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Yamamoto H, Sakamoto H, Kumagai H, Abe T, Ishiguro S, Uchida K, Kawasaki Y, Saida Y, Sano Y, Takeuchi Y, Tajika M, Nakajima T, Banno K, Funasaka Y, Hori S, Yamaguchi T, Yoshida T, Ishikawa H, Iwama T, Okazaki Y, Saito Y, Matsuura N, Mutoh M, Tomita N, Akiyama T, Yamamoto T, Ishida H, Nakayama Y. Clinical Guidelines for Diagnosis and Management of Peutz-Jeghers Syndrome in Children and Adults. Digestion 2023; 104:335-347. [PMID: 37054692 DOI: 10.1159/000529799] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/14/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Peutz-Jeghers syndrome (PJS) is a rare disease characterized by the presence of hamartomatous polyposis throughout the gastrointestinal tract, except for the esophagus, along with characteristic mucocutaneous pigmentation. It is caused by germline pathogenic variants of the STK11 gene, which exhibit an autosomal dominant mode of inheritance. Some patients with PJS develop gastrointestinal lesions in childhood and require continuous medical care until adulthood and sometimes have serious complications that significantly reduce their quality of life. Hamartomatous polyps in the small bowel may cause bleeding, intestinal obstruction, and intussusception. Novel diagnostic and therapeutic endoscopic procedures such as small-bowel capsule endoscopy and balloon-assisted enteroscopy have been developed in recent years. SUMMARY Under these circumstances, there is growing concern about the management of PJS in Japan, and there are no practice guidelines available. To address this situation, the guideline committee was organized by the Research Group on Rare and Intractable Diseases granted by the Ministry of Health, Labour and Welfare with specialists from multiple academic societies. The present clinical guidelines explain the principles in the diagnosis and management of PJS together with four clinical questions and corresponding recommendations based on a careful review of the evidence and involved incorporating the concept of the Grading of Recommendations Assessment, Development and Evaluation system. KEY MESSAGES Herein, we present the English version of the clinical practice guidelines of PJS to promote seamless implementation of accurate diagnosis and appropriate management of pediatric, adolescent, and adult patients with PJS.
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Affiliation(s)
- Hironori Yamamoto
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hirotsugu Sakamoto
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hideki Kumagai
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Takashi Abe
- Department of Gastroenterology, Hanwa Sumiyoshi General Hospital, Osaka, Japan
| | | | - Keiichi Uchida
- Department of Pediatric Surgery, Mie University Hospital, Tsu, Japan
| | - Yuko Kawasaki
- University of Hyogo, College of Nursing, Akashi, Japan
| | - Yoshihisa Saida
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yasushi Sano
- Gastrointestinal Center & Institute of Minimally-invasive Endoscopic Care, Sano Hospital, Kobe, Japan
| | - Yoji Takeuchi
- Division of Hereditary Tumors, Department of Gastrointestinal Oncology, And Department of Genetic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | | | - Takeshi Nakajima
- Department of Clinical Genetic Oncology, Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Kouji Banno
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Yoko Funasaka
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Shinichiro Hori
- Department of Cancer Genomic Medicine, NHO Shikoku Cancer Center, Matsuyama, Japan
| | - Tatsuro Yamaguchi
- Department of Clinical Genetics, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Teruhiko Yoshida
- Department of Genetic Medicine and Services, National Cancer Center Hospital, Tokyo, Japan
| | - Hideki Ishikawa
- Department of Molecular-Targeting Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Ishikawa Gastroenterology Clinic, Osaka, Japan
| | - Takeo Iwama
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Yasushi Okazaki
- Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Michihiro Mutoh
- Department of Molecular-Targeting Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naohiro Tomita
- Cancer Treatment Center, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
| | - Takashi Akiyama
- Department of Pediatric Surgery, Chuden Hospital, Hiroshima, Hiroshima, Japan
| | - Toshiki Yamamoto
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hideyuki Ishida
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Yoshiko Nakayama
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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Medeiros YDL, Faria LV, Chandretti PCDS, Mainenti P. Laser therapy and light sources for labial lentigines in patients with
Peutz‐Jeghers
syndrome. Dermatol Ther 2022; 35:e15519. [DOI: 10.1111/dth.15519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 03/25/2022] [Accepted: 04/12/2022] [Indexed: 11/27/2022]
Affiliation(s)
| | - Luan Viana Faria
- School of Dentistry Universidade Federal de Juiz de Fora Minas Gerais Brazil
| | | | - Pietro Mainenti
- Department of Pathology, School of Medicine Universidade Presidente Antônio Carlos Minas Gerais Brazil
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Klimkowski S, Ibrahim M, Ibarra Rovira JJ, Elshikh M, Javadi S, Klekers AR, Abusaif AA, Moawad AW, Ali K, Elsayes KM. Peutz-Jeghers Syndrome and the Role of Imaging: Pathophysiology, Diagnosis, and Associated Cancers. Cancers (Basel) 2021; 13:cancers13205121. [PMID: 34680270 PMCID: PMC8533703 DOI: 10.3390/cancers13205121] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 02/03/2023] Open
Abstract
Simple Summary The Peutz-Jeghers Syndrome is a rare autosomal dominant syndrome characterized by mucocutaneous pigmentations, multiple gastrointestinal hamartomatous polyps, and an elevated risk of malignancy. Awareness of various Peutz-Jeghers Syndrome imaging patterns, associated malignancies, and their complications is crucial for accurate imaging interpretation and patient management. In this manuscript, we provide an overview of this condition, associated malignancies, and imaging surveillance protocols. Abstract The Peutz-Jeghers Syndrome (PJS) is an autosomal dominant neoplastic syndrome defined by hamartomatous polyps through the gastrointestinal tract, development of characteristic mucocutaneous pigmentations, and an elevated lifetime cancer risk. The majority of cases are due to a mutation in the STK11 gene located at 19p13.3. The estimated incidence of PJS ranges from 1:50,000 to 1:200,000. PJS carries an elevated risk of malignancies including gastrointestinal, breast, lung, and genitourinary (GU) neoplasms. Patients with PJS are at a 15- to 18-fold increased malignancy risk relative to the general population. Radiologists have an integral role in the diagnosis of these patients. Various imaging modalities are used to screen for malignancies and complications associated with PJS. Awareness of various PJS imaging patterns, associated malignancies, and their complications is crucial for accurate imaging interpretation and patient management. In this manuscript, we provide a comprehensive overview of PJS, associated malignancies, and surveillance protocols.
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Affiliation(s)
- Sergio Klimkowski
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77555, USA; (J.J.I.R.); (S.J.); (A.R.K.); (A.A.A.)
- Correspondence: (S.K.); (K.M.E.)
| | - Mohamed Ibrahim
- Department of Diagnostic and Interventional Radiology, University of Kansas-Wichita, Wichita, KS 67214, USA; (M.I.); (K.A.)
| | - Juan J. Ibarra Rovira
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77555, USA; (J.J.I.R.); (S.J.); (A.R.K.); (A.A.A.)
| | - Mohamed Elshikh
- Department of Diagnostic and Interventional Radiology, The University of Texas Medica Branch, Galveston, TX 77555, USA;
| | - Sanaz Javadi
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77555, USA; (J.J.I.R.); (S.J.); (A.R.K.); (A.A.A.)
| | - Albert R. Klekers
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77555, USA; (J.J.I.R.); (S.J.); (A.R.K.); (A.A.A.)
| | - Abdelraham A. Abusaif
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77555, USA; (J.J.I.R.); (S.J.); (A.R.K.); (A.A.A.)
| | - Ahmed W. Moawad
- Department of Diagnostic and Interventional Radiology, Mercy Catholic Health System, Darby, PA 19023, USA;
| | - Kamran Ali
- Department of Diagnostic and Interventional Radiology, University of Kansas-Wichita, Wichita, KS 67214, USA; (M.I.); (K.A.)
| | - Khaled M. Elsayes
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77555, USA; (J.J.I.R.); (S.J.); (A.R.K.); (A.A.A.)
- Correspondence: (S.K.); (K.M.E.)
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Abstract
Although CO2 lasers have been available to the cosmetic surgeon for more than 20 years, it is only recently that the ultrapulse mode has made the laser user-friendly. Now, tissue can be vaporized without significant charring. To shorten our learning curve with this treatment modality, various skin lesions were ablated with variable spot sizes and energy settings. Our results are presented as personal guidelines. Large and small areas may be resurfaced. If occlusive dressings are used, rapid reepithelization occurs across previous skin lesions or scars. This results in the appearance of rejuvenation. The only troublesome sequela has been persistent erythema similar to that seen after a phenol peel.
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Efficacy of serial excisions of melanocytic nevi on the face using a carbon dioxide laser: a cosmetic point of view. Aesthetic Plast Surg 2014; 38:316-21. [PMID: 24682590 DOI: 10.1007/s00266-014-0303-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 03/07/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED In cosmetic clinical practice, many patients express the desire for removal of melanocytic nevi, especially those on the face. The carbon dioxide (CO2) laser currently is the preferred for treatment of such lesions because of less scar formation, less bleeding, and simplicity of the procedure. However, if the diameter of the lesion is greater than 5 mm, many clinicians prefer surgical resection to laser resection because laser resection of relatively large nevi often results in the formation of a conspicuous dimple. The authors developed a serial laser excision method for melanocytic nevi larger than 5 mm, with division of the lesion into multiple segments, which allowed the ablated area to gain optimal granulation and reepithelialization, leading to a satisfactory cosmetic appearance. This novel procedure was performed for 25 patients with melanocytic nevi ranging from 5 to 10 mm in diameter. The lesions were divided into two segments in 21 patients, three segments in 3 patients, and four segments in 1 patient. The divided parts of the lesions were ablated by CO2 laser serially at intervals of 2-4 weeks. All the patients obtained optimal granulation and epithelialization in the treated lesions, and the final appearance was satisfactory. Although the therapeutic period was longer than for a surgical excision or a single laser treatment, the new treatment approach of serial excision by CO2 laser achieved favorable outcomes for the treatment of relatively large nevi 5-10 mm in size. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Abstract
Hyperpigmentation of the lips is a common condition. It is associated with a wide variety of conditions that include physiologic changes, genodermatoses, inflammatory diseases, endocrinologic disorders, drugs and chemicals, benign and malignant neoplasm, and other non-melanotic conditions. The aim of this article is to provide a clinical approach to hyperpigmented lesions on the lips based on the extent of lesions, the age of onset, and associated systemic involvements. In this review, we present an algorithm to guide the diagnosis of and plan for therapeutic intervention for pigmented lesions of the lips. The algorithm is based on the typical clinical presentation of each entity and should not be taken as an absolute indicator of diagnosis. Although the differences in color can help to differentiate among pigmented lesions, the interpretation of color can be subjective and is influenced by the amount and location of the pigment within the mucosa. The limitations of this review are that some data are based on case reports and small case series that may not reflect true association.
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Affiliation(s)
- Vasanop Vachiramon
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Nogita T, Mitsuhashi Y, Takeo C, Tsuboi R. Removal of facial and labial lentigines in dyschromatosis universalis hereditaria with a Q-switched alexandrite laser. J Am Acad Dermatol 2011; 65:e61-e63. [PMID: 21763558 DOI: 10.1016/j.jaad.2011.01.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Revised: 01/27/2011] [Accepted: 01/31/2011] [Indexed: 10/18/2022]
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Remington BK, Remington TK. Treatment of facial lentigines in Peutz-Jeghers syndrome with an intense pulsed light source. Dermatol Surg 2002; 28:1079-81. [PMID: 12460308 DOI: 10.1046/j.1524-4725.2002.02089.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Peutz-Jeghers syndrome is a hereditary condition characterized by distinctive mucocutaneous lentigines and intestinal hamartomatous polyposis. The cutaneous lesions may be cosmetically disfiguring and frequently present a therapeutic challenge. OBJECTIVE To determine if intense pulsed light (IPL) is effective in treating facial lentigines in Peutz-Jeghers syndrome. METHODS The IPL, utilizing a 590 nm cutoff filter, was used to treat facial lentigines in a 10-year-old girl with Peutz-Jeghers syndrome. RESULTS A series of 12 treatment sessions, each to different facial regions, resulted in complete clearance of lentigines in the treated areas. Most of the lentigines resolved after a single treatment, with a few areas requiring a second treatment. CONCLUSION In this case, treatment with IPL resulted in dramatic improvement of cosmetically disfiguring lentigines. To our knowledge, this is the first report of using IPL in Peutz-Jeghers syndrome.
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Ratner D, Tse Y, Marchell N, Goldman MP, Fitzpatrick RE, Fader DJ. Cutaneous laser resurfacing. J Am Acad Dermatol 1999; 41:365-89; quiz 390-2. [PMID: 10459111 DOI: 10.1016/s0190-9622(99)70110-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED Cutaneous resurfacing with the new generation of carbon dioxide and erbium lasers has recently come into favor for the treatment of facial rhytides, photodamage, and scarring. The precise control of these resurfacing lasers over the extent of tissue vaporization minimizes thermal damage to the skin while maximizing therapeutic efficacy. Proper use of resurfacing lasers is contingent upon a complete understanding of their clinical, histologic, and ultrastructural effects, as well as an appreciation of the principles of laser safety. An organized approach to the preoperative, intraoperative, and postoperative management of the patient undergoing laser resurfacing will be provided, including a discussion of prevention and treatment of postoperative side effects and complications. (J Am Acad Dermatol 1999;41:365-89.) LEARNING OBJECTIVE At the conclusion of this learning activity, participants should be familiar with the clinical, histologic, and ultrastructural effects of resurfacing lasers and be able to discuss the preoperative, intraoperative, and postoperative management of patients undergoing laser resurfacing.
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Affiliation(s)
- D Ratner
- Department of Dermatology, College of Physicians and Surgeons of Columbia University, New York, NY, USA
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Weinstein C, Roberts TL. Aesthetic Skin Resurfacing with the High-Energy Ultrapulsed CO2 Laser. Clin Plast Surg 1997. [DOI: 10.1016/s0094-1298(20)31071-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Affiliation(s)
- R E Fitzpatrick
- Dermatology Associates of San Diego County, Inc., La Jolla, California, USA
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Abstract
The accessibility of the skin to examination and study has permitted dermatologists to play an extremely important role in defining the clinical usefulness and limitations of many laser systems as well as developing innovative concepts, techniques and devices that further improved the effectiveness of laser treatment. As new laser technology evolved over the years, dermatologists have also helped define the specificity of laser-tissue interaction and employed the newly developed laser technologies in innovative ways which further expanded the usefulness of these devices. One of the most important concepts to be developed by dermatologists--selective photothermolysis--has led to the creation of a series of laser systems which have provided numerous unique advantages in the management of many common vascular and pigmented conditions of the skin and mucous membranes, even in infants and children. The net result of these technologic advances has been the creation of new and effective treatment techniques which have been so profoundly superior to existing technology that they have been rapidly incorporated into the daily practice of most dermatologists.
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Affiliation(s)
- R G Wheeland
- Department of Dermatology, University of New Mexico, Albuquerque 87131, USA
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DePadova-Elder SM, Milgraum SS. Q-switched ruby laser treatment of labial lentigines in Peutz-Jeghers syndrome. THE JOURNAL OF DERMATOLOGIC SURGERY AND ONCOLOGY 1994; 20:830-2. [PMID: 7798417 DOI: 10.1111/j.1524-4725.1994.tb03714.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND. The Q-switched ruby laser emits energy with a 694-nm wavelength and has a pulse duration in the nanosecond range, which allows selective treatment of benign pigmented lesions. Labial and perioral pigmented macules associated with Peutz-Jeghers syndrome are often numerous and cosmetically disfiguring. RESULTS/CONCLUSION. We report successful treatment of these lentigines with the Q-switched ruby laser and consider it the treatment of choice for these lesions.
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Affiliation(s)
- S M DePadova-Elder
- Department of Dermatology, Hahnemann University Hospital, Philadelphia, Pennsylvania
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