A CASE OF PEUTZ-JEGHERS SYNDROME ASSOCIATED WITH ADENOCARCINOMA ARISING IN A HAMARTOMATOUS POLYP

Abstract

A 32-year-old man who had pigmented spots on his lips, fingers and toes, complained of bloody stool. An upper gastrointestinal series showed numerous sessile polyps throughout the stomach and several polyps in the duodenum. A barium enema study showed multiple pedunculated and sessile polyps throughout the large intestine. Thus, the patient was diagnosed as having Peutz-Jeghers syndrome. Thirty polyps of the large intestine were endoscopically polypectomized. The diagnosis of the 30 polyps were all hamartomatous polyps. However, a focus of well differenciated adenocarcinoma was recognized on the luminal surface of the pedunculated polyp of the descending colon, 25 × 17mm in size. To date, 48 cases of Peutz-Jeghers syndrome developing colorectal cancer have been reported in Japan. It was possible that the focal cancer in the descending colon in our case may have developed directly from the hamartomatous polyp without adenomatous component.