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Linardoutsos D, Mela E, Triantafyllou S, Machairas A. Massive Gastric Juvenile Polyposis Associated With Intermittent Gastric Outlet Obstruction: A Case Report. Cureus 2024; 16:e61792. [PMID: 38975412 PMCID: PMC11227121 DOI: 10.7759/cureus.61792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 07/09/2024] Open
Abstract
Juvenile polyposis syndrome is a condition distinguished by numerous hyperproliferative polyps that can affect the entire gastrointestinal tract, though they are uncommon in the stomach. We report a rare case of a 70-year-old woman with a three-year history of epigastric pain and severe bloating who was referred to our department for gastric outlet obstruction due to massive gastric juvenile polyps also causing gastroparesis. The patient was successfully treated with a total gastrectomy.
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Affiliation(s)
- Dimitrios Linardoutsos
- First Propaedeutic Department of Surgery, Hippocration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, GRC
- Department of Surgery, Metropolitan General Hospital, Athens, GRC
| | - Evgenia Mela
- First Propaedeutic Department of Surgery, Hippocration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, GRC
| | - Stamatina Triantafyllou
- First Propaedeutic Department of Surgery, Hippocration General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, GRC
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Utsunomiya H, Akazawa Y, Ueyama H, Iwano T, Yamamoto M, Uchida R, Oki S, Suzuki N, Abe D, Ikeda A, Takeda T, Ueda K, Hojo M, Yube Y, Kaji S, Okano S, Tsuyama S, Eguchi H, Okazaki Y, Arai M, Fukunaga T, Yao T, Nagahara A. Gastric Juvenile Polyposis with Intramucosal Cancer Diagnosed by Magnifying Endoscopy with Narrow-band Imaging. Intern Med 2023; 62:3333-3339. [PMID: 37005260 PMCID: PMC10713360 DOI: 10.2169/internalmedicine.1612-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/05/2023] [Indexed: 04/04/2023] Open
Abstract
Although gastric juvenile polyposis (GJP) often coexists with gastric cancer, a preoperative accurate diagnosis is still difficult to obtain. A 70-year-old woman was referred for epigastralgia and anemia. Esophagogastroduodenoscopy with a conventional endoscope showed numerous gastric polyps with no cancerous findings. Magnifying endoscopy with narrow-band imaging (M-NBI) showed cancerous findings, and a target biopsy revealed adenocarcinoma. Histopathological findings after endoscopic resection confirmed a diagnosis of juvenile polyposis with intramucosal adenocarcinoma. Genetic analyses revealed a germline pathogenic variant of SMAD4. A target biopsy using M-NBI and endoscopic resection proved useful for confirming the preoperative diagnosis of coexisting cancerous lesions in GJP.
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Affiliation(s)
- Hisanori Utsunomiya
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Yoichi Akazawa
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Hiroya Ueyama
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Tomoyo Iwano
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Momoko Yamamoto
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Ryota Uchida
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Shotaro Oki
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Nobuyuki Suzuki
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Daiki Abe
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Atsushi Ikeda
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Tsutomu Takeda
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Kumiko Ueda
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Mariko Hojo
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Yukinori Yube
- Department of Esophageal and Gastroenterological Surgery, Juntendo University School of Medicine, Japan
| | - Sanae Kaji
- Department of Esophageal and Gastroenterological Surgery, Juntendo University School of Medicine, Japan
| | - Soh Okano
- Department of Human Pathology, Juntendo University Graduate School of Medicine, Japan
| | - Sho Tsuyama
- Department of Human Pathology, Juntendo University School of Medicine, Japan
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Japan
| | - Hidetaka Eguchi
- Intractable Disease Research Center/Diagnostics and Therapeutics of Intractable Diseases, Juntendo University Graduate School of Medicine, Japan
| | - Yasushi Okazaki
- Intractable Disease Research Center/Diagnostics and Therapeutics of Intractable Diseases, Juntendo University Graduate School of Medicine, Japan
| | - Masami Arai
- Department of Clinical Genetics, Juntendo University, Graduate School of Medicine, Japan
| | - Tetsu Fukunaga
- Department of Esophageal and Gastroenterological Surgery, Juntendo University School of Medicine, Japan
| | - Takashi Yao
- Department of Human Pathology, Juntendo University Graduate School of Medicine, Japan
| | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
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Nikaido M, Takimoto T, Sakurai T, Hoki M, Minamiguchi S, Nakajima T, Torishima M, Nishigori T, Obama K, Koyama Y, Chiba T, Ushiama M, Gotoh M, Teramura M, Takeda H, Shimizu T, Seno H. Gastric juvenile polyposis syndrome with inflammatory changes in the intervening mucosa. Pathol Int 2023; 73:566-569. [PMID: 37559445 DOI: 10.1111/pin.13374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 08/11/2023]
Affiliation(s)
- Mitsuhiro Nikaido
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Takafumi Takimoto
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Takaki Sakurai
- Department of Pathology, Kansai Electric Power Hospital, Fukushima-ku, Osaka, Japan
- Department of Diagnostic Pathology, Osaka Red Cross Hospital, Tennoji-ku, Osaka, Japan
| | - Masahito Hoki
- Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Sachiko Minamiguchi
- Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Takeshi Nakajima
- Department of Medical Ethics and Medical Genetics, Kyoto University School of Public Health, Kyoto, Japan
- Department of Clinical Genetics Unit, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan
| | - Masako Torishima
- Department of Medical Ethics and Medical Genetics, Kyoto University School of Public Health, Kyoto, Japan
- Department of Clinical Genetics Unit, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan
| | - Tatsuto Nishigori
- Department of Surgery, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Kazutaka Obama
- Department of Surgery, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Yukari Koyama
- Department of Gastroenterology and Hepatology, Kansai Electric Power Hospital, Fukushima-ku, Osaka, Japan
| | - Tsutomu Chiba
- Department of Gastroenterology and Hepatology, Kansai Electric Power Hospital, Fukushima-ku, Osaka, Japan
| | - Mineko Ushiama
- Department of Genetic Medicine and Services, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
- Department of Clinical Genomics, National Cancer Center Research Institute, Chuo-ku, Tokyo, Japan
| | - Masahiro Gotoh
- Department of Genetic Medicine and Services, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
- Department of Clinical Genomics, National Cancer Center Research Institute, Chuo-ku, Tokyo, Japan
| | - Mari Teramura
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Haruhiko Takeda
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Takahiro Shimizu
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
| | - Hiroshi Seno
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto, Japan
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Morini A, Burys A, Cazals-Hatem D, Sauvanet A, Fléjou JF, Cros J. [An astonishing diagnosis!]. Ann Pathol 2023; 43:421-424. [PMID: 36702725 DOI: 10.1016/j.annpat.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023]
Affiliation(s)
- Aurélien Morini
- Laboratoire d'anatomie pathologique, hôpital Beaujon, université de Paris, Clichy, France.
| | - Artur Burys
- Laboratoire d'anatomie pathologique, hôpital Beaujon, université de Paris, Clichy, France
| | - Dominique Cazals-Hatem
- Laboratoire d'anatomie pathologique, hôpital Beaujon, université de Paris, Clichy, France
| | - Alain Sauvanet
- Chirurgie hépato-biliaire et pancréatique, hôpital Beaujon, université de Paris, Clichy, France
| | | | - Jérôme Cros
- Laboratoire d'anatomie pathologique, hôpital Beaujon, université de Paris, Clichy, France; Institut national de la santé et de la recherche médicale, centre de recherche biomédicale Bichat Beaujon (CRI)/Inserm U1149, Clichy, France
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Occurrence of gastric cancer in patients with juvenile polyposis syndrome: a systematic review and meta-analysis. Gastrointest Endosc 2023; 97:407-414.e1. [PMID: 36265529 DOI: 10.1016/j.gie.2022.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/15/2022] [Accepted: 10/10/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND AIMS The true rate of gastric cancer (GC) in juvenile polyposis syndrome (JPS) is unknown because of its rarity and ascertainment bias in published literature. To better assess this, we conducted a systematic review and meta-analysis. METHODS MEDLINE, Embase, and Scopus databases were searched for the key words juvenile polyposis syndrome, juvenile polyps, stomach cancer, GC, SMAD4, BMPR1A, hamartomatous polyposis syndrome, hamartomas, and hereditary cancers for studies reporting upper GI manifestations in JPS. The primary outcome was the reported occurrence of GC in JPS. We then compared GC occurrence based on the presence or absence of pathogenic germline variants (PGVs) and in untested patients. RESULTS Eleven studies including 637 patients were included. The pooled occurrence of GC was 3.5% (95% confidence interval [CI], 1.8-5.2; I2 = 12.3%) at a median age of 42.5 years (range, 15-57.6). The pooled occurrence of GC in patients with SMAD4 PGV was 10.1% (95% CI, 3.2-16.8%; I2 = 54.7%). GC was reported in only 1 BMPR1A PGV carrier and was not reported in patients without an identifiable PGV. In patients with prior germline testing, the risk of GC was higher in SMAD4 PGV carriers (odds ratio, 11.6; 95% CI, 4.6-29.4; I2 = 18.3%) compared with patients without SMAD4 PGV. In JPS patients with unknown status of germline testing, pooled occurrence of GC was 7.5% (95% CI, 0-15.5). There was an overall moderate risk of bias in the studies. CONCLUSIONS GC is highest in SMAD4-associated JPS and was not reported in patients without identifiable PGVs. The value of GC surveillance in BMPR1A PGV carriers and JPS patients without an identifiable PGV is questionable. Germline testing should be performed in all JPS patients to inform GC risk discussion and utility of surveillance.
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Yamashiro Y, Yanai Y, Takeda T, Hayashi T, Akazawa Y, Yatagai N, Ueyama H, Eguchi H, Nagahara A, Yao T, Saito T. Molecular and clinicopathological analysis of three cases of gastric juvenile polyposis. JGH Open 2022; 6:531-538. [PMID: 35928693 PMCID: PMC9344582 DOI: 10.1002/jgh3.12781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022]
Abstract
Background and Aim Juvenile polyposis (JP) is a rare disease known to be associated with mutations either in SMAD4/BMPR1A. JP is known to often develop into malignant tumors, with a reported probability of 9–50%. However, the mechanisms of its carcinogenesis are not fully understood. We tried to elucidate the mechanisms of malignant transformation underlying this condition in three cases of gastric JP. Methods We selected polyps from each patient displaying varying degrees of atypia and their nearby normal polyps and compared them using immunohistochemistry, Sanger sequencing, and loss of heterozygosity (LOH) analysis of SMAD4, BMPR1A, and TP53. Results Two of the three cases were suspected of having germline SMAD4 mutations based on their familial medical histories; the remaining case was found to have a SMAD4 germline mutation following preoperative genetic testing. All three cases were shown to present with both SMAD4 positive and negative areas across each lesion, with the neoplastic lesions tending to show stronger nuclear SMAD4 expression. This expression was closely associated with the SMAD4 LOH status; however, we also noted paradoxical SMAD4 expression in the neoplastic lesions despite the biallelic inactivation of SMAD4 revealed in the genetic evaluation. Conclusions These data suggest that strong nuclear expression of SMAD4, even when seemingly paradoxical, seems to be closely associated with dysplastic polyps in JP. Complete inactivation of SMAD4 was not shown to be essential for the development of dysplastic polyps in gastric JP, and other pathways seemed to be involved in the acquisition of the malignant phenotype.
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Affiliation(s)
- Yuya Yamashiro
- Department of Human Pathology Juntendo University School of Medicine Tokyo Japan
| | - Yuka Yanai
- Department of Human Pathology Juntendo University School of Medicine Tokyo Japan
| | - Tsutomu Takeda
- Department of Gastroenterology Juntendo University School of Medicine Tokyo Japan
| | - Takuo Hayashi
- Department of Human Pathology Juntendo University School of Medicine Tokyo Japan
| | - Yoichi Akazawa
- Department of Gastroenterology Juntendo University School of Medicine Tokyo Japan
| | - Noboru Yatagai
- Department of Gastroenterology Juntendo University School of Medicine Tokyo Japan
| | - Hiroya Ueyama
- Department of Gastroenterology Juntendo University School of Medicine Tokyo Japan
| | - Hidetaka Eguchi
- Intractable Disease Research Center Juntendo University, Graduate School of Medicine Tokyo Japan
| | - Akihito Nagahara
- Department of Gastroenterology Juntendo University School of Medicine Tokyo Japan
| | - Takashi Yao
- Department of Human Pathology Juntendo University School of Medicine Tokyo Japan
| | - Tsuyoshi Saito
- Department of Human Pathology Juntendo University School of Medicine Tokyo Japan
- Intractable Disease Research Center Juntendo University, Graduate School of Medicine Tokyo Japan
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Gullo I, van der Post RS, Carneiro F. Recent advances in the pathology of heritable gastric cancer syndromes. Histopathology 2020; 78:125-147. [PMID: 33382491 DOI: 10.1111/his.14228] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/04/2020] [Indexed: 02/06/2023]
Abstract
Despite the relative rarity of hereditary gastric cancer syndromes, the prompt recognition of their specific clinical features and histopathological characteristics is pivotal in offering patients the most appropriate treatment. In this article, we address the three major inherited syndromes that primarily affect the stomach: hereditary diffuse gastric cancer (HDGC), caused by germline variants in CDH1 and CTNNA1; gastric adenocarcinoma and proximal polyposis of the stomach, caused by germline mutations in promoter 1B of APC; and familial intestinal gastric cancer, which has a poorly defined genetic cause. The main focus will be on HDGC, in light of the recent publication of updated clinical practice guidelines and emerging concepts regarding HDGC histopathology. In particular, we describe the broad morphological spectrum of HDGC lesions, stressing the importance of recognising indolent and aggressive phenotypes. Moreover, we discuss the increased risk of gastric (pre)malignancies developing in patients with other well-defined hereditary cancer syndromes, such as familial adenomatous polyposis, Lynch syndrome, Peutz-Jeghers syndrome, juvenile polyposis, Li-Fraumeni syndrome, and hereditary breast and ovarian cancer syndrome.
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Affiliation(s)
- Irene Gullo
- Department of Pathology, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal.,Department of Pathology, Faculty of Medicine of the University of Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde (i3S), Porto, Portugal.,Institute of Molecular Pathology and Immunology of the University of Porto (Ipatimup), Porto, Portugal
| | - Rachel S van der Post
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Fátima Carneiro
- Department of Pathology, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal.,Department of Pathology, Faculty of Medicine of the University of Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde (i3S), Porto, Portugal.,Institute of Molecular Pathology and Immunology of the University of Porto (Ipatimup), Porto, Portugal
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Massive juvenile polyposis of the stomach in a family with SMAD4 gene mutation. Fam Cancer 2018; 18:165-172. [PMID: 30196345 DOI: 10.1007/s10689-018-0100-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Relatively little is known on the genotype-phenotype correlations between SMAD4 gene mutations, juvenile polyposis of the intestine and Hereditary Hemorrhagic Teleangectasia. We describe a family in which the proband (a 46-year old woman) had massive polyposis of the stomach-leading to surgery-with high-grade dysplasia at histology. Molecular analysis was carried out using Next Generation sequencing techniques with Miseq Illumina Platforms and a minimal coverage of 40 reads. In the proband, the analysis showed the presence of a truncating mutation in the SMAD4 gene (c.1213dupC, a variant previously associated with juvenile polyposis and Hereditary Hemorrhagic Teleangectasia). The same mutation was detected in two other members of the family (father and brother of the proband), who showed massive polypoid involvement of the stomach at gastroscopy. By taking the family history, subtle evidence of Hereditary Teleangectasia was found (nasal bleeding and arterovenous malformations) in the three gene carriers. Colonoscopy showed polyp occurrence in all three affected members with SMAD4 mutation, with prevalence of adenomatous lesions in one (father), of hamartomas in the brother, and of a mix of histological types in the proband. The main features of the family can be summarized as follows: (A) In hereditary juvenile polyposis, lesions of different histology can be detected at colonoscopy; (B) In the gene carriers of SMAD4 mutations, lesions of the stomach require careful surveillance and, when necessary, surgical interventions; (C) Signs and symptoms of Hereditary Hemorrhagic Teleangectasia should be suspected (and searched) in individuals with SMAD4 constitutional mutations.
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Bruceta M, De Souza L, Carr Z, Bonavia A, Karamchandani K. Novel Association of Juvenile Polyposis Syndrome With Atrial Septal Aneurysm and Patent Foramen Ovale: A Case Report. A A Pract 2018; 10:331-334. [PMID: 29634562 DOI: 10.1213/xaa.0000000000000714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Juvenile polyposis syndrome is an autosomal-dominant disorder characterized by the presence of hundreds of gastrointestinal polyps. The genes most commonly found are BMPR1A and SMAD4. The latter has been linked to vascular malformations and hereditary hemorrhagic telangiectasias. We present the case of a young woman diagnosed with juvenile polyposis syndrome and SMAD-4 mutation, who developed embolic strokes from an atrial septal aneurysm and patent foramen ovale. This case highlights the propensity of patients with juvenile polyposis syndrome and SMAD-4 mutations to develop atrial septal aneurysm and patent foramen ovale, and warrants appropriate cardiac workup in at-risk individuals.
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Affiliation(s)
- Melanio Bruceta
- From the Department of Anesthesiology & Perioperative Medicine, Penn State University College of Medicine, Hershey, Pennsylvania
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