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Liu J, Zeng SC, Wang A, Cheng HY, Zhang QJ, Lu GX. Two missense STK11 gene variations impaired LKB1/adenosine monophosphate-activated protein kinase signaling in Peutz-Jeghers syndrome. World J Gastrointest Oncol 2024; 16:1532-1546. [PMID: 38660671 PMCID: PMC11037055 DOI: 10.4251/wjgo.v16.i4.1532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/29/2023] [Accepted: 02/03/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Peutz-Jeghers syndrome (PJS) is a rare hereditary neoplastic disorder mainly associated with serine/threonine kinase 11 (STK11/LKB1) gene mutations. Preimplantation genetic testing can protect a patient's offspring from mutated genes; however, some variations in this gene have been interpreted as variants of uncertain significance (VUS), which complicate reproductive decision-making in genetic counseling. AIM To identify the pathogenicity of two missense variants and provide clinical guidance. METHODS Whole exome gene sequencing and Sanger sequencing were performed on the peripheral blood of patients with PJS treated at the Reproductive and Genetic Hospital of Citic-Xiangya. Software was employed to predict the protein structure, conservation, and pathogenicity of the two missense variation sites in patients with PJS. Additionally, plasmids were constructed and transfected into HeLa cells to observe cell growth. The differences in signal pathway expression between the variant group and the wild-type group were compared using western blot and immunohistochemistry. Statistical analysis was performed using one-way analysis of variance. P < 0.05 was considered statistically significant. RESULTS We identified two missense STK11 gene VUS [c.889A>G (p.Arg297Gly) and c.733C>T (p.Leu245Phe)] in 9 unrelated PJS families who were seeking reproductive assistance. The two missense VUS were located in the catalytic domain of serine/threonine kinase, which is a key structure of the liver kinase B1 (LKB1) protein. In vitro experiments showed that the phosphorylation levels of adenosine monophosphate-activated protein kinase (AMPK) at Thr172 and LKB1 at Ser428 were significantly higher in transfected variation-type cells than in wild-type cells. In addition, the two missense STK11 variants promoted the proliferation of HeLa cells. Subsequent immunohistochemical analysis showed that phosphorylated-AMPK (Thr172) expression was significantly lower in gastric, colonic, and uterine polyps from PJS patients with missense variations than in non-PJS patients. Our findings indicate that these two missense STK11 variants are likely pathogenic and inactivate the STK11 gene, causing it to lose its function of regulating downstream phosphorylated-AMPK (Thr172), which may lead to the development of PJS. The identification of the pathogenic mutations in these two clinically characterized PJS patients has been helpful in guiding them toward the most appropriate mode of pregnancy assistance. CONCLUSION These two missense variants can be interpreted as likely pathogenic variants that mediated the onset of PJS in the two patients. These findings not only offer insights for clinical decision-making, but also serve as a foundation for further research and reanalysis of missense VUS in rare diseases.
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Affiliation(s)
- Jin Liu
- Hunan Guangxiu Hospital, Hunan Normal University, Changsha 410000, Hunan Province, China
- Scientific Research Department, Reproductive and Genetic Hospital of Citic-Xiangya, Changsha 410000, Hunan Province, China
| | - Si-Cong Zeng
- Hunan Guangxiu Hospital, Hunan Normal University, Changsha 410000, Hunan Province, China
- Scientific Research Department, Reproductive and Genetic Hospital of Citic-Xiangya, Changsha 410000, Hunan Province, China
| | - An Wang
- Hunan Guangxiu Hospital, Hunan Normal University, Changsha 410000, Hunan Province, China
| | - Hai-Ying Cheng
- Hunan Guangxiu Hospital, Hunan Normal University, Changsha 410000, Hunan Province, China
| | - Qian-Jun Zhang
- Hunan Guangxiu Hospital, Hunan Normal University, Changsha 410000, Hunan Province, China
| | - Guang-Xiu Lu
- Hunan Guangxiu Hospital, Hunan Normal University, Changsha 410000, Hunan Province, China
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Yoshida H, Hiranuma K, Nakahara M, Kobayashi-Kato M, Tanase Y, Uno M, Shiraishi K, Ishikawa M, Kato T. Ovarian Mucinous Tumor Presenting Atypical Lobular Endocervical Glandular Hyperplasia-Like Appearance in a Patient With Germline STK11 p.F354L Variant: A Case Report. Int J Surg Pathol 2024; 32:394-400. [PMID: 37226494 DOI: 10.1177/10668969231177256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Peutz-Jeghers syndrome (PJS) is associated with female genital lesions, such as cervical gastric-type adenocarcinoma and lobular endocervical glandular hyperplasia (LEGH). However, ovarian mucinous borderline tumors (OMBT) with atypical LEGH-like histology have not been described. The patient was a 60-year-old female with PJS clinically diagnosed at 23 years old with gastrointestinal polyposis. Abdominal distension was noted, and computed tomography scan revealed bilateral breast masses, multiple lung nodules, and a multicystic ovarian tumor. A needle biopsy revealed invasive ductal carcinoma of the breast. For the ovarian tumor, simple hysterectomy and bilateral salpingo-oophorectomy were performed. The left ovarian tumor was 25 × 20 × 12 cm in size and a multicystic tumor containing yellowish mucus without a solid part. Histologically, the cyst wall was covered with mucus cells with focal mild-to-moderate cellular atypia, forming LEGH-like architectures. The glandular cells were immunohistochemically positive for MUC5AC, MUC6 (focal), HIK1083 (focal), and HNF4α. Stromal invasion was not observed. Cervical lesions were not observed. The final pathological diagnosis was OMBT showing atypical LEGH morphology. Targeted sequencing of nontumor tissues revealed the germline STK11 p.F354L variant. Six months later, peritoneal dissemination of adenocarcinoma showing features similar to those of the ovarian tumor was observed, and the patient died of the disease. In summary, we report a case of OMBT with an atypical LEGH-like appearance in a patient with germline STK11 p.F354L variant. This case provides us with unresolved questions regarding the pathogenicity of this STK11 variant and the malignant potential of OMBT with this unusual morphology.
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Affiliation(s)
- Hiroshi Yoshida
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Kengo Hiranuma
- Division of Genome Biology, National Cancer Center Research Institute, Tokyo, Japan
| | - Mariko Nakahara
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Yasuhito Tanase
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Masaya Uno
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Kouya Shiraishi
- Division of Genome Biology, National Cancer Center Research Institute, Tokyo, Japan
| | - Mitsuya Ishikawa
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoyasu Kato
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
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Miresa F, Beyene B, Abdulhadi M, Mohamud A, Belachew A. Poorly differentiated adenocarcinoma of the jejunum in a patient with Peutz-Jeghers syndrome: A case report. Int J Surg Case Rep 2024; 117:109519. [PMID: 38471213 PMCID: PMC10945191 DOI: 10.1016/j.ijscr.2024.109519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Despite being the longest and containing a greater proportion of the gastrointestinal tract's mucosal surface area, the small bowel is where <2 % to 5 % of gastrointestinal cancers can occur. Peutz-Jeghers syndrome is the rarest risk factor for the development of small intestinal cancers. Here we report a case of perforated poorly differentiated adenocarcinoma of the jejunum for which Peutz-Jeghers syndrome is identified. CASE PRESENTATION A 25-year-old male patient presented to the emergency department with generalized peritonitis caused by a perforated jejunal mass. The patient underwent an emergency exploratory laparotomy. There was 800 ml of thin pus in the peritoneal cavity and 5 cm by 6 cm perforated mass over the jejunum which extends to the mesentery. Palpable intraluminal polyps with an inverted serosal surface for some of them were identified. The pus was sucked out, and the mass was resected with its mesenteric lymph nodes and segments containing polyps. Subsequently, end-to-end hand-sewn anastomosis was performed, and the abdomen was closed. The histopathology report showed poorly differentiated adenocarcinoma, stage IIIC (PT3, PN2), and Peutz-Jeghers polyps, suggesting Peutz-Jeghers syndrome. CLINICAL DISCUSSION Even though small bowel malignancy is a rare entity, early detection is a challenging issue, especially when it happens below the ligaments of the trietz. Surgical resection offers the only potential cure for small bowel malignancy. CONCLUSION We conclude that patients with long-term, nonspecific abdominal complaints are good candidates for evaluation and investigation without overlooking small bowel malignancy. Peutz-Jeghers syndrome was a potential risk factor in our case.
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Affiliation(s)
- Fufa Miresa
- Department of Surgery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia.
| | - Badhaasaa Beyene
- Department of Surgery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Munewor Abdulhadi
- Department of Surgery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Abdulaziz Mohamud
- Department of Surgery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Anteneh Belachew
- Department of Pathology, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
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Yang L, Duan D, Xiong Y, Liu T, Zhao L, Lai F, Gu D, Zhou L. Preoperative multimodal ultrasonic imaging in a case of Peutz-Jeghers syndrome complicated by atypical lobular endocervical glandular hyperplasia: a case report and literature review. Hered Cancer Clin Pract 2024; 22:3. [PMID: 38419118 PMCID: PMC10900695 DOI: 10.1186/s13053-024-00275-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/13/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Peutz-Jeghers syndrome (PJS), an autosomal dominant multiple cancerous disorder, is clinically characterized by mucocutaneous macules and multiple gastrointestinal hamartomatous polyps. Gastric-type endocervical adenocarcinoma (G-EAC), a special subtype of cervical adenocarcinoma with non-specific symptoms and signs, is known to occur in approximately 11% of female patients with PJS. CASE PRESENTATION Here, we report a case of PJS in a 24-year-old female with multiple mucocutaneous black macules who complained of vaginal discharge and menorrhagia. Moreover, we first described the multimodal ultrasonographical manifestations of PJS-correlated G-EAC. The three-dimensional reconstructed view of G-EAC on 3D realisticVue exhibited a distinctive "cosmos pattern" resembling features on magnetic resonance imaging, and the contrast-enhanced ultrasound displayed a "quick-up and slow-down" pattern of the solid components inside the mixed cervical echoes. We reported the multimodal ultrasonographical characteristics of a case of PJS-related G-EAC, as well as reviewed PJS-related literature and medical imaging features and clinical characteristics of G-EAC to provide insight into the feasibility and potential of utilizing multimodal ultrasonography for the diagnosis of G-EAC. CONCLUSIONS Multimodal ultrasound can visualize morphological features, solid components inside, and blood supplies of the G-EAC lesion and distinguish the G-EAC lesion from normal adjacent tissues. This facilitates preoperative diagnosis and staging of PJS-related G-EAC, thereby aiding subsequent health and reproductive management for patients with PJS.
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Affiliation(s)
- Liwen Yang
- Department of Ultrasonography, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology, No. 1617, Riyue Avenue, Chengdu, Sichuan, 610091, China
| | - Duan Duan
- Department of Gynecology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology, Chengdu, China
| | - Ying Xiong
- Department of Gynecology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology, Chengdu, China
| | - Tianjiao Liu
- Department of Gynecology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology, Chengdu, China
| | - Lijun Zhao
- Department of Ultrasonography, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology, No. 1617, Riyue Avenue, Chengdu, Sichuan, 610091, China
| | - Fan Lai
- Department of Obstetrics, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology, Chengdu, China
| | - Dingxian Gu
- Department of Gynecology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology, Chengdu, China
| | - Liuying Zhou
- Department of Ultrasonography, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology, No. 1617, Riyue Avenue, Chengdu, Sichuan, 610091, China.
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Mascaro N, Aboelnasr LS, Masood M, Yague E, Moran L, El-Bahrawy M. Exploring the histogenesis of STK11 adnexal tumour using electron microscopy. Virchows Arch 2024:10.1007/s00428-024-03763-2. [PMID: 38376618 DOI: 10.1007/s00428-024-03763-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/22/2024] [Accepted: 02/05/2024] [Indexed: 02/21/2024]
Abstract
STK11 adnexal tumour is a recently described female genital tract tumour, usually identified in a paratubal location, often associated with Peutz-Jeghers syndrome (PJS) and with STK11 gene alterations identified in most of the cases. Morphologically, this tumour is composed of cells arranged in a variety of patterns, including cords, trabeculae, tubules and cystic and acinar structures. The cells are only moderately pleomorphic and mitotic activity is variable. As tumour cells express epithelial, sex cord stromal and mesothelial markers, STK11 adnexal tumour may be of sex cord stromal, epithelial or mesothelial origin; a Wolffian origin has also been suggested. We report the ultrastructural features of two STK11 adnexal tumours and compare their ultrastructural features with those of other sex cord stromal tumours, a granulosa cell tumour cell line, as well as the known ultrastructural features of epithelial, mesothelial and Wolffian cells. On ultrastructural examination, two STK11 adnexal tumours showed an admixture of elongated cells with regular elongated nuclei and polygonal cells with nuclei showing markedly irregular outlines and prominent nucleoli. Extracellular collagen fibres were identified. These are common ultrastructural features of sex cord stromal tumours, principally sex cord tumour with annular tubules; no ultrastructural features of epithelial, mesothelial or Wolffian cells were found. These findings in conjunction with the shared clinical and genetic association with PJS and shared molecular changes in STK11 gene suggest that STK11 adnexal tumour represents a poorly differentiated sex cord tumour.
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Affiliation(s)
- Nuria Mascaro
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 0NN, UK
| | - Lamia Sabry Aboelnasr
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 0NN, UK
| | - Motasim Masood
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 0NN, UK
| | - Ernesto Yague
- Department of Cancer and Surgery, Imperial College London, London, UK
| | - Linda Moran
- Electron Microscopy Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Mona El-Bahrawy
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Hammersmith Campus, DuCane Road, London, W12 0NN, UK.
- Department of Pathology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
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Dréau A, Barthomeuf C, Balesdent M, Fumery M, Sabbagh C, Chatelain D. [Enteritis cystica profunda]. Ann Pathol 2024; 44:65-68. [PMID: 37635018 DOI: 10.1016/j.annpat.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/16/2023] [Indexed: 08/29/2023]
Abstract
Enteritis cystica profunda is a rare and benign disease defined as the invagination of the intestinal epithelium into the submucosa and more profound layers of intestinal wall leading to the formation of mucin-filled cystic spaces. We reported the case of a 45-year-old female, suffering from a Crohn's disease, with a Koenig's syndrome, diarrhea, abdominal pain and weight loss. The colonoscopy and the abdominopelvic scan showed a terminal ileal stenosis, with parietal calcifications. A surgical ileocecal resection was decided. Gross examination of the ileocecal resection showed a thickening of the ileal wall, with many mucin-filled cysts measuring 1mm to 2cm, with some calcifications. The ileal mucosa was ulcerated, and showed a stenotic sector extending over 3cm. Histological examination showed acute ulcerated ileitis lesions, with chronic ileitis lesions and stenosis, compatible with the known diagnosis of Crohn's disease. There were also many cysts into the ileal wall. They were lined with a regular ileal epithelium. The cysts contained mucus, with some calcifications. Some cysts were ruptured, with extravasation of mucus within the wall. Cystica profunda can be found anywhere along the digestive tract. The physiopathology is not yet well understood, but it seems to be favored by chronic aggression of the intestinal wall. This pathology most often coexists with Crohn's disease. The main differential diagnosis is mucinous adenocarcinoma. Cystica profunda does not require any specific treatment.
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Affiliation(s)
- Axel Dréau
- Service d'anatomopathologie, CHU Amiens Picardie, site Nord (hôpital Nord), 1, place Victor-Pauchet, 80054 Amiens cedex 1, France.
| | - Clémence Barthomeuf
- Service d'anatomopathologie, CHU Amiens Picardie, site Nord (hôpital Nord), 1, place Victor-Pauchet, 80054 Amiens cedex 1, France
| | - Marion Balesdent
- Service d'anatomopathologie, CHU Amiens Picardie, site Nord (hôpital Nord), 1, place Victor-Pauchet, 80054 Amiens cedex 1, France
| | - Mathurin Fumery
- Service d'anatomopathologie, CHU Amiens Picardie, site Nord (hôpital Nord), 1, place Victor-Pauchet, 80054 Amiens cedex 1, France
| | - Charles Sabbagh
- Service d'anatomopathologie, CHU Amiens Picardie, site Nord (hôpital Nord), 1, place Victor-Pauchet, 80054 Amiens cedex 1, France
| | - Denis Chatelain
- Service d'anatomopathologie, CHU Amiens Picardie, site Nord (hôpital Nord), 1, place Victor-Pauchet, 80054 Amiens cedex 1, France
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Wu X, Liang D, He Y. Peutz Jeghers syndrome accompanied with cervical gastric adenocarcinoma and extensive metastasis: a case report. Int J Clin Exp Pathol 2023; 16:386-392. [PMID: 38188351 PMCID: PMC10767481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/10/2023] [Indexed: 01/09/2024]
Abstract
Female pathological tumors are easily misdiagnosed and missed in clinical practice. Especially in patients with Peutz-Jeghers syndrome (PJS) who often have a variety of rare types of gynecological tumors. We reported a patient with a case of PJS with a lower abdominal mass as the clinical manifestation. Physical and auxiliary examinations showed a large pelvic and abdominal mass. According to the patient's PJS history, gastric adenocarcinoma (GAC) was diagnosed after timely cervical biopsy. The patient underwent abdominal and pelvic mass resection and extensive hysterectomy. The tumor extensively disseminated to the bilateral ovaries, endometrium, fallopian tubes and pelvis. The cyclin-dependent kinase inhibitor 2A gene mutation was demonstrated in cervical GAC samples using next-generation sequencing. We summarized the literature on PJS accompanied by GAC with metastases to bilateral ovaries and analyzed the clinical characteristics of female patients with PJS combined with multiple gynecological tumors. Being aware of the PJS history of the patient is helpful for the standardized diagnosis and treatment of PJS-related gynecological tumors.
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Affiliation(s)
- Xia Wu
- Department of Pathology, West China Second Hospital of Sichuan UniversityChengdu, Sichuan, P. R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of EducationChengdu, Sichuan, P. R. China
| | - Dongni Liang
- Department of Pathology, West China Second Hospital of Sichuan UniversityChengdu, Sichuan, P. R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of EducationChengdu, Sichuan, P. R. China
| | - Ying He
- Department of Pathology, West China Second Hospital of Sichuan UniversityChengdu, Sichuan, P. R. China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of EducationChengdu, Sichuan, P. R. China
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8
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Shin H, Hur K, Lee JS, Seong MW, Mun JH. Acral Pigmentation in Peutz-Jeghers Syndrome: Dermoscopic Findings and Treatment with the Q-Switched Nd:YAG Laser. Ann Dermatol 2023; 35:S201-S204. [PMID: 38061703 PMCID: PMC10727881 DOI: 10.5021/ad.21.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/24/2021] [Accepted: 01/12/2022] [Indexed: 12/20/2023] Open
Abstract
Peutz-Jeghers syndrome (PJS; MIM 175200) is an autosomal dominant multiple-organ cancer syndrome. It is characterized by brown macules distributed in the perioral skin, oral mucosa, hands and feet, and hamartomatous gastrointestinal polyps that can eventually lead to intestinal obstruction, abdominal pain, bleeding, and anemia. Patients with PJS are at a higher risk of ovarian, testicular, breast, lung, and pancreatic cancers. This predisposition is due to the pathogenic variant in serine/threonine kinase 11 (STK11) gene located on chromosome 19p13.3. Here, we present the dermoscopic findings, histopathologic features of acral pigmentation, and DNA sequencing results of the patient with PJS. We also report a successful removal of acral pigmentation using the Q-switched Nd:YAG laser (QSNYL) treatment. Our results suggest that QSNYL therapy could be a treatment option for acral pigmentation in patients with PJS.
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Affiliation(s)
- Hyeonwoo Shin
- Department of Premedicine, Seoul National University College of Medicine, Seoul, Korea
| | - Keunyoung Hur
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Jee-Soo Lee
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Moon-Woo Seong
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Je-Ho Mun
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.
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Sharma AE, Slack JC, Parra-Herran CE, Quade BJ, Shusterman S, Church AJ, Kolin DL, Carreon CK. STK11 Adnexal Tumor in an Adolescent Female: Diagnostic Pitfalls of a Recently Described Entity. Pediatr Dev Pathol 2023; 26:486-493. [PMID: 37334562 DOI: 10.1177/10935266231176681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
STK11 adnexal tumor is a recently described entity with less than 25 cases reported to date. These aggressive tumors typically occur in paratubal/paraovarian soft tissues, have characteristically striking morphologic and immunohistochemical heterogeneity, and harbor pathognomonic alterations in STK11. These occur almost exclusively in adult patients, with only one reported in a pediatric patient (to our knowledge). A previously healthy 16-year-old female presented with acute abdominal pain. Imaging studies revealed large bilateral solid and cystic adnexal masses, ascites, and peritoneal nodules. Following frozen section evaluation of a left ovarian surface nodule, bilateral salpingo-oophorectomy and tumor debulking were performed. Histologically, the tumor demonstrated distinctively variable cytoarchitecture, myxoid stroma, and mixed immunophenotype. A next generation sequencing-based assay identified a pathogenic STK11 mutation. We report the youngest patient to date with an STK11 adnexal tumor, highlighting key clinicopathologic and molecular features in order to contrast them with those of other pediatric intra-abdominal malignancies. This rare and unfamiliar tumor poses a considerable diagnostic challenge and requires a multidisciplinary integrated approach to diagnosis.
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Affiliation(s)
- Aarti E Sharma
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham & Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Jonathan C Slack
- Department of Pathology, Boston Children's Hospital/Harvard Medical School, Boston, MA, USA
| | - Carlos E Parra-Herran
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham & Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Bradley J Quade
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham & Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Suzanne Shusterman
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Alanna J Church
- Department of Pathology, Boston Children's Hospital/Harvard Medical School, Boston, MA, USA
| | - David L Kolin
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham & Women's Hospital/Harvard Medical School, Boston, MA, USA
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Kamoun S, Charfi L, Doghri R, Driss M, Boujelbene N, Abess I, Mrad K. [Sex cord tumors with annular tubules: About 4 cases and literature review]. Ann Pathol 2023; 43:400-406. [PMID: 36842896 DOI: 10.1016/j.annpat.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 10/23/2022] [Accepted: 01/12/2023] [Indexed: 02/26/2023]
Abstract
Sex cord tumor with annular tubules (SCTAT) is a rare ovarian tumor. It belongs to sex cord and stromal tumor of the ovary and represents less than 1% of cases. It includes two forms: the first one associated with Peuz-Jeghers syndrome and the second sporadic. We report 4 cases of SCTAT collected at the department of pathology of Salah Azaiez Institute of Tunis over the 12 last years. The age ranged from 10 to 32 years. Symptoms were non specific except for one case revealed by precocious puberty. One patient had Peutz-Jeghers syndrome associated. Tumors were unilateral. Gross findings showed often a solid tumor with yellow cut surface. Their size ranged from 0.5cm to 28cm. Their morphological features were characteristic. Immunohistochemistry showed that tumor cells expressed inhibin and claretinin. The treatment was surgical, often conservative. The diagnosis of malignancy wasn't focused on histological features, but on tumor extension, clinical course, and presence of metastases. Evolution was often favorable. We also performed a systematic review of the literature that identified 166 cases. Features of these cases were studied. We also compared these features between sporadic and syndromic forms and between benign and malignant forms. In conclusion, SCTAT is a rare tumor, usually benign. Its diagnosis is based on histological examination. There is a malignant potential especially in sporadic forms, estimated at 20%. Treatment is most often conservative, based on oophorectomy.
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Affiliation(s)
- Salma Kamoun
- Service d'anatomie et cytologie pathologiques, institut Salah Azaiez, boulevard 9 Avril 1938, 1006 Bab Saadoun, Tunis, Tunisie.
| | - Lamia Charfi
- Service d'anatomie et cytologie pathologiques, institut Salah Azaiez, boulevard 9 Avril 1938, 1006 Bab Saadoun, Tunis, Tunisie
| | - Raoudha Doghri
- Service d'anatomie et cytologie pathologiques, institut Salah Azaiez, boulevard 9 Avril 1938, 1006 Bab Saadoun, Tunis, Tunisie
| | - Maha Driss
- Service d'anatomie et cytologie pathologiques, institut Salah Azaiez, boulevard 9 Avril 1938, 1006 Bab Saadoun, Tunis, Tunisie
| | - Nadia Boujelbene
- Service d'anatomie et cytologie pathologiques, institut Salah Azaiez, boulevard 9 Avril 1938, 1006 Bab Saadoun, Tunis, Tunisie
| | - Imen Abess
- Service d'anatomie et cytologie pathologiques, institut Salah Azaiez, boulevard 9 Avril 1938, 1006 Bab Saadoun, Tunis, Tunisie
| | - Karima Mrad
- Service d'anatomie et cytologie pathologiques, institut Salah Azaiez, boulevard 9 Avril 1938, 1006 Bab Saadoun, Tunis, Tunisie
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11
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Bläker H. [Hereditary colorectal carcinogenesis]. Pathologie (Heidelb) 2023; 44:311-317. [PMID: 37273076 DOI: 10.1007/s00292-023-01200-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 06/06/2023]
Abstract
Hereditary cancer is characterized by the development of certain cancer types in combination with pathogenic germline mutations in genes known to predispose to these cancer types. Familial cancer differs from hereditary cancer in that no predisposing germline mutation is detected in affected families. However, familial cancer may have a genetic background of as yet unknown origin. Colorectal cancer is unique among human tumors since almost all cancers derive from macroscopically visible benign polypoid precursors. Molecular mechanisms of precursor development differ from that of malignant transformation. Hereditary colorectal cancer can be categorized into polypous and non-polypous predispositions. While the former elevate cancer risk by increasing the number of cancer precursors, the latter elevate cancer risk by increasing the likeliness of malignant transformation. It is the pathologist's responsibility to use morphologic criteria in combination with clinical data in order to raise suspicion of hereditary tumorigenesis and recommend genetic counselling. This article summarizes the current knowledge on hereditary colorectal cancer.
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Affiliation(s)
- Hendrik Bläker
- Institut für Pathologie, Universitätsklinikum Leipzig AöR, Liebigstraße 26, 04103, Leipzig, Deutschland.
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12
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Jiang LX, Chen YR, Xu ZX, Zhang YH, Zhang Z, Yu PF, Dong ZW, Yang HR, Gu GL. Peutz-Jeghers syndrome without STK11 mutation may correlate with less severe clinical manifestations in Chinese patients. World J Gastroenterol 2023; 29:3302-3317. [PMID: 37377590 PMCID: PMC10292148 DOI: 10.3748/wjg.v29.i21.3302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/15/2023] [Accepted: 05/04/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Peutz-Jeghers syndrome (PJS) is an autosomal dominant genetic disease with skin mucosal pigment spots and gastrointestinal (GI) multiple hamartoma polyps as clinical characteristics. At present, it is considered that the germline mutation of STK11 gene is the genetic cause of PJS. However, not all PJS patients can be detected STK11 germline mutations. The specific clinical characteristics of these PJS patients without STK11 mutation is an interesting clinical question. Or, like wild type GI stromal tumor, whether these PJS without STK11 mutation are also called PJS is worth discussing. Therefore, we designed the study to understand the clinical characteristics of these PJS patients without STK11 mutation.
AIM To investigates whether PJS patients with known STK11 mutations have a more severe spectrum of clinical phenotypes compared to those without.
METHODS A total of 92 patients with PJS admitted to the Air Force Medical Center from 2010 to 2022 were randomly selected for study. Genomic DNA samples were extracted from peripheral blood samples, and pathogenic germline mutations of STK11 were detected by high-throughput next-generation gene sequencing. Clinical-pathologic manifestations of patients with and without STK11/LKB1 mutations were compared.
RESULTS STK11 germline mutations were observed in 73 patients with PJS. Among 19 patients with no detectable STK11 mutations, six had no pathogenic germline mutations of other genes, while 13 had other genetic mutations. Compared with PJS patients with STK11 mutations, those without tended to be older at the age of initial treatment, age of first intussusception and age of initial surgery. They also had a lower number of total hospitalizations relating to intussusception or intestinal obstruction, and a lower load of small intestine polyps.
CONCLUSION PJS patients without STK11 mutations might have less severe clinical-pathologic manifestations than those with.
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Affiliation(s)
- Li-Xin Jiang
- Air Force Clinical College of China Medical University, Beijing 100142, China
| | - Yu-Rui Chen
- Air Force Clinical College of China Medical University, Beijing 100142, China
| | - Zu-Xin Xu
- Fifth Clinical College (Air Force Clinical College) of Anhui Medical University, Beijing 100142, China
| | - Yu-Hui Zhang
- Department of General Surgery, Air Force Medical Center, Chinese People's Liberation Army, Fifth Clinical (Air Force Clinical College) of China Medical University, Beijing 100142, China
| | - Zhi Zhang
- Department of General Surgery, Air Force Medical Center, Chinese People's Liberation Army, Fifth Clinical (Air Force Clinical College) of China Medical University, Beijing 100142, China
| | - Peng-Fei Yu
- Department of General Surgery, Air Force Medical Center, Chinese People's Liberation Army, Fifth Clinical (Air Force Clinical College) of China Medical University, Beijing 100142, China
| | - Zhi-Wei Dong
- Department of General Surgery, Air Force Medical Center, Chinese People's Liberation Army, Fifth Clinical (Air Force Clinical College) of China Medical University, Beijing 100142, China
| | - Hai-Rui Yang
- Department of General Surgery, Air Force Medical Center, Chinese People's Liberation Army, Fifth Clinical (Air Force Clinical College) of China Medical University, Beijing 100142, China
| | - Guo-Li Gu
- Department of General Surgery, Air Force Medical Center, Chinese People's Liberation Army, Fifth Clinical (Air Force Clinical College) of China Medical University, Beijing 100142, China
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13
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Jelsig AM, van Overeem Hansen T, Gede LB, Qvist N, Christensen LL, Lautrup CK, Frederiksen JH, Sunde L, Ousager LB, Ljungmann K, Bertelsen B, Karstensen JG. Survival, surveillance, and genetics in patients with Peutz-Jeghers syndrome: A nationwide study. Clin Genet 2023. [PMID: 37017260 DOI: 10.1111/cge.14337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/23/2023] [Accepted: 03/25/2023] [Indexed: 04/06/2023]
Abstract
Peutz-Jeghers syndrome (PJS) is an autosomal dominant hereditary polyposis syndrome causing increased morbidity and mortality due to complications of polyposis and the development of cancer. STK11 is the only gene known to be associated with PJS, although in 10%-15% of patients fulfilling the diagnostic criteria no pathogenic variant (PV) is identified. The primary aim of this study was to identify the genetic etiology in all known PJS patients in Denmark and to estimate the risk of cancer, effect of surveillance and overall survival. We identified 56 patients (2-83 years old) with PJS. The detection rate of PVs was 96%, including three cases of mosaicism (6%). In two patients a variant was not detected. At the age of 40 years, the probabilities of cancer and death were 21% and 16%, respectively; at the age of 70 years these probabilities were 71% and 69%. Most cases of cancer (92%) were identified between the scheduled examinations in the surveillance program. These observations emphasize that PJS should be regarded as a general cancer predisposition syndrome, where improvement of clinical care is needed.
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Affiliation(s)
- Anne Marie Jelsig
- Department of Clinical Genetics, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Thomas van Overeem Hansen
- Department of Clinical Genetics, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lene Bjerring Gede
- Department of Clinical Genetics, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Niels Qvist
- Research Unit for Surgery, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | | | | | - Jane Hübertz Frederiksen
- Department of Clinical Genetics, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Lone Sunde
- Department of Clinical Genetics, Aalborg University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aalborg University, Aarhus, Denmark
| | - Lilian Bomme Ousager
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ken Ljungmann
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Birgitte Bertelsen
- Center for Genomic Medicine, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - John Gásdal Karstensen
- Danish Polyposis Registry, Gastrounit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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15
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Hu XC, Gan CX, Zheng HM, Wu XP, Pan WS. Immunotherapy in combination with chemotherapy for Peutz-Jeghers syndrome with advanced cervical cancer: A case report. World J Gastrointest Surg 2023; 15:480-487. [PMID: 37032790 PMCID: PMC10080604 DOI: 10.4240/wjgs.v15.i3.480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/31/2023] [Accepted: 03/04/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant disorder, and female patients may develop gynecologic tumours. The prognosis for such patients is poor and the specific pathogenesis remains uncertain. Therefore, there are currently no uniform treatment options.
CASE SUMMARY Herein, we introduce the case of a 45-year-old female who was diagnosed with PJS for 45 years and cervical cancer for 3 years. Postoperative pathological examination showed metastases in the right external iliac lymph nodes. The patient was initially treated with a combination of doxorubicin and carboplatin chemotherapy and pelvic magnetic resonance showed that the metastases had grown. Subsequently, we performed whole exome sequencing in this patient and identified the relevant causative gene. In addition to the chemotherapy regimen, sindilizumab was administered and the patient was followed up. After 4 cycles of treatment, the metastases were substantially reduced and were not enlarged after six months of follow-up. This case report suggests that patients with PJS combined with cervical cancer may have a sustained response to immune-combination chemotherapy regimens.
CONCLUSION Clinicians should be aware of the importance of immunotherapy in patients with PJS combined with advanced cervical cancer.
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Affiliation(s)
- Xiang-Cheng Hu
- Department of Gastroenterology, Bengbu Medical College, Bengbu 233000, Anhui Province, China
| | - Chen-Xiao Gan
- Department of Gastroenterology, Zhejiang Provincial People’s hospital, Hangzhou 310014, Zhejiang Province, China
| | - Hui-Min Zheng
- Department of Gastroenterology, Bengbu Medical College, Bengbu 233000, Anhui Province, China
| | - Xue-Ping Wu
- Department of Gastroenterology, Zhejiang Provincial People’s hospital, Hangzhou 310014, Zhejiang Province, China
| | - Wen-Sheng Pan
- Department of Gastroenterology, Zhejiang Provincial People’s hospital, Hangzhou 310014, Zhejiang Province, China
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16
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Xiao N, Zhang T, Zhang J, Zhang J, Li H, Ning S. Proposal of a Risk Scoring System to Facilitate the Treatment of Enteroenteric Intussusception in Peutz-Jeghers Syndrome. Gut Liver 2023; 17:259-266. [PMID: 36424719 PMCID: PMC10018310 DOI: 10.5009/gnl210390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 11/27/2022] Open
Abstract
Background/Aims Enteroenteric intussusception in Peutz-Jeghers syndrome (EI-PJS) is traditionally treated by surgery. However, enteroscopic treatment is a minimally invasive approach worth attempting. We aimed to develop a risk scoring system to facilitate decision-making in the treatment of EI-PJS. Methods This was a single-center case-control study, including 80 patients diagnosed with PJS and coexisting intussusception between January 2015 and January 2021 in Air Force Medical Center. We performed logistic regression analysis to identify independent risk factors and allocated different points to each subcategory of risk factors; the total score of individuals ranged from 0 to 9 points. Then, we constructed a risk stratification system based on the possibility of requiring surgery: 0-3 points for "low-risk," 4-6 points for "moderate-risk," and 7-9 points for "high-risk." Results Sixty-one patients (76.25%) were successfully treated with enteroscopy. Sixteen patients (20.0%) failed enteroscopic treatment and subsequently underwent surgery, and three patients (3.75%) received surgery directly. Abdominal pain, the diameter of the responsible polyp, and the length of intussusception were independent risk factors for predicting the possibility of requiring surgery. According to the risk scoring system, the incidence rates of surgery were 4.44% in the low-risk tier, 30.43% in the moderate-risk tier, and 83.33% in the high-risk tier. From low- to high-risk tiers, the trend of increasing risk was significant (p<0.001). Conclusions We developed a risk scoring system based on abdominal pain, diameter of the responsible polyps, and length of intussusception. It can preoperatively stratify patients according to the risk of requiring surgery for EI-PJS to facilitate treatment decision-making.
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Affiliation(s)
- Nianjun Xiao
- Department of Gastroenterology, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Tongzhen Zhang
- Department of Gastroenterology, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Jing Zhang
- Department of Gastroenterology, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Jinlong Zhang
- Department of Radiology, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Hao Li
- Department of General Surgery, Air Force Medical Center, Air Force Medical University, Beijing, China
| | - Shoubin Ning
- Department of Gastroenterology, Air Force Medical Center, Air Force Medical University, Beijing, China
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17
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Xu ZX, Jiang LX, Chen YR, Zhang YH, Zhang Z, Yu PF, Dong ZW, Yang HR, Gu GL. Clinical features, diagnosis, and treatment of Peutz-Jeghers syndrome: Experience with 566 Chinese cases. World J Gastroenterol 2023; 29:1483-1493. [DOI: 10.3748/wjg.v29.i10.1483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Peutz-Jeghers syndrome (PJS) is a clinically rare disease with pigmented spots on the lips and mucous membranes and extremities, scattered gastrointestinal polyps, and susceptibility to tumors as clinical manifestations. Effective preventive and curative methods are still lacking. Here we summarize our experience with 566 Chinese patients with PJS from a Chinese medical center with regard to the clinical features, diagnosis, and treatment.
AIM To explore the clinical features, diagnosis, and treatment of PJS in a Chinese medical center.
METHODS The diagnosis and treatment information of 566 cases of PJS admitted to the Air Force Medical Center from January 1994 to October 2022 was summarized. A clinical database was established covering age, gender, ethnicity, family history, age at first treatment, time and sequence of appearance of mucocutaneous pigmentation, polyp distribution, quantity, and diameter, frequency of hospitalization, frequency of surgical operations, etc. The clinical data was retrospectively analyzed using SPSS 26.0 software, with P < 0.05 considered statistically significant.
RESULTS Of all the patients included, 55.3% were male and 44.7% were female. Median time to the appearance of mucocutaneous pigmentation was 2 years, and median time from the appearance of mucocutaneous pigmentation to the occurrence of abdominal symptoms was 10 years. The vast majority (92.2%) of patients underwent small bowel endoscopy and treatment, with 2.3% having serious complications. There was a statistically significant difference in the number of enteroscopies between patients with and without canceration (P = 0.004, Z = -2.882); 71.2% of patients underwent surgical operation, 75.6% of patients underwent surgical operation before the age of 35 years, and there was a statistically significant difference in the frequency of surgical operations between patients with and without cancer (P = 0.000, Z = -5.127). At 40 years of age, the cumulative risk of intussusception in PJS was approximately 72.0%, and at 50 years, the cumulative risk of intussusception in PJS was approximately 89.6%. At 50 years of age, the cumulative risk of cancer in PJS was approximately 49.3%, and at 60 years of age, the cumulative risk of cancer in PJS was approximately 71.7%.
CONCLUSION The risk of intussusception and cancer of PJS polyps increases with age. PJS patients ≥ 10 years old should undergo annual enteroscopy. Endoscopic treatment has a good safety profile and can reduce the occurrence of polyps intussusception and cancer. Surgery should be conducted to protect the gastrointestinal system by removing polyps.
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Affiliation(s)
- Zu-Xin Xu
- Fifth Clinical College of Anhui Medical University, Air Force Clinical College of Anhui Medical University, Beijing 100142, China
| | - Li-Xin Jiang
- Air Force Clinical College of China Medical University, Beijing 100142, China
| | - Yu-Rui Chen
- Air Force Clinical College of China Medical University, Beijing 100142, China
| | - Yu-Hui Zhang
- Department of General Surgery, Air Force Medical Center, Chinese People's Liberation Army, Beijing 100142, China
| | - Zhi Zhang
- Department of General Surgery, Air Force Medical Center, Chinese People's Liberation Army, Beijing 100142, China
| | - Peng-Fei Yu
- Department of General Surgery, Air Force Medical Center, Chinese People's Liberation Army, Beijing 100142, China
| | - Zhi-Wei Dong
- Department of General Surgery, Air Force Medical Center, Chinese People's Liberation Army, Beijing 100142, China
| | - Hai-Rui Yang
- Department of General Surgery, Air Force Medical Center, Chinese People's Liberation Army, Beijing 100142, China
| | - Guo-Li Gu
- Department of General Surgery, Air Force Medical Center, Chinese People's Liberation Army, Beijing 100142, China
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18
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Xu ZX, Jiang LX, Chen YR, Zhang YH, Zhang Z, Yu PF, Dong ZW, Yang HR, Gu GL. Clinical features, diagnosis, and treatment of Peutz-Jeghers syndrome: Experience with 566 Chinese cases. World J Gastroenterol 2023; 29:1627-1637. [PMID: 36970589 PMCID: PMC10037245 DOI: 10.3748/wjg.v29.i10.1627] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/17/2023] [Accepted: 02/16/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Peutz-Jeghers syndrome (PJS) is a clinically rare disease with pigmented spots on the lips and mucous membranes and extremities, scattered gastrointestinal polyps, and susceptibility to tumors as clinical manifestations. Effective preventive and curative methods are still lacking. Here we summarize our experience with 566 Chinese patients with PJS from a Chinese medical center with regard to the clinical features, diagnosis, and treatment.
AIM To explore the clinical features, diagnosis, and treatment of PJS in a Chinese medical center.
METHODS The diagnosis and treatment information of 566 cases of PJS admitted to the Air Force Medical Center from January 1994 to October 2022 was summarized. A clinical database was established covering age, gender, ethnicity, family history, age at first treatment, time and sequence of appearance of mucocutaneous pigmentation, polyp distribution, quantity, and diameter, frequency of hospitalization, frequency of surgical operations, etc. The clinical data was retrospectively analyzed using SPSS 26.0 software, with P < 0.05 considered statistically significant.
RESULTS Of all the patients included, 55.3% were male and 44.7% were female. Median time to the appearance of mucocutaneous pigmentation was 2 years, and median time from the appearance of mucocutaneous pigmentation to the occurrence of abdominal symptoms was 10 years. The vast majority (92.2%) of patients underwent small bowel endoscopy and treatment, with 2.3% having serious complications. There was a statistically significant difference in the number of enteroscopies between patients with and without canceration (P = 0.004, Z = -2.882); 71.2% of patients underwent surgical operation, 75.6% of patients underwent surgical operation before the age of 35 years, and there was a statistically significant difference in the frequency of surgical operations between patients with and without cancer (P = 0.000, Z = -5.127). At 40 years of age, the cumulative risk of intussusception in PJS was approximately 72.0%, and at 50 years, the cumulative risk of intussusception in PJS was approximately 89.6%. At 50 years of age, the cumulative risk of cancer in PJS was approximately 49.3%, and at 60 years of age, the cumulative risk of cancer in PJS was approximately 71.7%.
CONCLUSION The risk of intussusception and cancer of PJS polyps increases with age. PJS patients ≥ 10 years old should undergo annual enteroscopy. Endoscopic treatment has a good safety profile and can reduce the occurrence of polyps intussusception and cancer. Surgery should be conducted to protect the gastrointestinal system by removing polyps.
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Affiliation(s)
- Zu-Xin Xu
- Fifth Clinical College of Anhui Medical University, Air Force Clinical College of Anhui Medical University, Beijing 100142, China
| | - Li-Xin Jiang
- Air Force Clinical College of China Medical University, Beijing 100142, China
| | - Yu-Rui Chen
- Air Force Clinical College of China Medical University, Beijing 100142, China
| | - Yu-Hui Zhang
- Department of General Surgery, Air Force Medical Center, Chinese People's Liberation Army, Beijing 100142, China
| | - Zhi Zhang
- Department of General Surgery, Air Force Medical Center, Chinese People's Liberation Army, Beijing 100142, China
| | - Peng-Fei Yu
- Department of General Surgery, Air Force Medical Center, Chinese People's Liberation Army, Beijing 100142, China
| | - Zhi-Wei Dong
- Department of General Surgery, Air Force Medical Center, Chinese People's Liberation Army, Beijing 100142, China
| | - Hai-Rui Yang
- Department of General Surgery, Air Force Medical Center, Chinese People's Liberation Army, Beijing 100142, China
| | - Guo-Li Gu
- Department of General Surgery, Air Force Medical Center, Chinese People's Liberation Army, Beijing 100142, China
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19
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Kim SH, Kim ER, Park JJ, Kim ES, Goong HJ, Kim KO, Nam JH, Park Y, Lee SP, Jang HJ. Cancer risk in patients with Peutz-Jeghers syndrome in Korea: a retrospective multi-center study. Korean J Intern Med 2023; 38:176-185. [PMID: 36517957 PMCID: PMC9993101 DOI: 10.3904/kjim.2022.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/14/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND/AIMS There have been little research on the cancer risks of patients with Peutz-Jeghers syndrome (PJS) in Korea. We aimed to investigate the clinical features of PJS patients and their cancer incidence rate. METHODS Patients with PJS from nine medical centers were enrolled. In those patients diagnosed with cancer, data obtained included the date of cancer diagnosis, the tumor location, and the cancer stage. The cumulative risks of gastrointestinal cancers and extra-gastrointestinal cancers were calculated using the Kaplan-Meier method. RESULTS A total of 96 PJS patients were included. The median age at diagnosis of PJS was 23.4 years. Cancer developed in 21 of the 96 patients (21.9%). The age of PJS diagnosis was widely distributed (0.9 to 72.4 years). The most common cancers were gastrointestinal cancer (n = 12) followed by breast cancer (n = 6). The cumulative lifetime cancer risk was calculated to be 62.1% at age 60. The cumulative lifetime gastrointestinal cancer risk was 47.1% at age 70. The cumulative lifetime extra- gastrointestinal cancer risk was 40.3% at age 60. CONCLUSION PJS onset may occur at any age and the risks of gastrointestinal and extra-gastrointestinal cancer are high. Thorough surveillance of PJS patients for malignancies is vital.
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Affiliation(s)
- Su Hwan Kim
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul,
Korea
| | - Eun Ran Kim
- Division of Gastroenterology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Jae Jun Park
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Eun Sun Kim
- Department of Gastroenterology, Korea University College of Medicine, Seoul,
Korea
| | - Hyeon Jeong Goong
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon,
Korea
| | - Kyeong Ok Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu,
Korea
| | - Ji Hyung Nam
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang,
Korea
| | - Yehyun Park
- Department of Internal Medicine, Ewha Womans University Seoul Hospital, Seoul,
Korea
| | - Sang Pyo Lee
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong,
Korea
| | - Hyun Joo Jang
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong,
Korea
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20
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Wang Z, Liang L, Liu L, Wang Z, Wang Y, Yu Z, Wu B, Chen Y. Changes in the Gut Microbiome Associated with Intussusception in Patients with Peutz-Jeghers Syndrome. Microbiol Spectr 2023; 11:e0281922. [PMID: 36719190 PMCID: PMC10101062 DOI: 10.1128/spectrum.02819-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/03/2023] [Indexed: 02/01/2023] Open
Abstract
Peutz-Jeghers syndrome (PJS) is a rare hereditary disorder characterized by intestinal polyposis, and intestinal intussusception is one of the most urgent complications. While it is known that imbalance of the gut microbiota is highly associated with intestinal disorders, the role of the gut microbiome in the pathogenesis of PJS has not been reported. In this study, we performed 16S rRNA sequencing on stools from 168 patients and 68 healthy family members who lived together to determine the gut microbiome composition of PJS patients. Metagenomics sequencing was further performed on the representative samples (61 PJS patients and 27 healthy family members) to analyze the functional changes. We found that the fecal microbiome of patients with PJS showed a greater variation in β-diversity. An enhancement of Escherichia coli and a reduction of Faecalibacterium prausnitzii was identified in PJS patients. Further reduction of Faecalibacterium prausnitzii was the characteristic microbial change observed in patients with intussusception. Functional analysis revealed that the abundance of propanoate metabolism was enriched in PJS patients and further enriched in those with intussusception. Escherichia coli was the major contributor to the enrichment of this metabolism pathway, which was associated with the abnormal expression of methylglyoxal synthase (encoded by mgsA) and phosphate acetyltransferase (encoded by pta). Our findings showed a distinct gut microbiome signature in PJS patients and identified the connection between the gut microbiome and intussusception. Alterations in the gut microbiome might be involved in the pathogenesis of PJS and may serve as biomarkers for gastrointestinal surveillance. IMPORTANCE Recent research has established a link between the gut microbiome and polyps and neoplasia, and antibiotic use influences the microbiome and the development of colorectal polyps. Familial adenomatous polyposis (FAP), which is characterized by the early development of benign precursor lesions (polyps), is associated with enterotoxigenic Bacteroides fragilis and Escherichia coli biofilms. However, the relationship between the gut microbiome and the pathophysiology of PJS has not yet been established. In this study, we found that PJS patients had a distinct microbiome composition, with a greater variation in β-diversity, an increase in Escherichia coli, and a decrease in Faecalibacterium prausnitzii. A further reduction of Faecalibacterium prausnitzii was observed in patients with intussusception. Moreover, PJS involved increased propanoate metabolism as well as abnormal mgsA and pta expression. These findings may contribute to a better understanding of the etiology of PJS and improve disease control strategies.
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Affiliation(s)
- Zhiqing Wang
- Department of Gastroenterology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Liping Liang
- Department of Gastroenterology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Le Liu
- Department of Gastroenterology, Integrative Microecology Center, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Zhi Wang
- Department of Gastroenterology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ying Wang
- Department of Gastroenterology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zonglin Yu
- Department of Gastroenterology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Baoping Wu
- Department of Gastroenterology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ye Chen
- Department of Gastroenterology, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Gastroenterology, Integrative Microecology Center, Shenzhen Hospital, Southern Medical University, Shenzhen, China
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21
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Choi E, Lee J, Park Y. Solitary Peutz-Jeghers type harmartomatous polyp in duodenum with gastric foveolar epithelium: a case report. J Pathol Transl Med 2023; 57:128-131. [PMID: 36623815 PMCID: PMC10028010 DOI: 10.4132/jptm.2022.11.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/06/2022] [Indexed: 01/11/2023] Open
Abstract
Peutz-Jeghers type hamartomatous polyp is known to be associated with Peutz-Jeghers syndrome, which shows characteristic multiple hamartomatous polyp involvement in the gastrointestinal tract, combined with mucocutaneous symptom, familial history of Peutz- Jeghers syndrome or STK11/LTB1 mutation. However, some cases showing histologic appearance of the polyps discovered in Peutz- Jeghers syndrome while lacking other diagnostic criteria of the syndrome have been reported, and these are called solitary Peutz- Jeghers type polyps. Herein, we report a case of solitary Peutz-Jeghers type polyp covered with heterotopic epithelium. The patient was 47-year-old female without any mucocutaneous symptoms nor familial history of Peutz-Jeghers syndrome. Microscopic examination revealed Peutz-Jeghers type hamartomatous polyp in duodenum covered with gastric type foveolar epithelium. Considering the definition of hamartomatous polyp, which is, the abnormal overgrowth of the indigenous epithelial component, the histological feature of current case is noteworthy in a point that it shows proliferation of heterotopic component, rather than the indigenous component.
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Affiliation(s)
- Eugene Choi
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Junghwan Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Youngsoo Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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22
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Li X, Qi Y, Zhang W, Rao Y, Zhang N, Qu P. Peutz-Jeghers syndrome with gastric-type mucinous endocervical adenocarcinoma and sex-cord tumor with annular tubules: A case report. Front Med (Lausanne) 2023; 10:1094839. [PMID: 37025955 PMCID: PMC10072263 DOI: 10.3389/fmed.2023.1094839] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/23/2023] [Indexed: 04/08/2023] Open
Abstract
Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant genetic disorder characterized by mucocutaneous pigmentation and multiple hamartomatous polyps in the gastrointestinal tracts. About 11% of female PJS patients are diagnosed with Gastric-type endocervical adenocarcinoma (G-EAC) and about one third have a sex-cord tumor with annular tubules (SCTATs). Gastric-type endocervical adenocarcinoma is a special subtype of cervical adenocarcinoma which accounts for only 1-3%. Here we report a rare case of a 31-year-old woman affected with G-EAC and SCTAT accompanied by PJS. After surgery, we followed up for 5 years without recurrence.
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Affiliation(s)
- Xuanyan Li
- Department of Gynecological Oncology, Tianjin Central Hospital Gynecology Obstetrics, Tianjin, China
- Nankai University School of Medicine, Nankai University, Tianjin, China
| | - Yue Qi
- Department of Gynecological Oncology, Tianjin Central Hospital Gynecology Obstetrics, Tianjin, China
- Clinical College of Central Gynecology and Obstetrics, Tianjin Medical University, Tianjin, China
| | - Wenwen Zhang
- Department of Gynecological Oncology, Tianjin Central Hospital Gynecology Obstetrics, Tianjin, China
| | - Yang Rao
- Department of Gynecological Oncology, Tianjin Central Hospital Gynecology Obstetrics, Tianjin, China
| | - Na Zhang
- Department of Gynecological Oncology, Tianjin Central Hospital Gynecology Obstetrics, Tianjin, China
| | - Pengpeng Qu
- Department of Gynecological Oncology, Tianjin Central Hospital Gynecology Obstetrics, Tianjin, China
- Nankai University School of Medicine, Nankai University, Tianjin, China
- Clinical College of Central Gynecology and Obstetrics, Tianjin Medical University, Tianjin, China
- *Correspondence: Pengpeng Qu,
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23
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Fujima T, Saito D, Shibuta H, Ogihara R, Morikubo H, Ozaki R, Tokunaga S, Minowa S, Mitsui T, Miura M, Hayashida M, Watanabe Y, Miyoshi J, Matsuura M, Shibahara J, Ukiyama E, Hisamatsu T. Endoscopic Treatment of Colo-Colonic Intussusception in a Patient with Peutz-Jeghers Syndrome. Case Rep Gastroenterol 2023; 17:339-345. [PMID: 38020466 PMCID: PMC10656115 DOI: 10.1159/000534201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/07/2023] [Indexed: 12/01/2023] Open
Abstract
A 19-year-old man with a history of Peutz-Jeghers syndrome (PJS) and two previous partial small bowel resections because of intussusception presented with lower abdominal pain. Computed tomography (CT) showed concentric multilayer and cord-like structures in the transverse colon. Colo-colonic intussusception was suspected and he was hospitalized. After two therapeutic enemas were unsuccessful, a colonoscopy was performed. The intussusception was reduced and a 40-mm transverse colon polyp with a thick stalk was resected. After the procedure, his abdominal pain was relieved and he was discharged on the sixth hospital day. This case and several previous reports suggest that PJS polyps with tumor diameter exceeding 30 mm and location in the transverse or sigmoid colon can cause intussusception. Endoscopic treatment should be considered for these lesions.
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Affiliation(s)
- Takeshi Fujima
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Daisuke Saito
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Hidenori Shibuta
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Ryota Ogihara
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Hiromu Morikubo
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Ryo Ozaki
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Sotaro Tokunaga
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Shintaro Minowa
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Tatsuya Mitsui
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Miki Miura
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Mari Hayashida
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Yoshiko Watanabe
- Department of Pediatric Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Jun Miyoshi
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Minoru Matsuura
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Junji Shibahara
- Department of Pathology, Kyorin University School of Medicine, Tokyo, Japan
| | - Etsuji Ukiyama
- Department of Pediatric Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
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Liu Q, Wang Z, Yu C, Zhu J, Liu C, Li X, Ren L, Li T. Intraductal oncocytic papillary neoplasm arising in Peutz-Jeghers Syndrome bile duct: a unique case report. Diagn Pathol 2022; 17:96. [PMID: 36578081 PMCID: PMC9795596 DOI: 10.1186/s13000-022-01275-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Peutz-Jeghers syndrome (PJS) is a rare, autosomal dominant disorder caused by germline mutations of STK11/LKB1, with an increased risk of tumors at multiple sites. Intraductal oncocytic papillary neoplasm (IOPN) is a unique subtype of intraductal papillary neoplasm of the bile duct (IPNB) defined by a premalignant neoplasm with intraductal papillary or villous growth of biliary-type epithelium. IOPN has a distinct mutation profile compared with both IPNB and intraductal papillary mucinous neoplasm (IPMN). CASE PRESENTATION We herein describe the case of a 44-year-old woman who presented as polyps in the intestinal lumen of sigmoid colon and a 3.1 × 2.1 cm mass in the left lobe of liver. Gross feature revealed a cystic papillary mass and the neoplasm had a clear boundary with the surrounding liver tissue. Histology revealed complex papillary structures, a small amount of fine fibrovascular cores and immunohistochemistry showed extensive positive for MUC5AC, MUC6, CD117. Therefore, histological and immunohistochemical examination of the liver tumor suggested the diagnosis of IOPN. Next-generation sequencing (NGS) revealed other than STK11 germline mutation, the tumor also harbors GNAS somatic mutation at codon 478 and EGFR amplification. CONCLUSION To our knowledge, this is the first report of IOPN arising in PJS. This case enlarges the spectrum of PJS related tumors and genetic rearrangements in IOPN.
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Affiliation(s)
- Qingyue Liu
- grid.488137.10000 0001 2267 2324Department of Pathology, Air Force Medical Center, PLA, Beijing, People’s Republic of China ,grid.412449.e0000 0000 9678 1884China Medical University, Shenyang, People’s Republic of China
| | - Zhiyu Wang
- grid.488137.10000 0001 2267 2324Department of Pathology, Air Force Medical Center, PLA, Beijing, People’s Republic of China
| | - Chaoran Yu
- grid.488137.10000 0001 2267 2324Department of Pathology, Air Force Medical Center, PLA, Beijing, People’s Republic of China
| | - Jianping Zhu
- grid.488137.10000 0001 2267 2324Department of Pathology, Air Force Medical Center, PLA, Beijing, People’s Republic of China
| | - Chengli Liu
- grid.488137.10000 0001 2267 2324Department of Hepatobiliary Surgery, Air Force Medical Center, PLA, Beijing, People’s Republic of China
| | - Xiangsheng Li
- grid.488137.10000 0001 2267 2324Department of Radiology, Air Force Medical Center, PLA, Beijing, People’s Republic of China
| | - Li Ren
- grid.488137.10000 0001 2267 2324Department of Pathology, Air Force Medical Center, PLA, Beijing, People’s Republic of China
| | - Teng Li
- grid.488137.10000 0001 2267 2324Department of Pathology, Air Force Medical Center, PLA, Beijing, People’s Republic of China
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25
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Yu Z, Liu L, Jiang F, Ji Y, Wang X, Liu L. A novel missense mutation of the STK11 gene in a Chinese family with Peutz-Jeghers syndrome. BMC Gastroenterol 2022; 22:536. [PMID: 36550395 PMCID: PMC9784088 DOI: 10.1186/s12876-022-02617-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant inherited disease caused by mutations in the Serine-Threonine Kinase 11 (STK11) gene. This study aimed to diagnose a Chinese pedigree with PJS and to expand the spectrum of STK11 variants. METHODS We performed an inductive analysis of clinical features, gastrointestinal endoscopy, radiologic imaging, and pathological findings in a Chinese family with PJS. Whole-exome sequencing (WES), Sanger sequencing, and STK11 protein 3D structure prediction were performed for establishing a molecular diagnosis. RESULTS The proband, her mother, and grandfather presented with pigmentation spots on lips, oral mucosa, and fingers. Her mother and grandfather also had pigmentation spots on face and feet, while her brother had pigmentation spots only on the lower lip. On endoscopy, polyps were discovered in the proband, her mother, and grandfather. A novel heterozygous mutation (c.521A > C) in exon 4 of STK11 was identified in all four patients, leading to a change from histidine to proline in amino acid 174. The variable site p.H174 was highly conserved in different species on multiple sequence alignment analysis. CONCLUSIONS We diagnosed a Chinese pedigree with PJS based on clinical features, gastrointestinal endoscopy, and genetic testing results. Our results expanded the spectrum of STK11 variants, which will be helpful for genetic counseling.
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Affiliation(s)
- Zhen Yu
- grid.27255.370000 0004 1761 1174Department of Pediatrics, Qilu Hospital, Shandong University, 107 Wen Hua Xi Road, Jinan, 250012 Shandong People’s Republic of China
| | - Lin Liu
- grid.27255.370000 0004 1761 1174Shandong Provincial Maternal and Child Health Care Hospital, Shandong University, 238 Jing Shi Dong Road, Jinan, 250012 Shandong People’s Republic of China
| | - Fang Jiang
- grid.27255.370000 0004 1761 1174Department of Pediatrics, Qilu Hospital, Shandong University, 107 Wen Hua Xi Road, Jinan, 250012 Shandong People’s Republic of China
| | - Yimin Ji
- grid.27255.370000 0004 1761 1174Department of Pediatrics, Qilu Hospital, Shandong University, 107 Wen Hua Xi Road, Jinan, 250012 Shandong People’s Republic of China
| | - Xiao Wang
- grid.27255.370000 0004 1761 1174Department of Pediatrics, Qilu Hospital, Shandong University, 107 Wen Hua Xi Road, Jinan, 250012 Shandong People’s Republic of China
| | - Lili Liu
- grid.27255.370000 0004 1761 1174Department of Pediatrics, Qilu Hospital, Shandong University, 107 Wen Hua Xi Road, Jinan, 250012 Shandong People’s Republic of China
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Ortegón-Gallareta R, Vázquez-Frías R, Blanco-Rodríguez G, Consuelo-Sánchez A, Jimena Ortiz-Rivera C, Murillo-Eliosa JR, Vicenteño-León AI, Valencia-Mayoral PF. Peutz-Jeghers syndrome in pediatric patients: experience in a tertiary care institution in Mexico. Bol Med Hosp Infant Mex 2022; 79:357-362. [PMID: 36477417 DOI: 10.24875/bmhim.22000036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant inherited disease characterized by the development of polyps in the gastrointestinal tract, mucocutaneous pigmentation, and the risk of developing malignant neoplasms. This study aimed to analyze the epidemiological, clinical, and histopathological data of patients with PJS treated in a tertiary pediatric hospital. METHODS We conducted a retrospective observational study to describe the epidemiological, clinical, endoscopic, and histological characterization of patients with PJS treated in a tertiary pediatric hospital in Mexico. RESULTS We included 13 cases with a male-female ratio of 1.16:1. Abdominal pain was the main reason for consultation, followed by rectorrhagia. Patients showed mucocutaneous pigmentation and polyps in the gastrointestinal tract, frequently of the hamartomatous type, although inflammatory polyps, follicular hyperplasia, and adenomatous polyps were also found. Among the complications, there was a high prevalence of emergency surgery secondary to abdominal obstructive processes, the main reason for first-time consultation in these patients. CONCLUSIONS The main clinical manifestations were mucocutaneous pigmentation, abdominal pain, and rectorrhagia. PJS should be included in the differential diagnosis in the presence of intestinal obstruction. The diagnosis of PJS should not be excluded if hamartomatous polyps are not evident on the first endoscopy. Nutritional assessment should be included due to the risk of presenting some degree of malnutrition.
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Affiliation(s)
| | | | | | | | | | - Juan Rafael Murillo-Eliosa
- Departamento de Patología Clínica y Experimental. Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Mexico City, Mexico
| | - Alan Irving Vicenteño-León
- Departamento de Patología Clínica y Experimental. Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Mexico City, Mexico
| | - Pedro Francisco Valencia-Mayoral
- Departamento de Patología Clínica y Experimental. Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Mexico City, Mexico
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27
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Long JM, Ebrahimzadeh J, Stanich PP, Katona BW. Endoscopic Surveillance in Patients with the Highest Risk of Gastric Cancer: Challenges and Solutions. Cancer Manag Res 2022; 14:2953-2969. [PMID: 36238953 PMCID: PMC9553156 DOI: 10.2147/cmar.s277898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/22/2022] [Indexed: 11/23/2022] Open
Abstract
Gastric cancer is one of the most significant causes of cancer-related morbidity and mortality worldwide. Recognized modifiable risk factors include Helicobacter pylori infection, geographic location, select dietary factors, tobacco use and alcohol consumption. In addition, multiple hereditary cancer predisposition syndromes are associated with significantly elevated gastric cancer risk. Endoscopic surveillance in hereditary gastric cancer predisposition syndromes has the potential to identify gastric cancer at earlier and more treatable stages, as well as to prevent development of gastric cancer through identification of precancerous lesions. However, much uncertainty remains regarding use of endoscopic surveillance in hereditary gastric cancer predisposition syndromes, including whether or not it should be routinely performed, the surveillance interval and age of initiation, cost-effectiveness, and whether surveillance ultimately improves survival from gastric cancer for these high-risk individuals. In this review, we outline the hereditary gastric cancer predisposition syndromes associated with the highest gastric cancer risks. Additionally, we cover current evidence and guidelines addressing hereditary gastric cancer risk and surveillance in these syndromes, along with current challenges and limitations that emphasize a need for continued research in this field.
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Affiliation(s)
- Jessica M Long
- Division of Hematology and Oncology, Penn Medicine, Philadelphia, PA, USA
| | | | - Peter P Stanich
- Division of Gastroenterology, Hepatology & Nutrition, The Ohio State University, Wexner Medical Center, Columbus, OH, USA
| | - Bryson W Katona
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Correspondence: Bryson W Katona, Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, 751 South Pavilion, Philadelphia, PA, 19104, USA, Tel +1-215-349-8222, Fax +1-215-349-5915, Email
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28
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Park SY, Kim KS, Min HJ. Peutz-Jeghers syndrome and sinonasal diseases: A case report and literature review. Ear Nose Throat J 2022:1455613221116325. [PMID: 36121203 DOI: 10.1177/01455613221116325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Peutz-Jeghers syndrome is an unusual inherited intestinal polyposis syndrome associated with distinct mucocutaneous pigmentation. Peutz-Jeghers syndrome is known to show variable penetrance and clinical heterogeneity. It can involve various organs and lead to intestinal and extra-intestinal malignancies. Sinonasal inverted papilloma is a benign tumor originating from the nasal cavity and paranasal sinuses. It is characterized by high recurrence and malignant transformation; however, the exact pathogenesis and risk factors remain unclear. Recently, we encountered a case of sinonasal inverted papilloma in a patient with Peutz-Jeghers syndrome. Although we performed a molecular genetic study to evaluate the STK11/LKB1 mutation, we could not provide direct evidence of the association between sinonasal inverted papilloma and Peutz-Jeghers syndrome. Based on our experience, we here tried to introduce Peutz-Jeghers syndrome and the potential involvement of the upper airway tract based on previously reported cases.
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Affiliation(s)
- Seung Yong Park
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Kyung Soo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Hyun Jin Min
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chung-Ang University, Seoul, Korea
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Rycyk A, Kasztelan-Szczerbinska B, Cichoz-Lach H. A rare case of a juvenile polyp of patient with Peutz-Jeghers syndrome, complicated with intussusception of the small intestine. Folia Med (Plovdiv) 2022; 64:693-696. [PMID: 36045464 DOI: 10.3897/folmed.64.e67044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/02/2021] [Indexed: 11/12/2022] Open
Abstract
We report a rare case of Peutz-Jeghers syndrome (PJS) in a 35-year-old female. The patient was diagnosed with PJS when she was 11 years old. She has remained under observation since then. We strongly believe that PJS is a very rare diagnosis. However, it can have serious complications such as the intussusception we observed in our patient. Her condition (recurrent abdominal pain and vomiting) in childhood required further diagnostic procedures. Although the diagnosis of PJS was made, among many resected polyps, one of them appeared to be a juvenile polyp. The diagnosis was confirmed in the histopathology report, which was incredibly unique. Genetic testing revealed LKB1/STK11 gene mutation. Clinicians should be aware of the malignant potential in the course of PJS. Hence, these patients require tailor-made management, long-term follow-up, and our particular attention.
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Affiliation(s)
- Anna Rycyk
- Medical University of Lublin, Lublin, Poland
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Fostira F, Fountzilas E, Papadopoulou K, Karaiskos T, Mpatsi O, Pastelli N, Mountzios G, Konstantopoulou I, Fountzilas G. Lung cancer as a predominant feature in a patient with Peutz-Jeghers syndrome: Case report. Thorac Cancer 2022; 13:1862-1865. [PMID: 35543335 PMCID: PMC9200879 DOI: 10.1111/1759-7714.14447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/14/2022] [Accepted: 04/16/2022] [Indexed: 11/05/2022] Open
Abstract
Peutz–Jeghers syndrome (PJS) is characterized by mucocutaneous pigmentation and gastrointestinal hamartomatous polyposis, which can lead to intussusception. PJS patients face high lifetime risks for various cancer types, with the majority of patients being diagnosed with tumors along the gastrointestinal tract. Herein, we present the case of a 34‐year‐old man who carried a germline STK11 pathogenic variant, while lacking the cardinal features of PJS syndrome. Interestingly, he was diagnosed with lung adenocarcinoma despite being a never‐smoker. Tumor testing revealed clinically relevant molecular alterations, including the known germline pathogenic variant STK11, a KRAS somatic pathogenic variant, and FGFR3 gene amplification. Treatment with standard chemotherapy and immunotherapy did not have a clinical benefit. Due to clinical deterioration, the patient deceased 18 months after his initial diagnosis prior to having the chance for targeted therapy. Identification of rare hereditary cancer syndromes and the respective presence of tumor biomarkers can provide important alternatives to targeted treatments, including immunotherapy in patients with tumors unresponsive to conventional treatment protocols. This case highlights that although only a small proportion of lung cancer diagnoses will be due to hereditary predisposition, STK11 germline carriers should be under close surveillance for early detection of lung cancer.
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Affiliation(s)
- Florentia Fostira
- Molecular Diagnostics Laboratory, InRASTES, National Centre for Scientific Research Demokritos, Athens, Greece
| | - Elena Fountzilas
- Second Department of Medical Oncology, Euromedica General Clinic of Thessaloniki, Thessaloniki, Greece.,European University Cyprus, German Oncology Center, Limassol, Cyprus
| | - Kyriaki Papadopoulou
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Karaiskos
- Cardiothoracic Surgery Department, Papanikolaou Hospital, Thessaloniki, Greece
| | - Ourania Mpatsi
- Pathology Department, Papageorgiou Hospital, Thessaloniki, Greece
| | - Nikoleta Pastelli
- Department of Surgical Pathology, Papanikolaou Hospital, Thessaloniki, Greece
| | - Giannis Mountzios
- Second Oncology Department and Clinical Trials Unit, Henry Dunant Hospital, Athens, Greece
| | - Irene Konstantopoulou
- Molecular Diagnostics Laboratory, InRASTES, National Centre for Scientific Research Demokritos, Athens, Greece
| | - George Fountzilas
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Medical Oncology, German Oncology Center, Limassol, Cyprus
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Maity P, Das N, Chatterjee U, Basak D. Sex-Cord Tumor with Annular Tubules with Unusual Morphology in an Infant with Peutz-Jeghers Syndrome. Fetal Pediatr Pathol 2022; 41:306-311. [PMID: 32609034 DOI: 10.1080/15513815.2020.1786200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background Peutz-Jeghers syndrome (PJS) is characterized by hamartomatous gastrointestinal polyposis, mucocutaneous pigmentation and cancer predisposition. The clinical features of PJS manifest in first two decades of life; however, neonatal presentation is uncommon. Case report: We present a five day old girl with PJS that presented with obstructive hamartomatous polyps in the sigmoid colon. At colostomy closure at six months, an incidental ovarian sex-cord tumor with annular tubules (SCTAT) was detected. It showed predominantly a solid pattern with limited tubule formation and was composed of lipid-rich cells. She had no hormonal symptoms. Conclusion: SCTAT can occur as young as six months of age in PJS, and may show histologic overlap with lipid-rich Sertoli cell tumors.
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Affiliation(s)
- Priyanka Maity
- Department of Pathology, Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - Nandini Das
- Department of Pathology, Medical College and Hospital Kolkata, India
| | - Uttara Chatterjee
- Department of Pathology, Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - Dhananjay Basak
- Department of Pediatric Surgery, Park Clinic, Kolkata, India
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Ogawa C, Hirasawa A, Ida N, Nakamura K, Masuyama H. Hereditary gynecologic tumors and precision cancer medicine. J Obstet Gynaecol Res 2022; 48:1076-1090. [PMID: 35229413 DOI: 10.1111/jog.15197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/09/2022] [Indexed: 11/29/2022]
Abstract
Gynecologic cancers are more often caused by genetic factors than other cancers. Genetic testing has become a promising avenue for the prevention, prognosis, and treatment of cancers. This review describes molecular features of gynecologic tumors linked to hereditary syndromes, gives an overview of the current state of clinical management, and clarifies the role of gynecology in the treatment of hereditary tumors. Typical hereditary gynecologic tumors include hereditary breast and ovarian cancer, Lynch syndrome, Peutz-Jeghers syndrome, and Cowden syndrome. Multigene panel testing, which analyzes a preselected subset of genes for genetic variants, has recently become the first-choice test because it can provide more accurate risk assessment than a single test. Furthermore, comprehensive genomic cancer profiling enables personalized cancer treatment and aids in germline findings.
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Affiliation(s)
- Chikako Ogawa
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Akira Hirasawa
- Department of Clinical Genomic Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Naoyuki Ida
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Keiichiro Nakamura
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Hisashi Masuyama
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Tong T, Fan Q, Shi S, Li Y, Wang Y. Gastric-type mucinous adenocarcinoma of the cervix in a woman with Peutz-Jeghers syndrome: a case report. Acta Chir Belg 2022:1-6. [PMID: 35135434 DOI: 10.1080/00015458.2022.2040110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant disorder characterized by a predisposition to the development of multiple neoplasms. Gastric-type mucinous adenocarcinoma (GAS), a new variant of carcinoma of the cervix according to 2014 WHO classification, is less common compared with squamous cell carcinoma, is more aggressive and has a lower 5-year survival rate compared with the usual-type endocervical adenocarcinoma, and is also unrelated to human papillomavirus (HPV) infection. CASE SUMMARY We herein present the case of a 32-year-old patient with PJS who was diagnosed with GAS of the cervix. The patient was not sexually active and had been diagnosed with PJS at 2 years of age. A tumor ∼6 cm was found on the cervix and was diagnosed as GAS of the cervix of clinical-stage IB3. The patient was treated with intra-arterial chemotherapy for one course, followed by radical surgery and then systematic chemotherapy. CONCLUSION The present case highlights the need for more thorough cancer screening for patients with PJS, as this disorder is rare and is associated with a high risk of malignancies. Young patients with PJS, including those who are not sexually active, who present with watery vaginal discharge or bleeding should be screened for cervical carcinoma, even if the cytological results or HPV tests are negative.
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Affiliation(s)
- Tong Tong
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China; Shanghai Municipal Key Clinical Speciality, Shanghai, China
| | - Qiong Fan
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China; Shanghai Municipal Key Clinical Speciality, Shanghai, China
| | - Shu Shi
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China; Shanghai Municipal Key Clinical Speciality, Shanghai, China
| | - Yuhong Li
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China; Shanghai Municipal Key Clinical Speciality, Shanghai, China
| | - Yudong Wang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China; Shanghai Municipal Key Clinical Speciality, Shanghai, China
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Huang YQ, Chen KY, Zhang LL. Gardner syndrome: A case report. Shijie Huaren Xiaohua Zazhi 2022; 30:114-118. [DOI: 10.11569/wcjd.v30.i2.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gardner syndrome is a special subtype of familial adenomatous polyposis (FAP) and it is an autosomal dominant genetic disease mainly characterized by multiple gastrointestinal polyps, soft tissue tumors, and osteomas. It is a rare disease, and there are few relevant reports about it. However, the malignant transformation rate of Gardner syndrome is high. Therefore, understanding of its main clinical features, and early examination and timely discovery are of great significance for its treatment.
CASE SUMMARY We report the case of a 39-year-old man diagnosed with Gardner syndrome who presented with anemia and melena for more than 4 mo, along with nausea and vomiting for more than 20 d. Gastrointestinal endoscopy revealed multiple polyps in the gastrointestinal tract and polyp biopsy pathology confirmed the diagnosis. Endoscopic treatment was performed, and the patient had no postoperative discomfort. Finally, his condition improved.
CONCLUSION The clinical manifestations of Gardner syndrome are complex. The combination of clinical manifestations with relevant imaging and pathological examination results can help achieve early diagnosis and early treatment. Early treatment is usually associated with a good prognosis.
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Affiliation(s)
- Yan-Qi Huang
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Ke-Yu Chen
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
| | - Ling-Li Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
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Sandru F, Petca A, Dumitrascu MC, Petca RC, Carsote M. Peutz-Jeghers syndrome: Skin manifestations and endocrine anomalies (Review). Exp Ther Med 2021; 22:1387. [PMID: 34650635 PMCID: PMC8506952 DOI: 10.3892/etm.2021.10823] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/27/2021] [Indexed: 12/11/2022] Open
Abstract
Peutz-Jeghers syndrome (PJS), a rare autosomal dominant serine/threonine kinase 11 (STK11)/ liver kinase B1 (LKB1) gene-related genodermatosis, is characterized by oral hyperpigmentation (OHP); multiple gastro-intestinal mucosal benign hamartomatous polyps causing local bleeding, occlusion, intussusception, post-resection small bowel syndrome, associated increased risk of small intestinal cancer (incidence during the third decade); and 76% cumulative higher risk than the global population of developing non-gastrointestinal tumors (female predominance) including ovarian/testicular neoplasia, pancreatic and gynecologic (breast, uterus, ovarian) cancers. Suggestive PJS-associated OHP requires STK11 genetic testing. Abdominal pain in an OHP patient may be related to PJS-associated polyps. Other features include focal depigmentation followed by hyperpigmentation, and xeroderma pigmentosum-like lesions. The severity of the dermatological findings is correlated with gastrointestinal polyps. The STK11 gene is linked to reserve of primordial follicles, polycystic ovary syndrome, female fertility, and spermatogenesis. PJS is associated with 2 types of ovarian sex-cord stroma tumors (SCSTs): annular tubules (SCTATs) and pure Sertoli cell tumors. SCSTs accounts for 8% of ovarian cancer and SCTATs represents 2% of SCST, which may be associated with the overproduction of progesterone. PJS-SCTAT vs. non-PJS-SCTAT reveals bilateral/multifocal, small tumors with a benign behavior vs. a unique ovarian, large tumor with increased malignant/metastasis risk. Male precocious puberty is due to large cell calcifying Sertoli cell tumors (LCCSCTs). Notably, 30-40% of LCCSCTs are caused by PJS or Carney complex. PJS-LCCSCT is not aggressive, but it may be bilateral/multifocal, with the ultrasound hallmark being micro-calcifications. Testicular, intra-tubular large cell hyalinizing Sertoli cell tumor is the second testicle neoplasia in PJS. The skin and mucosal lesions are useful markers of PJS, assisting with the early identification of hamartomatouspolyps and initiation of serial surveillance of ovarian, or testicular neoplasia.
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Affiliation(s)
- Florica Sandru
- Department of Dermatology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Dermatology, ‘Elias’ Emergency Hospital, 011461 Bucharest, Romania
| | - Aida Petca
- Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Obstetrics and Gynecology, ‘Elias’ Emergency Hospital, 022461 Bucharest, Romania
| | - Mihai Cristian Dumitrascu
- Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Razvan-Cosmin Petca
- Department of Urology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Urology, ‘Prof. Dr. Theodor Burghele’ Clinical Hospital, 061344 Bucharest, Romania
| | - Mara Carsote
- Department of Endocrinology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Endocrinology, ‘C. I. Parhon’ National Institute of Endocrinology, 011863 Bucharest, Romania
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Yucel Cicek OS, Gezer S, Cakir O, Hekimoglu Gurbuz R. Extremely high anti-Mullerian hormone levels detected during infertility workup revealing sex cord tumor with annular tubules and underlying Peutz-Jeghers syndrome: A case report. J Obstet Gynaecol Res 2021; 48:492-496. [PMID: 34837285 DOI: 10.1111/jog.15107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/10/2021] [Accepted: 11/13/2021] [Indexed: 11/27/2022]
Abstract
We report an infertile, but otherwise asymptomatic woman, whose extremely high anti-Mullerian hormone (AMH) level detected during infertility investigation led to the diagnosis of sex cord tumor with annular tubules (SCTAT) which is a very rare sex cord-stromal tumor (SCST) and eventually revealed a previously undiagnosed hereditary cancer syndrome, Peutz-Jeghers syndrome (PJS). A 33-year-old woman attended Kocaeli University ART Clinic for infertility evaluation. Her AMH level was 319.63 ng/ml. Detection of bilateral ovarian cysts required surgical evaluation. The histopathological examination of ovaries revealed SCTAT. The strong association of SCTAT with PJS raised the suspicion of this syndrome. Whole STK11 gene sequencing confirmed PJS diagnosis. AMH has become a widely used tool in the evaluation of infertile women. Clinicians dealing with infertility should be familiar with the utility of AMH measurement besides being a marker of ovarian reserve. Detection of high AMH concentrations should raise the suspicion of an SCST.
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Affiliation(s)
- Ozge Senem Yucel Cicek
- Department of Obstetrics and Gynecology, Assisted Reproductive Technologies Clinic, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Sener Gezer
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Ozgur Cakir
- Department of Radiology, Kocaeli University, Faculty of Medicine, İzmit, Turkey
| | - Rumeysa Hekimoglu Gurbuz
- Department of Histology and Embryology, Bezmialem University, Faculty of Medicine, İstanbul, Turkey
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Gu GL, Zhang Z, Zhang YH, Yu PF, Dong ZW, Yang HR, Yuan Y. Detection and analysis of common pathogenic germline mutations in Peutz-Jeghers syndrome. World J Gastroenterol 2021; 27:6631-6646. [PMID: 34754157 PMCID: PMC8554407 DOI: 10.3748/wjg.v27.i39.6631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/31/2021] [Accepted: 08/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Different types of pathogenic mutations may produce different clinical phenotypes, but a correlation between Peutz-Jeghers syndrome (PJS) genotype and clinical phenotype has not been found. Not all patients with PJS have detectable mutations of the STK11/LKB1 gene, what is the genetic basis of clinical phenotypic heterogeneity of PJS? Do PJS cases without STK11/LKB1 mutations have other pathogenic genes? Those are clinical problems that perplex doctors.
AIM The aim was to investigate the specific gene mutation of PJS, and the correlation between the genotype and clinical phenotype of PJS.
METHODS A total of 24 patients with PJS admitted to the Air Force Medical Center, PLA (formerly the Air Force General Hospital, PLA) from November 1994 to January 2020 were randomly selected for inclusion in the study. One hundred thirty-nine common hereditary tumor-related genes including STK11/LKB1 were screened and analyzed for pathogenic germline mutations by high-throughput next-generation sequencing (NGS). The mutation status of the genes and their relationship with clinical phenotypes of PJS were explored.
RESULTS Twenty of the 24 PJS patients in this group (83.3%) had STK11/LKB1 gene mutations, 90% of which were pathogenic mutations, and ten had new mutation sites. Pathogenic mutations in exon 7 of STK11/LKB1 gene were significantly lower than in other exons. Truncation mutations are more common in exons 1 and 4 of STK11/LKB1, and their pathogenicity was significantly higher than that of missense mutations. We also found SLX4 gene mutations in PJS patients.
CONCLUSION PJS has a relatively complicated genetic background. Changes in the sites responsible for coding functional proteins in exon 1 and exon 4 of STK11/LKB1 may be one of the main causes of PJS. Mutation of the SLX4 gene may be a cause of genetic heterogeneity in PJS.
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Affiliation(s)
- Guo-Li Gu
- Department of General Surgery, Air Force Medical Center, Chinese People's Liberation Army, Beijing 100142, China
| | - Zhi Zhang
- Department of General Surgery, Air Force Medical Center, Chinese People's Liberation Army, Beijing 100142, China
| | - Yu-Hui Zhang
- Department of General Surgery, Air Force Medical Center, Chinese People's Liberation Army, Beijing 100142, China
- Graduate School, Hebei North University, Zhangjiakou 075000, Hebei Province, China
| | - Peng-Fei Yu
- Department of General Surgery, Air Force Medical Center, Chinese People's Liberation Army, Beijing 100142, China
| | - Zhi-Wei Dong
- Department of General Surgery, Air Force Medical Center, Chinese People's Liberation Army, Beijing 100142, China
| | - Hai-Rui Yang
- Department of General Surgery, Air Force Medical Center, Chinese People's Liberation Army, Beijing 100142, China
| | - Ying Yuan
- Department of Medical Oncology, Cancer Institute, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
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García Picazo A, López de la Torre B, Vivas A, García FJ, Ferrero E. Minimally Invasive Elective Surgery as a Treatment of Bowel Invagination in a Peutz-Jeghers Syndrome Case. Case Rep Gastroenterol 2021; 15:495-500. [PMID: 34616246 PMCID: PMC8454248 DOI: 10.1159/000512423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/16/2020] [Indexed: 11/19/2022] Open
Abstract
We present a case of a 24-year-old woman with Peutz-Jeghers syndrome, recurrent colic abdominal pain, and lower gastrointestinal bleed for the last 5 years. Colonoscopy showed hamartomas without any dysplasia. In the enteral magnetic resonance imaging, a distal jejunum and ileum invagination, secondary to hamartomas was detected. The patient was referred to the Surgery Department and despite few symptoms, elective surgery was proposed. By laparoscopic surgery approach, the entire bowel was carefully revised, 3 intussusceptions and bowel volvulus were found, 2 in jejunum and 1 in ileum, causing incomplete obstruction and intestinal dilatation, with a diameter of 6 cm. These intussusception areas were marked with a silk filament, after achieving devolvulation and disinvagination. A 5-cm laparotomy was done, to externalize the entire bowel, to explore it manually, to verify the absence of other lesions, and locate silk points. By longitudinal enterotomies on the antimesenteric intestinal border where silk filaments were located, the polyps were removed through their stalk, and the enterotomies were transversely closed. Postoperative evolution was favorable, starting oral tolerance on the fourth day and being discharged from the hospital on the seventh day. Eight months later, the patient was asymptomatic with a better quality of life.
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Affiliation(s)
- Alberto García Picazo
- General Surgery and Abdominal Organs Transplantation Department, 12th October University Hospital, Complutense University of Madrid, Madrid, Spain
| | - Beatriz López de la Torre
- General Surgery and Abdominal Organs Transplantation Department, 12th October University Hospital, Complutense University of Madrid, Madrid, Spain
| | - Alfredo Vivas
- General Surgery and Abdominal Organs Transplantation Department, 12th October University Hospital, Complutense University of Madrid, Madrid, Spain
| | - Francisco J García
- General Surgery and Abdominal Organs Transplantation Department, 12th October University Hospital, Complutense University of Madrid, Madrid, Spain
| | - Eduardo Ferrero
- General Surgery and Abdominal Organs Transplantation Department, 12th October University Hospital, Complutense University of Madrid, Madrid, Spain
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Iwamuro M, Toyokawa T, Matsueda K, Hori S, Yoshioka M, Moritou Y, Tanaka T, Mizuno M, Okada H. Two Types of Polyp Shape Observed in the Stomach of Patients with Peutz-Jeghers Syndrome. Acta Med Okayama 2021; 75:471-477. [PMID: 34511614 DOI: 10.18926/amo/62399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The characteristics of gastric polyps in patients with Peutz-Jeghers (PJ) syndrome (PJS) have not been fully investigated. The objective of this study was to reveal the endoscopic and pathologic findings of gastric polyps in patients with PJS. We reviewed 11 patients with PJS treated at 6 institutions, and summarized the endo-scopic and pathologic features of their gastric polyps. The polyps were mainly classified into 2 types: (i) soli-tary or sporadic polyps > 5 mm, reddish in color with a sessile or semi-pedunculated morphology (n = 9); and (ii) multiple sessile polyps ≤ 5 mm with the same color tone as the peripheral mucosa (n = 9). Patients who underwent endoscopic mucosal resection for polyps > 5 mm were diagnosed with PJ polyps (n = 2), whereas those who underwent biopsy were diagnosed with hyperplastic polyps. Polyps ≤ 5 mm were pathologically diagnosed as fundic gland polyps or hyperplastic polyps. This study revealed that patients with PJS present with 2 types of polyps in the stomach. Endoscopic mucosal resection of polyps > 5 mm seems necessary for the pathologic diagnosis of PJ polyps.
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Affiliation(s)
- Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | | | - Kazuhiro Matsueda
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital
| | | | - Masao Yoshioka
- Department of Internal Medicine, Okayama Saiseikai General Hospital
| | - Yuki Moritou
- Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital
| | - Takehiro Tanaka
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Motowo Mizuno
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
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Vu Dinh G, Doan Thi Hong N, Vo Ngoc T, Nguyen Thanh L, Hoang Thi H, Phung Thi H. Peuzt - Jeghers syndrome with gastric type mucinous endocervical adenocarcinoma in a young woman: A case report. Ann Med Surg (Lond) 2021; 69:102700. [PMID: 34429956 PMCID: PMC8371195 DOI: 10.1016/j.amsu.2021.102700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/07/2021] [Accepted: 08/08/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Patients with Peutz-Jeghers syndrome (PJS) have high risk of malignancies, including gynecological cancers. Gastric type mucinous cervical adenocarcinoma might be presented in about 11–17% of PJS patients but the literature about this is limited. Case presentation We presented a rare case of a 39-year-old Vietnamese woman with Peutz-Jeghers syndrome who has gastric type adenocarcinoma (GAS) of the cervix. She underwent radical hysterectomy, and the diagnosis was confirmed on final pathology. Conclusions Oncologists and pathologists should recognize this rare clinical scenario for early diagnosis and treatment. This subtype also has an aggressive nature and poor prognosis. Gastric type adenocarcinoma of the uterine cervix (GAS) is a rare variant of endocervical adenocarcinoma. An association exists between GAS and Peutz-Jeghers syndrome. Careful evaluation by gynecological oncologists is needed for early detection and treatment of this condition.
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Affiliation(s)
- Giap Vu Dinh
- Department of Breast and Gynecologic Surgical Oncology, Nghe An Oncology Hospital, Nghe An, Viet Nam
| | - Nhat Doan Thi Hong
- Deapartment of Clinical Surgery, Vinh Medical University, Nghe An, Viet Nam
| | - Tu Vo Ngoc
- Department of Breast and Gynecologic Surgical Oncology, Nghe An Oncology Hospital, Nghe An, Viet Nam
| | | | - Hoai Hoang Thi
- Department of Oncology, Hanoi Medical University, Hanoi, Viet Nam
| | - Huyen Phung Thi
- Department of Medical Oncology 6, Vietnam National Cancer Hospital, Hanoi, Viet Nam
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Chiew J, Sambanthan ST, Mahendran HA. Double intussusception in a teenage child with Peutz-Jeghers syndrome: A case report. World J Clin Cases 2021; 9:6804-6809. [PMID: 34447828 PMCID: PMC8362540 DOI: 10.12998/wjcc.v9.i23.6804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/14/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Peutz-Jeghers syndrome (PJS) is a genetic disorder characterized by the development of gastrointestinal hamartomatous polyps and mucocutaneous melanin pigmentation. Patients with PJS are at risk of complications such as intussusception. Intussusception is a condition where one segment of the intestine invaginates into another, causing intestinal obstruction. We report a PJS patient who was diagnosed with double intussusception in a single setting.
CASE SUMMARY A 16-year-old teenage male PJS patient presented with a history of colicky abdominal pain, vomiting, blood in stools, loss of appetite, and weight loss. On abdominal examination, a vague mass was palpable over the right upper quadrant. Contrast-enhanced computed tomography (CT) of the abdomen was performed and an intussusception involving the jejunum and rectosigmoid junction was observed. The patient subsequently underwent a laparotomy and intussusception involving the jejunum and another over the ileum was noted intra-operatively. Bowel resection and an endoscopic polypectomy were performed, followed by a primary anastomosis. The patient was discharged well and reviewed again one month later, and was noted to be well.
CONCLUSION PJS patients have a high risk of intussusception and can be diagnosed accurately by endoscopic surveillance or radiologically with abdominal CT or magnetic resonance imaging. The mainstay of treatment is surgical intervention followed by endoscopic surveillance with periodic polypectomy.
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Affiliation(s)
- Junloong Chiew
- Department of Surgery, Hospital Sultanah Aminah, Johor Bahru 80100, Malaysia
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Kotaka S, Kanno K, Yanai S, Omori M, Andou M. Peutz-Jeghers syndrome complicated by gastric-type cervical mucinous carcinoma and primary peritoneal carcinoma. J Obstet Gynaecol Res 2021; 47:3732-3736. [PMID: 34278661 DOI: 10.1111/jog.14944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/19/2021] [Accepted: 07/07/2021] [Indexed: 11/27/2022]
Abstract
A 45-year-old multiparous woman with a STK11 mutation and a history of Peutz-Jeghers syndrome underwent radical hysterectomy and bilateral salpingo-oophorectomy for a gastric-type cervical mucinous carcinoma. Four and a half years later, blood tests revealed elevations in CEA and CA125 tumor marker levels, and computed tomography showed multiple calcifications in the peritoneum. Peritoneal dissemination was suspected, and a laparoscopic biopsy was performed. Histopathology showed a high-grade serous carcinoma, and the patient was diagnosed with a metachronous stage IIIC primary peritoneal carcinoma. She had no BRCA1/2 mutation. After chemotherapy with docetaxel, carboplatin, and bevacizumab, she achieved complete remission.
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Affiliation(s)
- Saki Kotaka
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
| | - Kiyoshi Kanno
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
| | - Shiori Yanai
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
| | - Masako Omori
- Departments of Pathology, Kurashiki Medical Center, Okayama, Japan
| | - Masaaki Andou
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
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43
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Korsing S, Boede M, Ebrahimsade S, Meier K. [Laugier-Hunziker syndrome : A rare differential diagnosis of mucocutaneous hyperpigmentation]. Hautarzt 2021. [PMID: 34170334 DOI: 10.1007/s00105-021-04845-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 11/27/2022]
Abstract
Laugier-Hunziker syndrome (LHS) is characterized by lentiginous hyperpigmentation of the oral mucosa and lips. In addition, longitudinal melanonychia and palmoplantar hyperpigmented lesions may occur. LHS is a clinical diagnosis of exclusion. Herein, we report the case of a 66-year-old woman with LHS. The clinical and histopathologic features of LHS are presented and important differential diagnoses are discussed.
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44
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Sadhwani N, Bhandarwar A, Arora E, Gajbhiye R, Ansari W, Wagh A, Rahate P, Agarwal J. Intra-operative enteroscopic polypectomy-An innovative hybrid approach using straight sticks. Int J Surg Case Rep 2021; 84:106102. [PMID: 34157550 PMCID: PMC8220583 DOI: 10.1016/j.ijscr.2021.106102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background Peutz-Jeghers Syndrome (PJS) is an uncommon intestinal polyposis disorder. Bowel obstructions are a recurring problem in PJS and as many as 50% of these patients require surgery. The current standard of care for these patients is to perform a flexible enteroscopic polypectomy. The traditional push-pull enteroscopy however, might be unavailable or unsuitable in an emergency setting. Alternatively, repeated laparotomies with multiple small bowel resections can lead to short bowel syndrome. Methods In our series, we describe an innovative technique where a short midline laparotomy permitted sufficient access to reduce the intussusception(s) and perform a bowel walk. Rigid laparoscopic instruments were introduced within the small bowel lumen via enterotomies, to perform polypectomies along the entire small bowel length. This precludes the need for small bowel resections which can thwart the development of short bowel syndrome. Results Two patients with PJS presenting with acute small bowel obstruction underwent surgery using the described approach. Another two patients with PJS having multiple intussusceptions on CT underwent an elective prophylactic polypectomy using the same approach. We were able to run the bowel in its entirety and a maximum of 41 polyps were retrieved from the port site enterotomy. The operating times were modest and no unique complications pertaining to this technique were encountered. Conclusion Small bowel polypectomy using rigid instrumentation employing a limited midline laparotomy is an attractive option for both emergency and elective settings in patients with PJS. Bowel obstructions are a recurring problem in PJS. Polypectomy using rigid instrumentation serves as an attractive option for patients with PJS, undergoing a laparotomy for acute bowel obstruction. This technique can be empolyed in both, elective as well as emergency settings.
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Affiliation(s)
- Nidhisha Sadhwani
- Department of General Surgery, Grant Medical College & Sir JJ Group of Hospitals, Mumbai, India.
| | - Ajay Bhandarwar
- Department of General Surgery, Grant Medical College & Sir JJ Group of Hospitals, Mumbai, India
| | - Eham Arora
- Department of General Surgery, Grant Medical College & Sir JJ Group of Hospitals, Mumbai, India
| | - Raj Gajbhiye
- Department of General Surgery, Government Medical College & Hospital, Nagpur, India
| | - Waqar Ansari
- Department of General Surgery, Grant Medical College & Sir JJ Group of Hospitals, Mumbai, India
| | - Amol Wagh
- Department of General Surgery, Grant Medical College & Sir JJ Group of Hospitals, Mumbai, India
| | | | - Jasmine Agarwal
- Department of General Surgery, Grant Medical College & Sir JJ Group of Hospitals, Mumbai, India
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Itani M, Lalwani N, Ganeshan D, Zulfiqar M, Siegel C. Current update on the molecular genetics and management of hereditary ovarian cancers: a primer for radiologists. Abdom Radiol (NY) 2021; 46:2281-92. [PMID: 33847772 DOI: 10.1007/s00261-020-02911-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 12/24/2022]
Abstract
More than one-fifth of ovarian cancers are hereditary, with most of them caused by BRCA genes. Malignant ovarian neoplasms are primarily epithelial tumors, a heterogeneous group of tumors with variable genetic backgrounds that translate into different biologic behaviors and morphologic features. Radiologists play an increasingly important role in the diagnosis and management of oncology patients. Familiarity with hereditary ovarian cancers will have a positive impact on patient management and radiologists' involvement in the multidisciplinary approach needed for this delicate patient population. In this paper, we review the basic histologic and genetic backgrounds of ovarian tumors with an emphasis on hereditary ovarian cancers, as well as the effects that these factors have on patient workup, primarily with regard to imaging studies.
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46
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Ponce GT, Zunana C, Viso M, Bailez MM, González Roibon N, Bosaleh A, Califano P. [Tumor of the sexual cords with ovarian annular tubules associated with Peutz-Jeghers syndrome in adolescence: a case report]. ARCH ARGENT PEDIATR 2021; 118:e329-e332. [PMID: 32470276 DOI: 10.5546/aap.2020.e329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/07/2019] [Indexed: 11/12/2022]
Abstract
Tumors of the sexual and stromal cords are rare neoplasms, corresponding to 8 % of primary ovarian tumors. The tumor of the sexual cords with annular tubules of the ovary is considered a subtype and is uncommon. It can occur sporadically or associated with Peutz-Jeghers Syndrome, having different behavior and characteristics in each situation. We present the case of an adolescent patient with a diagnosis of a tumor of the sexual cords with annular tubules of the ovary associated with Peutz-Jeghers Syndrome.
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Affiliation(s)
- Giselle T Ponce
- Sección de Ginecología, Clínica Pediátrica, Hospital Nacional de Pediatría S. A. M. I. C. "Prof. Dr. Juan P. Garrahan", Ciudad Autónoma de Buenos Aires.
| | - Cecilia Zunana
- Sección de Ginecología, Clínica Pediátrica, Hospital Nacional de Pediatría S. A. M. I. C. "Prof. Dr. Juan P. Garrahan", Ciudad Autónoma de Buenos Aires
| | - Marianela Viso
- Servicio de Hematooncología, Hospital Nacional de Pediatría S. A. M. I. C. "Prof. Dr. Juan P. Garrahan", Ciudad Autónoma de Buenos Aires
| | - María M Bailez
- Servicios Quirúrgicos, Hospital Nacional de Pediatría S. A. M. I. C. "Prof. Dr. Juan P. Garrahan", Ciudad Autónoma de Buenos Aires
| | - Nilda González Roibon
- Servicio de Patología, Hospital Nacional de Pediatría S. A. M. I. C. "Prof. Dr. Juan P. Garrahan", Ciudad Autónoma de Buenos Aires
| | - Andrea Bosaleh
- Servicio de Patología, Hospital Nacional de Pediatría S. A. M. I. C. "Prof. Dr. Juan P. Garrahan", Ciudad Autónoma de Buenos Aires
| | - Paula Califano
- Sección de Ginecología, Clínica Pediátrica, Hospital Nacional de Pediatría S. A. M. I. C. "Prof. Dr. Juan P. Garrahan", Ciudad Autónoma de Buenos Aires
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Syarifuddin E, Masadah R, Lusikooy RE, Uwuratuw JA, Faruk M. Peutz-Jeghers syndrome in a woman presenting as intussusception: A case report. Int J Surg Case Rep 2021; 79:286-290. [PMID: 33486311 PMCID: PMC7829114 DOI: 10.1016/j.ijscr.2021.01.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/14/2021] [Accepted: 01/14/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Peutz-Jeghers syndrome (PJS) is an uncommon autosomal dominant syndrome with a variable to high penetrance that leads to the development of polyps within the gastrointestinal mucosa. Here we report a case of an adult female suffering jejunoileal intussusception due to PJS. PRESENTATION OF CASE A 30-year-old woman came to an emergency department with a small bowel obstruction caused by intussusception. The patient underwent an emergency exploratory laparotomy. An intussusception at the level of 60 cm from the ligamentum treitz was revealed, and the intussusception small bowel segment was not viable; we decided to perform segmental jejunoileal resection with the Bishop-Koop procedure, and the specimen histopathology of the segmental jejunoileal resection showed a typical hamartomatous polyp features. Two month later, diagnostic endoscopy showed multiple polyps (between 5 and 15 mm) in the large bowel. The polyps were removed with endoscopic polypectomy and examined histopathologically, showing characteristics of PJS. Further detailed family history was obtained, and similar skin lesions were detected on our patient's child (since birth). Although endoscopy screening identified multiple polyps in the child's ileum and large bowel, he was not suffering from abdominal symptoms. CONCLUSION In patients with intussusception at a young age, PJS can be caused by the presence of a hamartoma polyp as a trigger for intussusception. If there are multiple polyps found in the gastrointestinal mucosa and other pathognomonic signs are found, such as hyperdense macular lesions on the lip and buccal mucosa, such cases should be confirmed as PJS.
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Affiliation(s)
- Erwin Syarifuddin
- Division of Digestive, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Rina Masadah
- Department of Pathology Anatomy, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Ronald Erasio Lusikooy
- Division of Digestive, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Julianus Aboyaman Uwuratuw
- Division of Digestive, Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Muhammad Faruk
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
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Ferreira LDS, Calderipe CB, Maass JB, Carrard VC, Martins MD, Abreu LG, Schuch LF, Uchoa Vasconcelos AC. Oral pigmented lesions in syndromic individuals: A systematic review. Oral Dis 2021; 28:531-540. [PMID: 33394507 DOI: 10.1111/odi.13769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/07/2020] [Accepted: 12/29/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To systematically integrate the available data published in the literature on oral pigmented lesions (OPL) associated with syndromes, summarizing the clinical and demographic features of the individuals. MATERIALS AND METHODS An electronic search was undertaken in six databases. Eligibility criteria were articles in English, Spanish, and Portuguese describing case reports or case series of OPL associated with syndromes. Data were aggregated and statistically evaluated. RESULTS About 108 articles reporting 149 cases of individuals with syndromes were identified. Among the affected individuals, nine syndromes were reported. The mean age at diagnosis was 35.93 years (0.41 to 83 years), with a predilection for white (n = 85/85.86%) female (n = 102/68.46%) individuals. As regards the number of lesions, 109 (73.15%) were multiple and 40 (26.85%) were single. Lip represented the anatomical location more affected (122 cases/38.01%), followed by the buccal mucosa (100 cases/31.15%). Brownish lesions accounted for 82 (69.49%) cases. The mean time of evolution was 10.52 years (0.16 to 56 years). OPL preceding diagnosis of the syndrome was observed in 111 (74.50%) cases. CONCLUSIONS Although these syndromes are uncommon, dentists should be able to recognize their manifestations, since oral manifestations can represent an important aspect in early diagnosis.
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Affiliation(s)
- Luíse Dos Santos Ferreira
- Diagnostic Center for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Camila Barcellos Calderipe
- Diagnostic Center for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Julianne Bartz Maass
- Diagnostic Center for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Vinicius Coelho Carrard
- Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Manoela Domingues Martins
- Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Oral Diagnosis, Piracicaba Dental School, Universidade de Campinas, Piracicaba, Brazil
| | - Lucas Guimarães Abreu
- Department of Child's and Adolescent's Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lauren Frenzel Schuch
- Department of Oral Diagnosis, Piracicaba Dental School, Universidade de Campinas, Piracicaba, Brazil
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Dundr P, Cibula D, Foretová L, Macek M, Kopečková K, Petruželka L, Němejcová K, Bártů M, Hojný J, Hájková N, Jakša R, Janega P, Stružinská I. Gynecological lesions in hereditary cancer predisposition syndromes. Cesk Patol 2021; 57:96-104. [PMID: 34275319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Hereditary tumor syndromes with a possible manifestation in the female internal genital tract represent a heterogeneous group of diseases. The two most common entities are the hereditary breast and ovarian cancer syndrome, and the Lynch syndrome. The less common syndromes include the rhabdoid tumor predisposition syndrome, Cowden syndrome, tuberous sclerosis complex, DICER1 syndrome, nevoid basal cell carcinoma syndrome, Peutz-Jeghers syndrome, von Hippel-Lindau disease, and hereditary leiomyomatosis and renal cell cancer syndrome. The goal of this manuscript is to provide a comprehensive overview of those hereditary tumor syndromes which can manifest in the area of the female genital system, with an emphasis on their summary, the characteristics of the tumors which can develop in association with these syndromes, and the approach to the processing of prophylactically removed tissues and organs. The issue of Lynch syndrome screening is also discussed.
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Ben Hammouda S, Njima M, Ben Abdeljelil N, Bellalah A, Njim L, Zakhama A. An unusual presentation revealing Peutz-Jeghers syndrome in adult. Ann Med Surg (Lond) 2020; 58:87-90. [PMID: 32953105 PMCID: PMC7486423 DOI: 10.1016/j.amsu.2020.08.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 01/23/2023] Open
Abstract
Introduction Peutz-Jeghers syndrome (PJS) is a rare hereditary disease characterized by hyperpigmentation on the lips and oral cavity and gastrointestinal hamartomatous polyps. The most common complications in PJS patients are bleeding, bowel obstruction and intussusception. Presentation of case We hereby report a case of a 33-year-old female, without a family history of the disease, who presented to the emergency room with acute abdominal pain, bloating and not passing gas. On abdominal examination, upper abdominal and periumbilical tenderness was found. Computed tomography (CT) of the abdomen demonstrated suspected ascending colon intussusception. The patient underwent a mid-line laparotomy that showed an ileocolic intussusception. Reduction of this intussusception was successfully done with resection of the affected segment that showed presence of two pedunculated polyps. The specimen was sent thereafter to our department for histopathological evaluation, which confirmed the diagnosis of hamartomatous Peutz-Jeghers polyps with no malignancy. Afterwards, the patient was carefully reexamined and the physical examination revealed multiple pigmented spots on the face and lips. Thus, the diagnosis of Peutz-Jeghers syndrome was made. Discussion PJS is a rare autosomal dominant disorder that often remain undiagnosed for many years. Acute complications such as intestinal obstruction secondary to intussusception is one of infrequent revealing symptoms. Conclusion Early identification, in patients with PJS and family members, as well as close cancer surveillance can improve certainly prognosis in these individuals.
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Affiliation(s)
- Seifeddine Ben Hammouda
- Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia.,Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| | - Manel Njima
- Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia.,Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| | - Nouha Ben Abdeljelil
- Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia.,Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| | - Ahlem Bellalah
- Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia.,Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| | - Leila Njim
- Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia.,Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| | - Abdelfattah Zakhama
- Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia.,Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
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