A case of Peutz-Jeghers syndrome with early gastric cancers associated with Peutz-Jeghers polyps treated by endoscopic submucosal dissection

Abstract

A 28-year-old man, who was diagnosed with Peutz- Jeghers syndrome (PJS) when he was 13 years old, was admitted for surveillance of gastric polyps by upper gastrointestinal endoscopy. Endoscopic examination revealed (i) a type 0-I lesion measuring 30 mm in diameter at the antrum and (ii) a type 0-I lesion measuring 25 mm in diameter at the lower gastric body. Both lesions revealed no malignancy under enlarged endoscopic observation with narrow band imaging and biopsy. The lesions were treated by endoscopic submucosal dissection since theses polyps were enlarged when compared with that of 3 years ago. Histopathological examination revealed that the surface of lesion (i) was made up of only hamartoma components, whereas the inside of the lesion comprised a mixture of hamartoma and adenocarcinoma components. The surface of lesion (ii) comprised a mixture of hamartoma and adenocarcinoma components. Therefore, both the lesions were diagnosed as adenocarcinoma associated with Peutz-Jeghers polyp (PJ polyp). In most of cases, it may be difficult to detect early gastric cancer in the PJ polyp of a patient with PJS. Therefore, endoscopic resection should be considered for a growing polyp, particularly when it exceeds 20 mm in size.