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Course and follow-up of solitary Peutz-Jeghers polyps: a case series
Mustafa Oncel1, Feza H Remzi, James M Church
1Department of Colorectal Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Insights
Solitary Peutz-Jeghers polyps (PJP) in patients without Peutz-Jeghers syndrome (PJS) do not increase gastrointestinal cancer risk. These isolated polyps do not warrant specific high-risk cancer screening protocols.
Area of Science:
- Gastroenterology
- Oncology
- Genetics
Background:
- Peutz-Jeghers syndrome (PJS) is a rare autosomal-dominant disorder.
- PJS is associated with hamartomatous polyps, skin hyperpigmentation, and a family history.
- Solitary Peutz-Jeghers polyps (PJP) can occur without other PJS features.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of patients with solitary Peutz-Jeghers polyps.
- To determine if solitary PJP are associated with an increased risk of gastrointestinal cancer.
- To assess the need for specific high-risk cancer screening in patients with solitary PJP.
Main Methods:
- Retrospective review of eight patients diagnosed with solitary PJP since 1979.
- Analysis of polyp location, size, diagnostic methods, and patient follow-up.
- Comparison of patient demographics and outcomes with literature data on PJS.
Main Results:
- The average age at diagnosis for solitary PJP was 56 years.
- Polyps were located in the colon, stomach, and duodenum.
- Patients followed for a median of 11.5 years showed no further PJP or gastrointestinal cancer.
Conclusions:
- Solitary Peutz-Jeghers polyps do not appear to carry a risk of gastrointestinal cancer.
- These isolated polyps do not necessitate specific high-risk cancer screening.
- Further research may be warranted to confirm these findings in larger cohorts.
Background And Aims:
Peutz-Jeghers syndrome (PJS) is a rare, autosomal-dominant disease characterized by hamartomatous polyps of the alimentary tract, hyperpigmentation of the skin, and family history of PJS. Rarely, solitary Peutz-Jeghers polyps (PJP) arise in patients without other features of PJS.
Patients And Methods:
We reviewed eight patients since 1979 with solitary PJP, six men and two women.
Results:
The average age at diagnosis was higher (56+/-13 years) than that of PJS patients in the literature. Polyps were found in the sigmoid colon ( n=4), cecum ( n=1), stomach ( n=1), and duodenum ( n=2). The colonic polyps were diagnosed and removed endoscopically. Indications for colonoscopy included routine screening ( n=4) or rectal bleeding ( n=1). The duodenal and gastric polyps were diagnosed and removed during gastroduodenoscopic examinations, which were performed for nonspecific dyspepsia ( n=2) or gastrointestinal bleeding ( n=1). The median size was 20 mm (range 2 mm-25 mm). Patients were followed for a median of 11.5 years (range 3-22) without another PJP or cancer. Three patients died of causes unrelated to PJP. Five patients are alive and polyp free.
Conclusion:
Solitary PJP do not carry a risk of gastrointestinal cancer and are not an indication for specific high-risk screening.