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Solitary Peutz-Jeghers type harmartomatous polyp in duodenum with gastric foveolar epithelium: a case report
Eugene Choi1, Junghwan Lee2, Youngsoo Park1
1Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Insights
This study reports a rare case of a solitary Peutz-Jeghers type polyp in the duodenum. The polyp was covered with heterotopic gastric-type epithelium, challenging the typical definition of hamartomatous polyps.
Area of Science:
- Gastroenterology
- Pathology
- Genetics
Background:
- Peutz-Jeghers syndrome is characterized by gastrointestinal hamartomatous polyps, mucocutaneous pigmentation, and a family history or STK11/LTB1 mutation.
- Solitary Peutz-Jeghers type polyps lack the full diagnostic criteria for Peutz-Jeghers syndrome but share histological features.
- Hamartomatous polyps are defined by the abnormal overgrowth of indigenous epithelial components.
Observation:
- A 47-year-old female presented with a solitary polyp in the duodenum.
- The patient exhibited no mucocutaneous symptoms or family history of Peutz-Jeghers syndrome.
- Microscopic examination revealed a Peutz-Jeghers type hamartomatous polyp.
Findings:
- The duodenal polyp was covered with heterotopic gastric-type foveolar epithelium.
- This histological feature represents a proliferation of a heterotopic component, deviating from the standard definition of hamartomatous polyps.
- The case highlights an unusual presentation of a solitary Peutz-Jeghers type polyp.
Implications:
- This case expands the understanding of Peutz-Jeghers type polyp morphology.
- It suggests that heterotopic epithelium can be a feature of solitary hamartomatous polyps.
- Further research may be needed to clarify the pathogenesis and classification of such polyps.
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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