps. In the current study, we investigated the presence and distribution of SMCs with immunohistochemical techniques using anti-alpha smooth muscle actin and anti-desmin antibodies on a series of hamartomatous polyps. In five Peutz-Jeghers polyps, large tree-like branches of SMCs were observed, while in 13 juvenile polyps, rare elongated SMCs were found in the lamina propria, partially surrounding cystically dilated glands. Apart from the quantitative differences, the SMC distribution was similar in the two types of hamartomatous polyps and not dissimilar from the pattern described in neoplastic polyps. These findings make the category "juvenile polyp" less clear and its differentiation from other histologic types of polyp less sharp. Thus, the presence or absence of SMCs cannot form the basis of the differential diagnosis between adenomatous and hamartomatous polyps.

Benign and malignant neoplasms in a family with Peutz-Jeghers syndrome: study of three generations

Three members of a family with Peutz-Jeghers syndrome had intussusception due to intestinal hamartomas. In addition, the grandfather had carcinoma of the jejunum, and the granddaughter had benign ovarian sex cord/stromal tumor causing sexual precocity. Benign and malignant tumors, not often associated with Peutz-Jeghers syndrome, pose a further threat in addition to the gastrointestinal bleeding and obstruction that often complicate this inherited syndrome.

Epithelial and neuroendocrine tumors of the duodenum

This review considers the pathologic features of epithelial tumors and tumor-like lesions of the duodenum and highlights potential pitfalls in their histological diagnosis. The tumor-like lesions include Brunner's gland hamartoma, myoepithelial hamartoma, and the mucosal polyps of the Peutz-Jeghers and juvenile polyposis syndromes. The true neoplasms are of two broad groups. The first includes duodenal adenomas and carcinomas, whose microscopic features, histogenetic relationships, and clinical significance closely mimic their commoner counterparts in the large intestine and which, when multiple, are closely associated with familial adenomatous polyposis coli. The second includes a number of uncommon endocrine cell tumors showing a great diversity of histological pattern, and which may be single or multiple. Among these are typical argyrophil carcinoids, which may secrete gastrin to give rise to the Zollinger-Ellison syndrome, and which may occur as part of the inherited multiple endocrine neoplasia syndrome type 1 (MEN-1); glandular somatostatin-rich, apparently nonargyrophil, carcinoids containing psammoma bodies that can be easily confused histologically with adenocarcinomas, and which are linked to type 1 neurofibromatosis (von Recklinghausen's disease) and phaeochromocytoma; and the gangliocytic paraganglioma, a rare tumor composed of neural elements, ganglion cells, and endocrine cells. Accurate histologic diagnosis of mucosal tumors and tumor-like lesions of the duodenum is important not only for immediate patient management, but also because it may provide the first clue to the existence of an inherited tumor syndrome, with its broader implications for the patient's family and potentially important consequences for genetic counseling.

Peutz-Jeghers-like melanotic macules associated with esophageal adenocarcinoma

A 67-year-old white man with esophageal adenocarcinoma presented with Peutz-Jeghers-like macules on the lips, face, nipples, and rectal mucosa. Pathological examination of the macules showed atypical melanocytes in the epidermis. The pleomorphic large melanocytes resembled the neoplastic cells seen in melanoma in situ. This is the first report of proliferation of atypical melanocytes in Peutz-Jeghers-like melanosis associated with a primary esophageal adenocarcinoma.

Peutz-Jeghers syndrome associated with adenocarcinoma of the cecum and focal carcinomas in hamartomatous polyps of the colon: a case report

We report herein a case of Peutz-Jeghers syndrome associated with an adenocarcinoma of the cecum and four focal cancers arising in hamartomatous polyps of the colon. There were a total 27 polyps in the intestine; 4 in the small intestine and the rest in the large intestine. The hamartomatous polyps in which the 4 focal cancers were found showed no component of adenoma, and the other polyps removed from the colon and small intestine at the same time were all hamartomas with no evidence of dysplasia or malignancy. This case was rare in that multiple focal cancers may have arisen directly from the hamartomous polyps of the colon.

[Peutz-Jeghers syndrome with carcinomatous degeneration of a duodenal hamartomatous polyp]

The authors report a case of Peutz-Jeghers syndrome in a young patient revealed by a duodenal carcinoma developed in a hamartomatous polyp. The absence of adenomatous lesion a the level of duodenal tumour, and the presence of hamartomatous lesions, particularly smooth muscular fibres, contiguous to carcinomatous glands, are favorable to a degenerescence of hamartomatous polyp. The question of malignant change or of the association of digestive carcinomas is discussed.

Peutz-Jeghers syndrome. A call for intraoperative enteroscopy

Peutz-Jeghers syndrome is a disease manifested by a combination of mucocutaneous pigmentation and gastrointestinal (GI) polyposis. The major morbidity results from intussusception, obstruction, and bleeding. Standard surgical management has been to perform enterotomies at the site of palpable polyps. A method of treating Peutz-Jeghers syndrome surgically with combined intraoperative enteroscopy is presented. The patient had eight large polyps that required three enterotomies for removal. Only three of the polyps were palpable. Two intussusceptions were reduced. The advantages of intraoperative enteroscopy are that 1) it provides accurate assessment of the extent of the disease, 2) smaller polyps can be treated endoscopically, preventing enterotomies, and 3) the endoscopist can direct the surgeon to the appropriate enterotomy sites. A combined surgical and endoscopic approach for the management of Peutz-Jeghers is successful. It more accurately removes the cause of the major morbidity associated with the disease and may allow the patient a longer interval between laparotomies.

Adenoma malignum (minimal deviation adenocarcinoma) of the uterine cervix. A clinicopathological and immunohistochemical analysis of 26 cases

We reviewed 26 examples of the rare variant of cervical adenocarcinoma that has been designated "adenoma malignum." The patients, three of whom had Peutz-Jeghers syndrome, ranged in age from 25 to 72 years (average, 42 years). The most common presenting symptom was menometrorrhagia, followed by vaginal discharge, postmenopausal bleeding, and abdominal swelling in decreasing order of frequency. In 12 of the patients, the diagnosis was established on the basis of the examination of a cervical biopsy specimen, endocervical curettage specimen, or both. In three of these cases, however, up to four biopsies were performed before the diagnosis was established. In the remaining 14 patients, the diagnosis was not made until the time of operation or pathologic examination of a hysterectomy specimen. On gross examination, the cervix usually appeared abnormal, but occasional specimens were considered unremarkable. The cervix was typically described as firm or indurated. Microscopic examination showed glands that were irregular in size and shape and lined predominantly by mucin-containing columnar epithelial cells with basal nuclei. The tumors typically exhibited deep invasion of the cervical wall, and a portion of the infiltrating tumor was associated with a stromal response in most cases. Minor foci of tumor with a less well-differentiated appearance were present in 15 of the 26 tumors. Argyrophil cells were present in six of 15 tumors. Five of the six tumors containing argyrophil cells stained immunohistochemically for serotonin and peptide hormones. Positive staining for serotonin was seen in four tumors; one of these also contained a few cells positive for neurotensin. Cytoplasmic staining of the tumor cells for carcinoembryonic antigen (CEA) was seen in five of six cases. CEA reactivity was very focal in two of the positive tumors. Microscopic features that were most helpful in distinguishing adenoma malignum from normal endocervix or benign endocervical glandular proliferations were the presence of markedly irregular, abnormally shaped glands; invasion of the cervical wall; a loose edematous or desmoplastic stromal response; foci of less well-differentiated tumor; vascular invasion; perineural invasion; and positive staining for CEA. Despite radical therapy in most of the cases, the prognosis was poor. Follow-up data were available for 22 patients. Thirteen of them died of recurrent tumor, four were alive with recurrent tumor at the time of last follow-up examination, and only three patients were disease free for 2 years or more.4+ tumor of the

Solitary Peutz-Jeghers type polyp of the stomach in the absence of familial polyposis coli in a teenage boy

We treated a male teenager with a solitary gastric Peutz-Jeghers type (hamartomatous) polyp showing neither mucocutaneous pigmentation nor inheritance. X-ray studies of the upper gastro-intestinal tract, small intestine and barium enema revealed a solitary thumb tip-sized polypoid mass in the posterior wall of the gastric body, with no evidence of any associated lesion. Histologically, the polypoid mass showed typical features of a Peutz-Jeghers type (hamartomatous) polyp. This may be the first documentation of a "solitary" gastric Peutz-Jeghers type polyp, in the absence of familial polyposis coli and mucocutaneous pigmentation.