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经双气囊小肠镜检查诊断的空肠单发 Peutz-Jeghers 息肉伴肠套叠 1 例

A case of jejunal solitary Peutz-Jeghers polyp with intussusception identified by double-balloon enteroscopy.

机构信息

Division of Gastroenterology, Tohoku Medical and Pharmaceutical University School of Medicine, 1-15-1 Fukumuro, Miyagino-ku, Sendai, Miyagi, 983-8536, Japan.

Division of Pathology, Tohoku Medical and Pharmaceutical University School of Medicine, Sendai, Japan.

出版信息

Clin J Gastroenterol. 2020 Dec;13(6):1129-1135. doi: 10.1007/s12328-020-01197-2. Epub 2020 Aug 10.

Abstract

Solitary Peutz-Jeghers polyp is a rare hamartomatous polyp that has similar histologic characteristics with those of polyps in Peutz-Jeghers syndrome, without associated mucocutaneous hyperpigmentation and a family history. Previous reports indicated that solitary Peutz-Jeghers polyp is rarely found in the small intestine. We experienced a rare case of jejunal solitary Peutz-Jeghers polyp. A 29-year-old man was admitted to our hospital with a 6-month history of upper abdominal pain. He had no hyperpigmentation or a family history of Peutz-Jeghers syndrome. Abdominal computed tomography showed a 3-cm tumor-like structure at the tip of a mildly intussuscepted jejunum. Per oral double-balloon enteroscopy revealed a 3-cm pedunculated polyp in the jejunum. The patient underwent partial jejunal resection under laparotomy. Macroscopically, the surgical specimen showed a pedunculated polyp, measuring 30 × 15 × 10 mm in size, with lobulated head. Histopathologic examination revealed irregular aggregation of hyperplastic crypts with branching muscular bundles originating from the muscularis mucosae. Based on these histologic findings, we finally diagnosed the patient as a solitary Peutz-Jeghers polyp in the jejunum. The present case indicated that solitary Peutz-Jeghers polyp should be considered in a patient with solitary hamartomatous polyp in the gastrointestinal tract.

摘要

单发的肠型 Peutz-Jeghers 息肉是一种罕见的错构瘤性息肉,其组织学特征与 Peutz-Jeghers 综合征中的息肉相似,无黏膜皮肤色素沉着和家族史。既往报道显示单发的肠型 Peutz-Jeghers 息肉在小肠中很少见。我们遇到一例罕见的空肠单发 Peutz-Jeghers 息肉。一名 29 岁男性因上腹痛 6 个月就诊。他无色素沉着或 Peutz-Jeghers 综合征家族史。腹部 CT 显示空肠轻度肠套叠处有一 3cm 大小的肿瘤样结构。经口双气囊小肠镜检查显示空肠有一 3cm 带蒂息肉。患者行剖腹部分肠切除术。大体标本显示手术标本为一带蒂息肉,大小为 30×15×10mm,头部呈分叶状。组织病理学检查显示增生性隐窝不规则聚集,分支状的肌束从黏膜肌层起源。基于这些组织学发现,我们最终诊断为空肠单发 Peutz-Jeghers 息肉。本病例提示对于胃肠道单发错构瘤性息肉的患者,应考虑单发的肠型 Peutz-Jeghers 息肉。

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