Peutz-Jeghers polyp

Peutz-Jeghers polyp is an uncommon gastrointestinal polyp. It is usually associated with Peutz-Jeghers syndrome.

Peutz-Jeghers polyp
Diagnosis in short
Peutz-Jeghers polyp. H&E stain.
LM	polyp with branching or thickened muscularis mucosae, benign epithelium, and lamina propria
Molecular	STK11 mutation
Site	colon, small bowel, stomach, others
Syndromes	Peutz-Jeghers syndrome
Clinical history	family history of cancer - esp. gastrointestinal and breast
Prognosis	benign lesion; suggests increased malignancy risk
Clin. DDx	other gastrointestinal polyps

Peutz-Jeghers polyp
External resources
EHVSC	10180

General

Epidemiology

Features:

• Peutz-Jeghers syndrome is autosomal dominant.
• Altered gene: STK11.

Clinical

Features:

• Melanocytic macules.
  • Lips, buccal mucosa, and digits.
  • Multiple Peutz-Jeghers polyps.

Increased risk of various neoplasms - primarily:

• Breast and gastrointestinal cancer.
• Others tumours:
  • Granulosa cell tumour.
  • Sertoli cell tumour - esp. with calcification.

Microscopic

Features:

• Frond-like polyp with all three components of mucosa:
  1. Muscosal epithelium (melanotic mucosa, goblet cells).
  2. Lamina propria.
  3. M. mucosae.

Notes:

• Frond = leaflike expansion.
  • The key is "thick" smooth muscle bundles - if one is lucky one sees branching.
    • "Thick" ~= thickness of muscularis mucosae.

DDx:

• Hyperplastic polyp of the stomach - should not have thickened muscle.
  • May be confused with PJP as branching may not be apparent.

Images

• 

  Peutz-Jeghers polyp - intestine (WC/Nephron)

• 

  Peutz-Jeghers polyp - stomach (WC/Nephron)

www:

• Peutz-Jeghers polyp (nature.com).

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Duodenum

POLYPS, DUODENUM, EXCISION:
- PEUTZ-JEGHERS POLYPS (x2) WITH BRUNNER'S GLANDS.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Colon

 POLYP, COLON (40 CM), EXCISION:
- PEUTZ-JEGHERS POLYP.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

See also

• Gastrointestinal tract polyps.