The intestinal polyps may result in obstruction and intussusception, which may predispose to chronic lower GI bleeding and anemia. These benign polyps are called hamartomas and usually begin to develop during the first decade of life; they fully manifest in childhood and early adulthood. These polyps can occur within any part of the GI tract, however, the small intestine is the most common site of occurrence. In rare cases, the polyps may occur in the urinary tract and lungs.

Within the first 30 years of life, patients with Peutz-Jeghers syndrome present with lower GI bleeding, abdominal pain, intestinal obstruction, intussusception, and anemia as a result of the polyps [8] [11]. Intussusception occurs in up to 50% of patients with this syndrome [12]. Colicky abdominal pain is the primary presentation of PJS, occurring as a symptom of intussusception [13]. Less frequent symptoms include melena and hematemesis [14].

Dermatological features of PJS include hyperpigmented macules on the skin and mucous membranes. These lesions are dark-blue to dark-brown in color and are seen around the mouth, nose, eyes, fingers, palms and soles of the feet, perianal region, and the intestinal mucosa. The characteristic hyperpigmentation of these lesions occurs in approximately 95% of patients and results from an excessive deposition of melanin pigment in the dermal macrophages. All the lesions, except for the perioral and buccal lesions, usually resolve spontaneously by puberty.

Furthermore, PJS presents a huge risk of malignancy including gynecological and andrological tumors in females and males respectively. Therefore, women who have developed ovarian tumors from this syndrome may present with menstrual irregularities or early menarche. Testicular tumors in affected men would result in gynecomastia.

• Laboratory Technician

  At least two laboratory technicians reviewed all the steps. Frozen embryo transfer (FET) and prenatal diagnosis (PND) Blastocysts with normal karyotypes and those that did not carry mutations were transferred back to the mother's uterus through FET. [ojrd.biomedcentral.com]

• Abdominal Pain

  A 21-year-old woman presented with acute onset of upper abdominal pain. [ncbi.nlm.nih.gov]

  Intussusception, colicky abdominal pain, and bleeding are the usual symptoms. [accessanesthesiology.mhmedical.com]

  Sign In A 45-year-old man presented with abdominal pain and vomiting. He had abdominal tenderness and hyperpigmented macules on the lips, oral mucosa, and nose. Emergency laparotomy revealed jejunojejunal intussusception and multiple polyps. [nejm.org]

  Sequel to these possible complications, the patient may present with severe abdominal pain that waxes and wanes, bloody stools, and anemia. [symptoma.com]

• Intestinal Disease

  […] title=Category:Peutz–Jeghers_syndrome&oldid=354079710 " Categorie : Autosomal dominant diseases and disorders Diseases and disorders of the digestive system Deficiencies of intracellular signaling peptides and proteins Diseases and disorders named after [commons.wikimedia.org]

  Also denied family history of intestinal disease, but the patient did not keep in touch with family members. [jcol.elsevier.es]

  Pathologic Processes Neoplastic Syndromes, Hereditary Neoplasms Intestinal Polyposis Intestinal Diseases Gastrointestinal Diseases Digestive System Diseases Genetic Diseases, Inborn Lentigo Melanosis Hyperpigmentation Pigmentation Disorders Skin Diseases [clinicaltrials.gov]

• Abdominal Cramps

  Peutz-Jeghers syndrome Peutz-Jeghers syndrome Surgery An AD condition characterized by brownish perioral and oral macules developed in infancy, accompanied by premalignant intestinal polyps causing abdominal cramping, intussusception, chronic bleeding [medical-dictionary.thefreedictionary.com]

  Abdominal cramping pain. Recurrent intestinal obstruction. Gross or microscopic malena or bloodstaining of feces. Vomiting. [news-medical.net]

  At the age of seven, the boy got paroxysmal abdominal cramps after meal and fresh blood came out with stool. He was soon sent to the local hospital, and colonoscopy revealed multiple colon polyps. [bmcgastroenterol.biomedcentral.com]

  The first clinical symptoms occurred during childhood or adolescence and included hyperpigmentation and gastrointestinal symptoms such as abdominal pain, abdominal cramps, hematochezia, and diarrhea. [ojrd.biomedcentral.com]

• Hyperactive Bowel Sounds

  Physical examination revealed hyperpigmented macules on her lips (figure, A), and an abdominal bulge, abdominal tenderness, and hyperactive bowel sounds. [thelancet.com]

• Oral Pigmentation

  Early onset of disease is often characterized by mucocutaneous pigmentation and intussusception due to GI polyps in childhood. A girl with a positive family history grew oral pigmentation at 1 and got intussusception by small bowel hamartomas at 5. [ncbi.nlm.nih.gov]

  Abdominal pain in a patient with oral pigmentations is suggestive of a complication of a digestive PJS polyp (23). [spandidos-publications.com]

  The role of STK 11 gene testing in individuals with oral pigmentation. Australas J Dermatol. 2017 May;58(2):135-138. doi: 10.1111/ajd.12443. Epub 2016 Jan 14. PubMed PMID: 26768676. PubMed. [dermnetnz.org]

• Hyperpigmentation

  For individuals with a first-degree relative with PJS, presence of mucocutaneous hyperpigmentation is sufficient for presumptive diagnosis. [clinicaltrials.gov]

  In association with hyperpigmentation, the presence of multiple hamartomatous polyps in the gastrointestinal tract is mandatory; these polyps are characterized by a single central bundle of smooth muscle fibers from muscularis mucosa, with branches in [jcol.elsevier.es]

  Differential diagnosis of oral hyperpigmentation Skin and mucosa hyperpigmentation need to be differentiated from other conditions that are indicated by hyperpigmentation: Addison disease (AD), McCune-Albright syndrome (MAS), and Laugier-Hunziker syndrome [spandidos-publications.com]

  Introduction Peutz-Jeghers syndrome (PJS) is an autosomal dominant disorder characterized by multiple hamartomatous polyps in the gastrointestinal tract, generally associated with mucocutaneous hyperpigmentation. 1 and 2 This is a rare condition, with [scielo.br]

  BACKGROUND: Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant inherited disorder characterized by gastrointestinal (GI) hamartomatous polyps, mucocutaneous hyperpigmentation, and an increased risk of cancer. [ncbi.nlm.nih.gov]

• Freckles

  Since these freckles may fade as one gets older, patients may forget that they had these freckles as a child and may be misdiagnosed when they develop bowel symptoms. There is no association between the number of freckles and the severity of PJS. [zanecohencentre.com]

  Some people with PJS also have these freckles on the palms of their hands or feet or on their fingertips. Freckles may merge together. [encyclopedia.com]

  People with PJS tend to develop dark blue or dark brown freckling, especially around the mouth and on the lips, fingers, or toes. [cancer.net]

  Clinical features 95% of people with PJS have characteristic freckling of the lips and perioral region, which develops during childhood and usually fades in adulthood. Freckling can also occur on the fingers, toes, anus and vulva. [genomicseducation.hee.nhs.uk]

Diagnosis of Peutz-Jeghers syndrome is mostly clinical and is based on history, physical examination, and histologic findings. The presence of at least one of the following criteria is diagnostic of PJS.

1. At least two Peutz-Jeghers polyps confirmed by histology.
2. Multiple Peutz-Jeghers polyps with a family history of the syndrome.
3. Characteristic mucocutaneous lesions and a positive family history of PJS.
4. Multiple typical polyps with characteristic hyperpigmented lesions in skin and mucous membranes.

The diagnosis is confirmed by molecular testing of the STK11 gene. It reveals the mutation in 80-94% of patients. Genetic testing and cancer screening for first-degree relatives may be considered.

Capsule endoscopy and barium enterography are safe and sensitive procedures employed to identify the polyps in children with PJS [15]. In adults, an MRI enterography is a superior alternative [16].

Cancer screening with imaging studies and endoscopy is indicated in all patients with PJS. Abdominal computed tomography (CT) scan and magnetic resonance imaging (MRI) are useful for the detection of intraabdominal malignancies.

• Small Bowel Mass

  Double balloon enteroscopy detects small bowel mass lesions missed by capsule endoscopy. Dig Dis Sci 2008; 53:2140–2143. 19. Soares J, Lopes L, Vilas Boas G, et al. [journals.lww.com]

• Polyps

  The colonoscopy revealed multiple polyps (approximately 50) throughout the colon, reaching distal rectum. The biggest polyps in the right colon were about 3cm in size. The rectum contained approximately 14 polyps (Fig. 1). [jcol.elsevier.es]

  Colonic Peutz-Jeghers polyps   Duodenal Peutz-Jeghers polyps Peutz-Jeghers polyp Differential diagnosis Sporadic Peutz-Jeghers polyps: Histologically identical, although they are exceedingly rare, if they exist at all (Am J Surg Pathol 2007;31:1209) Juvenile [pathologyoutlines.com]

  People with PJS can develop polyps — called Peutz-Jeghers polyps — in the small bowel, colon, stomach, lungs, nose, bladder and rectum. These polyps are considered hamartomatous polyps. [my.clevelandclinic.org]

  Prognosis The prognosis depends on the severity of polyp complications and on the development of malignancies. Routine surveillance of polyp growth will lead to better management. [orpha.net]

  A clinical diagnosis can be made following histopathological confirmation of typical Peutz-Jeghers syndrome morphology in 2 or more intestinal polyps or after any number of polyps or hyperpigmented macules (in a characteristic location) with a positive [radiopaedia.org]

• Trophoblastic Cells

  Trophoblast cell (TE cell) were used for WGA using the MDA method, and the DNA of all embryonic TE cells was successfully amplified (32/32). Determination of informative SNP The STK11 gene is located in the 13p21.32-p21.33 segment of chromosome 19. [ojrd.biomedcentral.com]

Surgery is the mainstay of treatment of Peutz-Jeghers syndrome. Surgery, which may involve laparotomy or laparoscopy, is indicated for small intestinal obstruction, intussusception, and chronic lower GI bleeding. However, routine endoscopic monitoring with resection of the polyps may reduce the frequency of some of the complications in young patients and detect malignancies in older patients. However, some studies have not shown any benefit of surveillance in preventing complications of the disease.

Two basic procedures have been used as diagnostic and therapeutic tools for PJS. These include double balloon enteroscopy (DBE) and intra-operative enteroscopy (IOE). DBE is useful for both diagnostic and therapeutic interventions of the jejunal and ileal lesions. IOE employs both laparotomy or laparoscopy and endoscopy to visualize the full length of the small intestine and excise the polyps [17]. IOE is considered more effective than DBE.

Cancer screening should be instituted as early as possible with periodic imaging studies and endoscopy. Affected women should have early mammography and regular breast examination. Additionally, a testicular examination is recommended in male patients.

Peutz-Jeghers syndrome increases the risk of gastrointestinal malignancies such as pancreatic, colorectal, and small intestinal cancers which develop in nearly 50% of the cases [10]. Furthermore, PJS also increases the risk of non-GI malignancies including breast, uterus, lung cancer and ovarian cancer.

PJS places women at an increased risk of certain gynecologic malignancies, including sex cord tumors with annular tubules (SCTAT) and adenoma malignum, an uncommon form of cervical cancer. In men, PJS increases the risk of urologic malignancies and particularly sertoli cell tumors.

In 66-94% of cases, Peutz-Jeghers syndrome is caused by a mutation of the STK11/LKB1 (seine threonine kinase 11), a tumor suppressor gene which is located on band 19p13.3. This mutation may be inherited from a parent or may occur de novo in the affected individual. In approximately 50% of cases, it is inherited from an affected parent. There is a 50% chance of passing the mutated gene to the offspring in each pregnancy.

The intestinal polyps in Peutz-Jeghers syndrome begin to appear in adolescents and young adults with the median age of presentation being 11-13 years [1]. Furthermore, symptoms begin to present within the first 10 years of life in over 30% of the patients and up to 50% of the patients have experienced the characteristic features of the disease by age 20 [2] [3] [4].

There are varying results of studies on the epidemiology of PJS. However, an estimated 1 in 100,000 individuals is the probable prevalence rate [3]. PJS has no sexual predilections or ethnic preferences.

The STK11 gene is a tumor suppressor gene such that, when overexpressed, halts the cell growth cycle at the G1 phase. Furthermore, when the unaffected allele is somatically inactivated, it results in GI polyps and malignancies notable in Peutz-Jeghers syndrome.

Certain other genes contribute to the etiogenesis of PJS. These include MYH11 gene, LKB1 gene, and genes which encode for MARK protein and homologs of Par 1 polarity protein.

The pathologic hallmark of PJS is an overgrowth of the cells in the GI tract. Initially, This overgrowth is not associated with a neoplastic predisposition [5] [6]. The hamartomatous polyps consist of normal cells with distorted morphology [7] [8]. The polyps in PJS may be differentiated from other hamartomatous polyps due to their characteristic core of smooth muscle that branches out throughout the polyp. This unique feature is best demonstrated in small intestine polyps [9]. Histopathology, therefore, is the most reliable tool to differentiate this syndrome from other hamartomatous polyposis syndromes.

Genetic testing is recommended for individuals with a family history of Peutz-Jeghers syndrome. This is essential for an early diagnosis and the prevention of complications. Likewise, cancer screening and surveillance are necessary for patients with the disease. Surveillance should begin at puberty and be carried out at intervals of two years [18].

In some cases, prophylactic surgery may be considered for patients at risk of certain cancers. Prophylactic mastectomy, hysterectomy or bilateral salpingo-oophorectomy may be considered in high-risk female patients who are older than 35 years, or who have completed childbearing.

Lifestyle modifications are essential and include weight loss, smoke cessation, and reduction in alcohol use. They may reduce the incidence of GI cancers complicating Peutz-Jeghers syndrome. However, no study has shown that these practices reduce the risk of malignant transformation.

Peutz-Jeghers syndrome (PJS) is a genetic disease with an autosomal dominant pattern of inheritance. It is characterized by multiple benign polyps in the gastrointestinal tract and typical pigmented mucocutaneous lesions. PJS is considered a premalignant disease.

The disease is caused by a mutation in the STK11/LKB1 gene, a tumor suppressor gene, on the long arm of chromosome 19. The mutation may be inherited from a parent or may arise as a spontaneous occurrence in the affected individual.

PJS presents with multiple hamartomatous, polyps which may occur anywhere in the lower GI tract, but most commonly affect the small intestine. Occasionally, the polyps may occur in the bladder, respiratory tract, ureters, and gallbladder. The characteristic mucocutaneous lesions are pigmented macules which occur in the perioral and perianal skin, fingers, palms, and soles of the feet.

This disease presents with colicky abdominal pain, vomiting, and lower GI bleeding. These symptoms are often the results of complications of the polyps including intussusception and intestinal obstruction.

Diagnosis is made on clinical grounds and is based on the history of symptoms, findings of the characteristic mucocutaneous lesions, a family history of the syndrome, and the presence of the hamartomatous polyps on histology. The diagnosis is subsequently confirmed by genetic testing, which reveals the mutation in 80-94% of patients. Genetic testing is also recommended for first-degree relatives of patients with the disease.

Treatment of the disease involves surgical resection of the polyps and surgical correction of complications that are surgically repairable. In certain high-risk patients, prophylactic mastectomy, bilateral salpingo-oophorectomy, or hysterectomy may be beneficial in order to prevent the respective cancers.

Peutz-Jeghers syndrome (PJS) is a genetic disorder, namely a disease resulting from a mutation or abnormality in a particular gene. All cells in the body have a material called chromosomes, which are paired, making up 23 pairs of chromosomes in each cell. The chromosomes contain the genes, which code for all structures and functions of the tissues in the body. An abnormality in these genes is called a mutation and it results in abnormal structure or function of the affected tissue. In PJS, the mutated gene may be inherited from a parent or occur spontaneously in the affected individual.

The gene which is damaged in PJS is on the 19th chromosomal pair. However, the mutation affecting at least one of the chromosomes in the pair is sufficient for the disease to manifest. This is called an autosomal dominant pattern of inheritance.

This disease typically begins to present during adolescence and young adults usually around the age of 12. By age 30, the disease has completely manifested. It presents with multiple benign outgrowths called polyps in the stomach, small intestine, and large intestine. These polyps may cause obstruction of the intestine, presenting with symptoms such as chronic vomiting, constipation, and bloating. The polyps may also cause telescoping of one segment of the small bowel into another, a condition called intussusception. Sequel to these possible complications, the patient may present with severe abdominal pain that waxes and wanes, bloody stools, and anemia.

Another common symptom of PJS is the presence of dark-brown or dark-blue rashes on the skin around the mouth, nose, eyes, in the soles of the feet, palms, and sometimes in the lining of the intestine. This disease is serious because of its ability to progress to cancer. Cancer of the stomach and intestines are very common. In a few cases, it may lead to cancers of the uterus, ovaries, and breasts in women, and cancer of the testicles in men.

Doctors can achieve a diagnosis by examining the skin for the typical rashes, asking questions about any family member with the disease, and detecting the polyps in the gut by a procedure called endoscopy and biopsy. PJS is then confirmed by testing the involved gene to detect the causative abnormality. This genetic testing is also recommended for relatives and siblings of anyone with the disease to ensure early diagnosis and management.

Generally, PJS is treated by surgically removing the polyps and surgically correcting any complication that can be repaired. Regular screening and examination are necessary once a diagnosis is made, to detect the development of cancers or other complications.

In some cases, high-risk women may be candidates for surgical removal of the breasts, uterus, or ovaries as a way of preventing cancers of these organs. Smoke cessation, regular exercise, weight loss, and reduced alcohol use may help to prevent cancer complications of this disease.

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