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Hamada Y, Katsurahara M, Umeda Y, Ikenoyama Y, Shigefuku A, Fujiwara Y, Beppu T, Tsuboi J, Yamada R, Nakamura M, Tanaka K, Horiki N, Nakagawa H. Endoscopic resection for a solitary Peutz‐Jeghers type polyp in the duodenum: A case report with literature review. DEN OPEN 2023; 3:e226. [PMID: 36998347 PMCID: PMC10043356 DOI: 10.1002/deo2.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/22/2023] [Accepted: 03/08/2023] [Indexed: 03/30/2023]
Abstract
A 68‐year‐old female patient was referred to our hospital with a 30‐mm polyp in the second portion of the duodenum found via esophagogastroduodenoscopy. The polyp had an irregular, lobular surface and a thick stalk. In addition, white dots were detected on the surface. Magnifying endoscopy with narrow‐band imaging showed a white material deep in the loop‐shaped microvessels on the white dots. Endoscopic ultrasonography showed a hypoechoic elevated lesion from the mucosal layer, and a feeding vessel traversing the stalk to supply the head of the polyp. Endoscopic biopsy did not provide a definitive diagnosis. Endoscopic resection was conducted for a definitive diagnosis and treatment. The resected specimen showed a branching bundle of smooth muscle fibers covered by hyperplastic mucosa, consistent with a hamartomatous polyp. The patient had no mucocutaneous pigmentation or familial history of the hamartomatous polyp. The polyp was finally diagnosed as a solitary Peutz‐Jeghers‐type polyp. No recurrence has been observed for seven years postoperatively.
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Affiliation(s)
- Yasuhiko Hamada
- Department of Gastroenterology and HepatologyMie University HospitalTsuMieJapan
| | - Masaki Katsurahara
- Department of Gastroenterology and HepatologyMie University HospitalTsuMieJapan
| | - Yuhei Umeda
- Department of Gastroenterology and HepatologyMie University HospitalTsuMieJapan
| | - Yohei Ikenoyama
- Department of Gastroenterology and HepatologyMie University HospitalTsuMieJapan
| | - Akina Shigefuku
- Department of Gastroenterology and HepatologyMie University HospitalTsuMieJapan
| | - Yasuko Fujiwara
- Department of Gastroenterology and HepatologyMie University HospitalTsuMieJapan
| | - Tuyoshi Beppu
- Department of Gastroenterology and HepatologyMie University HospitalTsuMieJapan
| | - Junya Tsuboi
- Department of Gastroenterology and HepatologyMie University HospitalTsuMieJapan
| | - Reiko Yamada
- Department of Gastroenterology and HepatologyMie University HospitalTsuMieJapan
| | - Misaki Nakamura
- Department of Gastroenterology and HepatologyMie University HospitalTsuMieJapan
| | - Kyosuke Tanaka
- Department of Gastroenterology and HepatologyMie University HospitalTsuMieJapan
| | - Noriyuki Horiki
- Department of Gastroenterology and HepatologyMie University HospitalTsuMieJapan
| | - Hayato Nakagawa
- Department of Gastroenterology and HepatologyMie University HospitalTsuMieJapan
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2
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Kakiuchi T, Takedomi H, Akutagawa T, Tsuruoka N, Sakata Y, Matsuo M. Gastrointestinal bleeding after endoscopic mucosal resection in a case of Peutz-Jeghers syndrome with hypofibrinogenemia: A case report. Front Pediatr 2022; 10:961501. [PMID: 36275070 PMCID: PMC9581254 DOI: 10.3389/fped.2022.961501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 09/21/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUD Peutz-Jegers syndrome (PJS) is an autosomal dominant hereditary disorder characterized by hamartomatous polyposis of the entire gastrointestinal tract. Fibrinogen (Fbg) is synthesized by the liver, and hypofibrinogenemia is often asymptomatic and manifests with bleeding after trauma or invasive surgical procedures. Here, we present a case of a pediatric patient with PJS and hypofibrinogenemia who manifested with gastrointestinal bleeding after endoscopic mucosal resection (EMR) of small intestinal polyps. CASE PRESENTATION An 11-year-old boy with PJS was referred to our hospital. Since his mother was diagnosed with PJS, with black pigments being observed on his lips, mouth, and limbs, he underwent upper and lower gastrointestinal endoscopy at the age of 8 years at a previous hospital. EMR for duodenal polyp was performed, and the pathological findings were consistent with hamartoma. His Fbg level was 117 mg/dl at the time, with no post-bleeding being detected after EMR. The small intestine was not assessed at the prior facility and was left neglected for three years. At our hospital, small intestine fluoroscopy was performed and revealed a polyp in the jejunum, and abdominal computed tomography showed two polyps and intussusception. On double-balloon enteroscopy, the resected polyps were hamartoma with diameters of 20 and 30 mm. The patient's Fbg level was 107 mg/dl. The day after EMR, he had melena and black stools. He was diagnosed with post-EMR bleeding and started to stop eating, and hemostatic agents were given. His hemoglobin level dropped to 9.2 g/dl the next day. Genetic testing for congenital Fbg deficiency revealed a heterozygous pathogenic variant in fibrinogen gamma chain Exon 10. Therefore, he was diagnosed with concurrent hypofibrinogenemia and PJS. CONCLUSION To the best of our knowledge, this is the first reported case with concurrent PJS and hypofibrinogenemia. In patients with PJS, hypofibrinogenemia should be considered as one of the risk factors of postoperative bleeding during polypectomy, and appropriate prophylactic measures should be taken.
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Affiliation(s)
- Toshihiko Kakiuchi
- Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan
| | - Hironobu Takedomi
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Takashi Akutagawa
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Nanae Tsuruoka
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yasuhisa Sakata
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Muneaki Matsuo
- Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan
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3
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Solitary Peutz–Jeghers polyp of jejunum in 3-month-old girl. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Kalliakmanis V, Perysinakis I, Koutsouvas K, Karras P, Margaris E, Angelakis C. Massive intussusception caused by a solitary Peutz-Jeghers type hamartomatous polyp. Ann R Coll Surg Engl 2018; 100:e91-e93. [PMID: 29484932 PMCID: PMC5958860 DOI: 10.1308/rcsann.2018.0019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 02/01/2023] Open
Abstract
Intussusception is a rare cause of intestinal obstruction in adults and represents a diagnostic challenge for the surgeon. In the majority of cases, presenting symptoms are not specific, making preoperative diagnosis difficult. Several medical conditions may cause intestinal intussusception. We present the case of a 16-year-old female patient with intussusception due to a hamartomatous Peutz-Jeghers type polyp. This is an extremely rare case in which the first manifestation of the intestinal polyp was jejunojejunal intussusception very close to the duodenojejunal junction, with a necrotic intussusceptum about 50 cm long. The patient was treated successfully with enterectomy and end-to-end anastomosis. Postoperative course was uneventful and the patient is currently under gastroenterological and genetic investigation to exclude the diagnosis of Peutz-Jeghers syndrome.
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Affiliation(s)
- V Kalliakmanis
- Surgical Department, General Hospital of Agrinio, Agrinio, Aitoloakarnania, Greece
| | - I Perysinakis
- Third Surgical Department, Hygeia Hospital, Athens, Greece
| | - K Koutsouvas
- Surgical Department, General Hospital of Agrinio, Agrinio, Aitoloakarnania, Greece
| | - P Karras
- Surgical Department, General Hospital of Agrinio, Agrinio, Aitoloakarnania, Greece
| | - E Margaris
- Third Surgical Department, G Gennimatas General Hospital, Athens, Greece
| | - C Angelakis
- Surgical Department, General Hospital of Agrinio, Agrinio, Aitoloakarnania, Greece
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Zou BC, Wang FF, Zhao G, Lu XL, Zhang L, Zhao P, Shi HT, Qin B, Guo XD, Zhang J. A giant and extensive solitary Peutz-Jeghers-type polyp in the antrum of stomach: Case report. Medicine (Baltimore) 2017; 96:e8466. [PMID: 29245215 PMCID: PMC5728830 DOI: 10.1097/md.0000000000008466] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
RATIONALE A solitary Peutz-Jeghers-type polyp is a hamartomatous polyp which without either mucocutaneous pigmentation or a family history of Peutz-Jeghers syndrome (PJS). It can occur in all of the gastrointestinal tract, but it is extremely rare in the stomach. PATIENT CONCERNS A 53-year-old man was admitted to the local hospital with left upper abdominal pain lasting 2 weeks. A gastroscopy showed a giant and extensive bulging lesion on the greater curvature and posterior and anterior walls of the gastric antrum, involving three-quarters of the gastric wall. Endoscopic ultrasonography showed a muscularis mucosa lesion. DIAGNOSES A solitary Peutz-Jeghers-type polyp in the antrum of stomach. INTERVENTIONS The patient underwent an endoscopic submucosal dissection (ESD). OUTCOMES The patient recovered quickly, without any complications. LESSONS This is the second largest gastric solitary Peutz-Jeghers-polyp reported until now, and the largest gastric solitary Peutz-Jeghers type-polyp treated by endoscope.
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Affiliation(s)
- Bai-Cang Zou
- Department of Gastroenterology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Feng-Fan Wang
- Department of Gastroenterology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Department of Gastroenterology, Xi’an Children's Hospital, Xi’an, Shaanxi, China
| | - Gang Zhao
- Department of Gastroenterology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xiao-Lan Lu
- Department of Gastroenterology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Li Zhang
- Department of Gastroenterology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Ping Zhao
- Department of Gastroenterology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Hai-Tao Shi
- Department of Gastroenterology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Bin Qin
- Department of Gastroenterology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xiao-Dan Guo
- Department of Gastroenterology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Jing Zhang
- Department of Gastroenterology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
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6
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Jelsig AM, Brusgaard K, Hansen TP, Qvist N, Larsen M, Bojesen A, Nielsen CB, Ousager LB. Germline variants in Hamartomatous Polyposis Syndrome-associated genes from patients with one or few hamartomatous polyps. Scand J Gastroenterol 2016; 51:1118-25. [PMID: 27146957 DOI: 10.1080/00365521.2016.1174880] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE A subgroup of patients with hamartomatous polyps in the GI tract has a hereditary Hamartomatous Polyposis Syndrome with an increased risk of cancer. The distinction between patients with one or few polyps and patients with a syndrome can be difficult. A pathogenic germline mutation can be detected in a majority of HPS patients. This study investigates whether patients with one or few hamartomatous polyps could have a syndrome based on genetic screening of relevant genes. METHODS We designed a gene panel including 26 hamartomatous polyposis-associated genes. Using targeted Next Generation Sequencing, DNA samples from 77 patients with 84 hamartomatous polyps were sequenced. The detected germline variants were classified into pathogenicity classes. RESULTS We detected several germline variants, among them three in ENG, two in BMPR1A, one in PTEN, and one in SMAD4. Although some of the detected variants have been reported previously none could be definitely pathogenic or likely pathogenic. CONCLUSIONS Our study points towards that genetic testing for the Hamartomatous Polyposis Syndromes in patients with one or few polyps does not improve diagnostics, however we illustrate that the clinical significance of genetic variants can be difficult to interpret. A family history of polyps, cancer, or extraintestinal findings or a minimum of 3-5 polyps seems to be relevant information to include before genetic testing.
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Affiliation(s)
- Anne Marie Jelsig
- a Department of Clinical Genetics , Odense University Hospital , Odense C , Denmark ;,b Institute of Clinical Research, University of Southern Denmark , Odense C , Denmark
| | - Klaus Brusgaard
- a Department of Clinical Genetics , Odense University Hospital , Odense C , Denmark ;,b Institute of Clinical Research, University of Southern Denmark , Odense C , Denmark
| | - Tine Plato Hansen
- c Department of Pathology , Hvidovre University Hospital , Hvidovre , Denmark
| | - Niels Qvist
- d Department of Surgery , Odense University Hospital , Odense C , Denmark
| | - Martin Larsen
- a Department of Clinical Genetics , Odense University Hospital , Odense C , Denmark ;,b Institute of Clinical Research, University of Southern Denmark , Odense C , Denmark
| | - Anders Bojesen
- e Department of Clinical Genetics , Vejle Hospital, Lillebaelt Hospital , Vejle , Denmark ;,f Institute of Regional Health Research, University of Southern Denmark , Odense C , Denmark
| | - Claus Buhl Nielsen
- g Department of Surgery , Hvidovre University Hospital , Hvidovre , Denmark
| | - Lilian Bomme Ousager
- a Department of Clinical Genetics , Odense University Hospital , Odense C , Denmark ;,b Institute of Clinical Research, University of Southern Denmark , Odense C , Denmark
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7
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Suzuki K, Higuchi H, Shimizu S, Nakano M, Serizawa H, Morinaga S. Endoscopic snare papillectomy for a solitary Peutz-Jeghers-type polyp in the duodenum with ingrowth into the common bile duct: Case report. World J Gastroenterol 2015; 21:8215-8220. [PMID: 26185397 PMCID: PMC4499368 DOI: 10.3748/wjg.v21.i26.8215] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 05/07/2015] [Accepted: 05/27/2015] [Indexed: 02/06/2023] Open
Abstract
Solitary duodenal Peutz-Jeghers (PJ)-type hamartomatous polyps are rare and considered a different disease entity than classic PJ syndrome. We describe the case of an 89-year-old man admitted to our emergency department with symptoms of acute cholangitis, liver dysfunction, and slight jaundice. Magnetic resonance imaging showed multiple signal voids, reflecting choledocholithiasis, and an oval-shaped tumor in the common bile duct (CBD). Following endoscopic retrograde cholangiopancreatography, the patient was diagnosed with a lower CBD tumor 20 mm in diameter. Endoscopic sphincterotomy was performed for choledocholithotomy, resulting in the expulsion of a large tumor with a stalk connected to the papilla of Vater. The tumor was successfully excised en bloc by endoscopic snare papillectomy. Histopathologic examination showed that the tumor was a PJ-type hamartomatous polyp. No mucocutaneous pigmentation of the skin was evident and the patient’s family history was negative. Solitary duodenal PJ-type hamartomatous polyps are usually diagnosed incidentally during endoscopy for other indications because most of these tumors are asymptomatic or have nonspecific presentations. To our knowledge, this is the first reported solitary PJ-type polyp with intra-CBD growth treated by endoscopic snare papillectomy.
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8
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Affiliation(s)
- Yoshiki Tsujii
- Department of Gastrointestinal OncologyOsaka Medical Center for Cancer and Cardiovascular Diseases Osaka Japan
| | - Noriya Uedo
- Department of Gastrointestinal OncologyOsaka Medical Center for Cancer and Cardiovascular Diseases Osaka Japan
| | - Shigenori Nagata
- Department of PathologyOsaka Medical Center for Cancer and Cardiovascular Diseases Osaka Japan
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9
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McGarrity TJ, Amos C. Less common colorectal cancer predisposition syndromes. Surg Oncol Clin N Am 2009; 18:647-61. [PMID: 19793572 DOI: 10.1016/j.soc.2009.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A variety of syndromes confer increased risk for intestinal polyp development, outside the more commonly occurring syndromes. Each of these uncommon syndromes predispose to pathognomonic histologies that are uncommonly observed. Accurate diagnosis of these syndromes is contingent on higher-level pathology review, evaluation of signs and symptoms beyond sole consideration of the polyps, and collection of a detailed family history. When a genetic mutation can be identified in the proband, the management of intestinal and extra-intestinal cancer screening can be more appropriately tailored.
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Affiliation(s)
- Thomas J McGarrity
- Department of Medicine, Penn State Hershey Medical Center, Hershey, PA 17033-0850, USA.
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10
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Jamaludin AZF, Telisinghe PU, Yapp SKS, Chong VH. Solitary duodenal hamartomatous polyp with malignant transformation: report of a case. Surg Today 2009; 39:527-32. [PMID: 19468811 DOI: 10.1007/s00595-008-3873-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Accepted: 04/06/2008] [Indexed: 12/25/2022]
Abstract
A solitary duodenal hamartomatous polyp is rare and it is considered to be either a variant of Peutz-Jeghers syndrome (PJS) or a separate entity. Patients do not have cutaneous manifestations and have only one hamartomatous polyp. The presentation is nonspecific and it resembles common conditions, such as a peptic ulcer disease. Most are incidentally diagnosed during endoscopy for other indications. Malignant transformation has been reported. This report describes the case of a 46-year-old man who presented with chronic intermittent abdominal pain. The initial endoscopy showed an abnormal twisting of the duodenum with a dilated duodenum. He was later diagnosed to have a solitary duodenal hamartomatous polyp with malignant transformation, which was treated by surgery. A review of the literature on the pertinent cases of this type of lesion is also presented.
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Affiliation(s)
- Aza Zetty Feroena Jamaludin
- Gastroenterology Unit, Department of Medicine, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, BA 1710, Brunei Darussalam
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11
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Ter Borg PP, Westenend PP, Hesp FW, van der Straaten FF, van de Vrie WW, Honkoop PP. A solitary Peutz-Jeghers type polyp in the jejunum of a 19 year-old male. CASES JOURNAL 2008; 1:68. [PMID: 18671840 PMCID: PMC2515291 DOI: 10.1186/1757-1626-1-68] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Accepted: 07/31/2008] [Indexed: 12/31/2022]
Abstract
A 19-year old male presented with melena and anemia. A duodenoscopy revealed no abnormalities, but a small bowel X-ray series demonstrated a large jejunal polyp. This 4 cm large polyp was visualised during peroperative small bowel endoscopy and was subsequently surgically removed. The polyp had the characteristic histologic appearance of a Peutz-Jeghers type polyp, but the patient had no other signs of Peutz-Jeghers syndrome, such as the characteristic mucocutaneous pigmentation, the presence of multiple polyps or a positive family history. After removal of the polyp, melena did not recur and his hemoglobin concentration normalized. Altogether, the patient does not fulfill the diagnostic criteria for Peutz-Jeghers syndrome and appears to have a solitary jejunal Peutz-Jeghers type polyp. All previously reported patients with such polyps were older than this patient.
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Affiliation(s)
- Pieter Pcj Ter Borg
- Department of Gastroenterology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
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12
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Suzuki S, Hirasaki S, Ikeda F, Yumoto E, Yamane H, Matsubara M. Three cases of solitary Peutz-Jeghers-type hamartomatous polyp in the duodenum. World J Gastroenterol 2008; 14:944-7. [PMID: 18240356 PMCID: PMC2687066 DOI: 10.3748/wjg.14.944] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A solitary Peutz-Jeghers-type hamartomatous polyp in the duodenum is rare, and few reports have described its characteristic endoscopic features. We describe three cases of solitary Peutz-Jeghers-type hamartomatous polyp and their endoscopic findings in detail. The polyp in all of our three cases showed an irregularly lobular or nodular surface, whereas adenomas often show a regularly nodular or granular surface. The color of the polyp was whitish in all of our cases. In the present cases, close observation by endoscopy revealed that the solitary Peutz-Jeghers-type hamartomatous polyps looked whitish because of the presence of diffusely scattered white spots on the surface of the polyps. Duodenal polyps that exhibit the aforementioned endoscopic characteristics may be diagnosed as Peutz-Jeghers-type hamartomatous polyps and treated by polypectomy because of the malignant potential.
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13
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Burkart AL, Sheridan T, Lewin M, Fenton H, Ali NJ, Montgomery E. Do sporadic Peutz-Jeghers polyps exist? Experience of a large teaching hospital. Am J Surg Pathol 2007; 31:1209-14. [PMID: 17667545 DOI: 10.1097/pas.0b013e3180339944] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Most types of sporadic gastrointestinal (GI) polyps vastly outnumber their syndromic counterparts. In contrast, the incidence of sporadic Peutz-Jeghers polyps (PJP) is unknown. We examined all potential PJP seen at our hospital over a 22-year (y) period to assess the incidence of sporadic PJP. The pathology database of a large hospital was searched for "Peutz-Jeghers polyp(s)," yielding 121 polyps from 38 patients. The polyps were reviewed by 3 pathologists to confirm the diagnosis. Clinical information to confirm or refute a diagnosis of Peutz-Jeghers syndrome (PJS) was collected. Of the 102 polyps included after histologic review, 94 polyps arose in patients meeting the World Health Organization criteria for PJS. These PJS polyps were eliminated from further analysis. Clinical information was obtained for the remaining 8 patients with potential "sporadic" PJP (1 to 50 y; mean=14 y; median=4 y). Of the 8 potential sporadic PJP, only 3 polyps from 3 patients had unequivocal PJP histologic features, all from the small intestine. All 3 patients had clinical histories suggesting syndromic PJP although they did not meet World Health Organization criteria, that is, 2 developed pancreatic cancer, 1 had bilateral "ovarian cystic masses" and a glomus tympanicum tumor, and 1 had strong family history of GI malignancies. The 5 remaining patients each had a colonic polyp with features suggestive, but not definitely diagnostic of, PJP. In these cases, prolapse lesions could not be excluded. One patient had a history of high-grade dysplasia in a tubulovillous adenoma in the colon at 53 years, but no family cancer history. Another had a family GI cancer history. Another had a history of pituitary adenoma at age 39, and the last had ductal breast carcinoma diagnosed 4 years before the discovery of the polyp. Our findings suggest that if sporadic PJP exist, they are extremely rare. Moreover, our data suggest that individuals with a single PJP may have a cumulative lifetime risk of cancer similar to those with the syndrome.
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Affiliation(s)
- Ashlie L Burkart
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA
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14
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Jaremko JL, Rawat B. Colo-colonic intussusception caused by a solitary Peutz-Jeghers polyp. Br J Radiol 2005; 78:1047-9. [PMID: 16249608 DOI: 10.1259/bjr/25000606] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
A case of acute large bowel obstruction by colo-colonic intussusception in a healthy 19-year-old man is presented. The lead point of the intussusception is a rare solitary colonic Peutz-Jeghers polyp in the descending colon of a man without the full Peutz-Jeghers syndrome. The clinical presentation, imaging findings on plain radiographs, single contrast enema and CT, and findings at colonoscopy and surgery are correlated with pathology results and a brief review of the literature.
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Affiliation(s)
- J L Jaremko
- Department of Radiology, 2nd Floor, University of Alberta Hospital, 8440 112 Street, Edmonton, Alberta, Canada
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15
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Schreibman IR, Baker M, Amos C, McGarrity TJ. The hamartomatous polyposis syndromes: a clinical and molecular review. Am J Gastroenterol 2005; 100:476-90. [PMID: 15667510 DOI: 10.1111/j.1572-0241.2005.40237.x] [Citation(s) in RCA: 248] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Inherited forms of gastrointestinal cancer have been a major focus of study and advancement over the past decade. Familial adenomatous polyposis and hereditary nonpolyposis colon cancer are the two most common heritable colon cancer syndromes. Inherited polyposis syndromes are characterized by the dominant type of polyp (whether adenomatous or hamartomatous) present and by the polyp's location within the gastrointestinal tract. The hamartomatous polyposis syndromes are characterized by an overgrowth of cells native to the area in which they normally occur. They represent a small but appreciable number of the gastrointestinal inherited cancer predisposition syndromes; it is now known that many of these syndromes carry a substantial risk for developing colon cancer as well as other gastrointestinal and pancreatic cancers. Patients afflicted with these syndromes are also at significant risk for extraintestinal malignancies. Seven inherited hamartomatous polyposis syndromes have been described: familial juvenile polyposis syndrome, Cowden's syndrome, Bannayan-Ruvalcaba-Riley syndrome, Peutz-Jeghers syndrome, basal cell nevus syndrome, neurofibromatosis 1, and multiple endocrine neoplasia syndrome 2B. Hereditary mixed polyposis syndrome is a variant of juvenile polyposis characterized by both hamartomatous and adenomatous polyps. The hamartomatous syndromes occur at approximately 1/10th the frequency of the adenomatous syndromes and account for <1% of colorectal cancer in Northern America. While the diagnosis of these inherited syndromes is primarily clinical, genetic testing is now available for all six syndromes. However, there are a significant number of spontaneous mutations seen in each of the syndromes. The management of these patients necessitates a coordinated multidisciplinary approach. The purpose of this review is to characterize the clinical and pathological features of these syndromes and to review the targets of cancer surveillance. The molecular alterations responsible for the inherited hamartomatous polyposis syndromes will also be discussed.
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Affiliation(s)
- Ian Roy Schreibman
- Division of Gastroenterology and Hepatology, The Milton S. Hershey/Penn State University Medical Center, 500 University Drive, Hershey, PA 17033, USA
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