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Gordhandas SB, Kahn R, Sassine D, Aviki EM, Baltich Nelson B, Catchings A, Liu YL, Lakhman Y, Abu-Rustum NR, Park KJ, Mueller JJ. Gastric-type adenocarcinoma of the cervix in patients with Peutz-Jeghers syndrome: a systematic review of the literature with proposed screening guidelines. Int J Gynecol Cancer 2021; 32:79-88. [PMID: 34903560 DOI: 10.1136/ijgc-2021-002997] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/02/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To perform a systematic review of gastric-type adenocarcinoma of the cervix and lobular endocervical glandular hyperplasia (a possible precursor lesion) in Peutz-Jeghers syndrome, and to analyze data from the literature, along with our institutional experience, to determine recommendations for screening and detection. METHODS A comprehensive literature searc and retrospective search of pathology records at our institutio were conducted. Articles were screened by two independent reviewers. Case reports/series on lobular endocervical glandular hyperplasia/gastric-type adenocarcinoma of the cervix in Peutz-Jeghers syndrome were included. Demographic, clinical, and radiologic information was collected. RESULTS A total of 1564 publications were reviewed; 38 met the inclusion criteria. Forty-nine were included in the analysis (43 from the literature, 6 from our institution). Forty-three reported on gastric-type adenocarcinoma alone, 4 on lobular endocervical glandular hyperplasia alone, and 2 on concurrent lobular endocervical glandular hyperplasia/gastric-type adenocarcinoma. Median age at diagnosis was 17 (range, 4-52) for patients with lobular endocervical glandular hyperplasia alone and 35 (range, 15-72) for those with gastric-type adenocarcinoma. The most common presenting symptoms were abdominal/pelvic pain and vaginal bleeding/discharge. Imaging was reported for 27 patients; 24 (89%) had abnormal cervical features. Papanicolaou (Pap) smear prior to diagnosis was reported for 12 patients; 6 (50%) had normal cytology, 4 (33%) atypical glandular cells, and 2 (17%) atypical cells not otherwise specified. Patients with gastric-type adenocarcinoma (n=45) were treated with surgery alone (n=16), surgery/chemotherapy/radiation (n=11), surgery/chemotherapy (n=9), surgery/radiation (n=5), or radiation/chemotherapy (n=4). Twelve (27%) of 45 patients recurred; median progression-free survival was 10 months (range, 1-148). Twenty patients (44%) died; median overall survival was 26 months (range, 2-156). Thirteen patients (27%) were alive with no evidence of disease. CONCLUSIONS Gastric-type adenocarcinoma in Peutz-Jeghers syndrome is associated with poor outcomes and short progression-free and overall survival. Screening recommendations, including pathognomonic symptom review and physical examination, with a low threshold for imaging and biopsy, may detect precursor lesions and early-stage gastric-type adenocarcinoma, leading to better outcomes in this high-risk population. PROSPERO REGISTRATION NUMBER CRD42019118151.
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Affiliation(s)
- Sushmita B Gordhandas
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ryan Kahn
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Dib Sassine
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Emeline M Aviki
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Joan & Sanford I. Weill Medical College of Cornell University, New York, New York, USA
| | - Becky Baltich Nelson
- Joan & Sanford I. Weill Medical College of Cornell University, New York, New York, USA
| | - Amanda Catchings
- Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ying L Liu
- Joan & Sanford I. Weill Medical College of Cornell University, New York, New York, USA.,Clinical Genetics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Gynecologic Medical Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yuliya Lakhman
- Body Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Joan & Sanford I. Weill Medical College of Cornell University, New York, New York, USA
| | - Kay J Park
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jennifer J Mueller
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA .,Joan & Sanford I. Weill Medical College of Cornell University, New York, New York, USA
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Fricain JC, Sibaud V. [Pigmentations of the oral cavity]. Presse Med 2017; 46:303-319. [PMID: 28410949 DOI: 10.1016/j.lpm.2017.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 02/14/2017] [Accepted: 02/21/2017] [Indexed: 12/29/2022] Open
Abstract
Buccal mucosa color is explained by hemoglobin in the vessels and melanin in the epithelium. Abnormal presence of melanin pigments (hypermelaninosis, hypermelanocytosis), hematic pigments (hemoglobin, hemosiderin, iron) but also some exogenous circonstancies explain pigmented lesions (figure 1). These lesions could be localized (single lesions), multifocal (multiple lesions) or diffused. In case of a localized pigmentation with melanic appearance, melanoma must be systematically eliminated with a biopsy. In the case of a more diffused lesion, systemic disease must be evoked. A drug etiology is also possible. A blood pigment excess could be a vascular malformation (flat lesions) or a tumoral process (nodular or swollen lesions). In both cases, Kaposi's disease should be systematically eliminated. Pigmentations near dental restorations (amalgams, prosthetic crowns) could be explained by an exogenous factor but a biopsy should be performed in case of a doubt with melanoma.
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Affiliation(s)
- Jean-Christophe Fricain
- CHU de Bordeaux, Inserm U1026, UFR odontologie, consultation de pathologies buccales, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France.
| | - Vincent Sibaud
- Institut universitaire du cancer, Toulouse Oncopole 1, oncodermatologie et consultation pluridisciplinaire de pathologies buccales, avenue Irène-Joliot-Curie, 31100 Toulouse, France
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Meserve EEK, Nucci MR. Peutz-Jeghers Syndrome: Pathobiology, Pathologic Manifestations, and Suggestions for Recommending Genetic Testing in Pathology Reports. Surg Pathol Clin 2016; 9:243-268. [PMID: 27241107 DOI: 10.1016/j.path.2016.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Peutz-Jeghers syndrome (PJS), in most cases, is attributed to mutation in STK11/LKB1 and is clinically characterized by gastrointestinal hamartomatous polyposis, mucocutaneous pigmentation, and predisposition to certain neoplasms. There are currently no recommended gynecologic screening or clinical surveillance guidelines beyond those recommended for the general population; however, cervical cytology samples must be examined with a high level of suspicion for cervical adenocarcinoma. It is considered prudent to note the established association with PJS and recommend referral for genetic counseling. Complete surgical excision after a diagnosis of atypical lobular endocervical glandular hyperplasia is recommended.
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Affiliation(s)
- Emily E K Meserve
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Marisa R Nucci
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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Ishida H, Tajima Y, Gonda T, Kumamoto K, Ishibashi K, Iwama T. Update on our investigation of malignant tumors associated with Peutz-Jeghers syndrome in Japan. Surg Today 2016; 46:1231-42. [PMID: 26746637 DOI: 10.1007/s00595-015-1296-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 11/19/2015] [Indexed: 12/15/2022]
Abstract
PURPOSE To investigate the recent incidence of malignant tumors associated with Peutz-Jeghers syndrome (PJS) in Japan to clarify if there are any differences in malignant tumor risk and the spectrum of malignancies by reviewing the literature on this subject. METHODS We reviewed PJS cases reported in 1115 papers in Japan between January, 1989 and December, 2014. RESULTS Malignant tumors were identified in 186 of the total 583 PJS cases from 523 evaluable studies. The estimated cumulative risk of a malignant tumor was 83.0 % at 70 years of age. Compared with a previous study, on a collective 91 cases reported up until 1988 in Japan, the reported proportion of gastrointestinal malignancies decreased, from 82.4 to 48.3 %, whereas that of gynecological malignancies increased, from 8.8 to 34.3 % (P < 0.01). Moreover, breast cancers were occasionally reported (4.8 %), even though none were reported in the previous study. Adenocarcinoma of the uterine cervix was the most common malignant tumor (46.8 %) among women with PJS. CONCLUSIONS The increased number of reports of cervical adenocarcinoma in women with PJS is the prominent trend in Japan, and a subject of concern among gynecologists. The risk of breast cancer seems to be increasing, but confirmation of this trend will require further investigation.
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Affiliation(s)
- Hideyuki Ishida
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, 350-8550, Japan.
| | - Yusuke Tajima
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, 350-8550, Japan
| | - Tsuyoshi Gonda
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, 350-8550, Japan
| | - Kensuke Kumamoto
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, 350-8550, Japan
| | - Keiichiro Ishibashi
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, 350-8550, Japan
| | - Takeo Iwama
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, 350-8550, Japan
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Chatziioannidou K, Botsikas D, Tille JC, Dubuisson J. Preservation of fertility in non-Peutz-Jegher syndrome-associated ovarian sex cord tumour with annular tubules. BMJ Case Rep 2015; 2015:bcr2014207841. [PMID: 25969483 PMCID: PMC4434316 DOI: 10.1136/bcr-2014-207841] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2015] [Indexed: 11/04/2022] Open
Abstract
We report the successful conservative management of a non-Peutz-Jegher syndrome-associated ovarian sex cord tumour with annular tubules in a 32-year-old patient. The patient underwent a unilateral salpingo-oophorectomy by laparoscopy, and conceived spontaneously approximately 6 months after the diagnosis. After a normal term pregnancy, she underwent a contralateral laparoscopic salpingo-oophorectomy with hysterectomy. The patient is now on hormone replacement therapy and, after 30 months of follow-up, continues to present no sign of disease recurrence.
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Affiliation(s)
| | - Diomidis Botsikas
- Department of Imaging and Medical Information Science, University Hospital of Geneva, Geneva, Switzerland
| | - Jean-Christophe Tille
- Department of Pathology and Immunology, University Hospital of Geneva, Geneva, Switzerland
| | - Jean Dubuisson
- Department of Obstetrics-Gynecology, Oncology Unit, University Hospital of Geneva, Geneva, Switzerland
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Resta N, Pierannunzio D, Lenato GM, Stella A, Capocaccia R, Bagnulo R, Lastella P, Susca FC, Bozzao C, Loconte DC, Sabbà C, Urso E, Sala P, Fornasarig M, Grammatico P, Piepoli A, Host C, Turchetti D, Viel A, Memo L, Giunti L, Stigliano V, Varesco L, Bertario L, Genuardi M, Lucci Cordisco E, Tibiletti MG, Di Gregorio C, Andriulli A, Ponz de Leon M. Cancer risk associated with STK11/LKB1 germline mutations in Peutz-Jeghers syndrome patients: results of an Italian multicenter study. Dig Liver Dis 2013; 45:606-11. [PMID: 23415580 DOI: 10.1016/j.dld.2012.12.018] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 11/27/2012] [Accepted: 12/29/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Germline mutations in the STK11/LKB1 gene cause Peutz-Jeghers syndrome, an autosomal-dominantly inherited condition characterized by mucocutaneous pigmentation, hamartomatous gastrointestinal polyposis, and an increased risk for various malignancies. We here report the results of the first Italian collaborative study on Peutz-Jeghers syndrome. AIMS To assess cancer risks in a large homogenous cohort of patients with Peutz-Jeghers syndrome, carrying, in large majority, an identified STK11/LKB1 mutation. METHODS One-hundred and nineteen patients with Peutz-Jeghers syndrome, ascertained in sixteen different Italian centres, were enrolled in a retrospective cohort study. Relative and cumulative cancer risks and genotype-phenotype correlations were evaluated. RESULTS 36 malignant tumours were found in 31/119 (29 STK11/LKB1 mutation carriers) patients. The mean age at first cancer diagnosis was 41 years. The relative overall cancer risk was 15.1 with a significantly higher risk (p < 0.001) in females (22.0) than in males (8.6). Highly increased relative risks were present for gastrointestinal (126.2) and gynaecological cancers (27.7), in particular for pancreatic (139.7) and cervical cancer (55.6). The Kaplan-Meier estimates for overall cumulative cancer risks were 20%, 43%, 71%, and 89%, at age 40, 50, 60 and 65 years, respectively. CONCLUSION Peutz-Jeghers syndrome entails markedly elevated cancer risks, mainly for pancreatic and cervical cancers. This study provides a helpful reference for improving current surveillance protocols.
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Affiliation(s)
- Nicoletta Resta
- Department of Biomedical Sciences and Human Oncology, Medical Genetics Unit, Aldo Moro, University of Bari, Italy.
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Riegert-Johnson D, Roberts M, Gleeson FC, Krishna M, Boardman L. Case studies in the diagnosis and management of Peutz-Jeghers syndrome. Fam Cancer 2012; 10:463-8. [PMID: 21503748 DOI: 10.1007/s10689-011-9438-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Peutz-Jeghers syndrome (PJS) is a rare genetic disorder characterized by melanotic macules, gastrointestinal polyps and increased cancer risks. We discuss several common scenarios encountered in the diagnosis and management of PJS patients. If the diagnosis is unclear, all pathological material should be re-evaluated by an expert gastrointestinal pathologist. The PJS discussion email list-serve (patient managed) and the peutz-jeghers.com, geneclinics.org, stk11.com websites are useful resources for patients. Cancer surveillance is accepted as a method to increase survival for PJS patients, thus all PJS patients should be prescribed an individualized surveillance plan based on personal and family history as well as available health care resources while taking into consideration the preferences of the patient. Several recent incremental improvements in PJS care have been made including the use of magnetic resonance enterography (MRE) and double balloon endoscopy (DBE). MRE combines cancer and small intestinal polyp surveillance, which previously had required two or more separate tests. How and when to perform pancreatic cancer surveillance continues to be an unclear area in the management of PJS patients. Endoscopic ultrasound (EUS) is probably the most sensitive investigation for pancreatic cancer detection at an early stage when cure may be possible. However, EUS is limited by variability and false positive results. Female patients with PJS are at risk for two rare cancers that require regular surveillance, adenoma malignum and ovarian sex cord tumors with annular tubules.
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An unusual case of sex cord tumor with annular tubules with malignant transformation in a patient with Peutz-Jeghers syndrome. Int J Gynecol Pathol 2010; 29:27-32. [PMID: 19952941 DOI: 10.1097/pgp.0b013e3181b6a7c2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report a case of a 54-year-old Caucasian woman with an earlier diagnosis of Peutz-Jeghers Syndrome (PJS) and sex cord tumor with annular tubules (SCTAT). The sex cord stromal tumors showed aggressive malignant behavior with repeated recurrence and metastasis. This is an unusual behavior of SCTAT in patients with PJS, with only 2 such cases reported earlier. Genetic analysis revealed that the patient has a new (unreported earlier) missense mutation of the LKB1 gene. A review of the literature reporting the clinicopathologic features and biologic behavior of SCTAT in patients with and without PJS is presented. We discuss the presentation and management of this case and highlight the importance of considering the possibility of aggressive behavior of these tumors in the management of patients with PJS.
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Khalifa M, Nofech-Mozes S, Atri M, Covens A. Chemotherapy-induced alterations in ovarian sex cord tumor with annular tubules (SCTAT): A diagnostic challenge. Pathol Res Pract 2006; 202:183-6. [PMID: 16459027 DOI: 10.1016/j.prp.2005.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2003] [Accepted: 12/15/2005] [Indexed: 11/20/2022]
Abstract
We present a case of ovarian sex cord tumor with annular tubules (SCTAT) in a patient that received neoadjuvant chemotherapy with 3.5 years of follow-up. Neo-adjuvant chemotherapy is a common practice in advanced cases of ovarian carcinoma and is rarely applied in nonepithelial ovarian tumors. Chemotherapy-induced morphologic alterations of the subsequently resected tissue samples are well recognized; in this case, chemotherapy-induced cytoarchitectural changes created diagnostic difficulties in the subsequently resected specimen.
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Affiliation(s)
- Mahmoud Khalifa
- Department of Pathology, Sunnybrook and Women's College Health Sciences Center, Toronto, Ont., Canada M4N 3M5.
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10
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Gibbon DG. Conservative management of sex cord tumors with annular tubules of the ovary in women with Peutz-Jeghers syndrome. J Pediatr Hematol Oncol 2005; 27:630-2. [PMID: 16282900 DOI: 10.1097/01.mph.0000188302.97324.6d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Darlene G Gibbon
- Department of Obstetrics and Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, The Cancer Institute of New Jersey, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ 08903, USA.
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Pereira CM, Coletta RD, Jorge J, Lopes MA. Peutz-Jeghers syndrome in a 14-year-old boy: case report and review of the literature. Int J Paediatr Dent 2005; 15:224-8. [PMID: 15854121 DOI: 10.1111/j.1365-263x.2005.00627.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Peutz-Jeghers syndrome (PSJ) is a relatively rare but well-recognized condition, with a prevalence of approximately one in 120,000 births in the USA. It is generally inherited as an autosomal dominant trait, although 35% of cases are new mutations. This disorder is characterized by melanocytic macules on the hands, feet, peri-oral skin and oral mucosa, and multiple gastrointestinal hamartomatous polyps. People with PSJ have an increased risk for developing a variety of malignant tumours. The aim of the present study was to report one case of PSJ in a 14-year-old boy with mucocutaneous pigmentation associated with duodenal hamartomatous polyps.
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Affiliation(s)
- C M Pereira
- Department of Semiology, School of Dentistry of Piracicaba, State University of Campinas, Piracicaba/SP, Brazil
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12
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Affiliation(s)
- D Eisen
- Dermatology Research Associates, Cincinnati, Ohio 45230, USA
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Westerman AM, Wilson JH. Peutz-Jeghers syndrome: risks of a hereditary condition. SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY. SUPPLEMENT 1999; 230:64-70. [PMID: 10499464 DOI: 10.1080/003655299750025561] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Peutz-Jeghers syndrome (PJS) is a rare autosomal-dominant disorder characterized by hamartomatous polyposis of the gastrointestinal tract and melanin pigmentation of the skin and mucous membranes. We review the clinical features of PJS with special emphasis on the risks for its gene carriers. METHODS Review of the literature. RESULTS Risks imposed by the presence of polyps in PJS patients include surgical emergencies like small bowel intussusception, and chronic or acute bleeding from the polyps. As the polyps in PJS are hamartomas, the disease had in the past always been thought not to have malignant potential. However, more and more reports suggest an association of PJS with both gastrointestinal and non-gastrointestinal tumours. Whether these malignancies originate from the polyps is not clear, but the frequent occurrence of some rare extra-intestinal malignancies such as tumours of the ovary (sex cord tumours with annular tubules), cervix (adenoma malignum) and testis (Sertoli cell tumours) indicates a general susceptibility for the development of malignancies. The PJS gene, which was recently identified to encode for the serine threonine kinase STK11, is therefore thought to act as a tumour-suppressor gene. CONCLUSIONS PJS gene carriers not only run risks of polyp-induced gastrointestinal complications, but also are at increased risk of developing cancer, both within and outside the gastrointestinal tract. As genetic identification of asymptomatic gene carriers in this relatively rare disorder becomes possible, surveillance and screening protocols need to be developed for PJS patients and their relatives.
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Affiliation(s)
- A M Westerman
- Dept. of Internal Medicine II, University Hospital Rotterdam Dijkzigt, The Netherlands
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Louis PJ, Williams MA. Problems and abnormalities found on routine clinical head and neck examination. Semin Orthod 1998; 4:99-112. [PMID: 9680908 DOI: 10.1016/s1073-8746(98)80007-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
During the initial examination of a patient, the orthodontist may encounter various findings that will, for the most part, be normal or variants of normal. Most pathological conditions encountered will be derived from structures normally found in the anatomic locations examined. Knowledge of the anatomy and common pathological entities based on location can prove helpful when abnormalities are encountered. This article describes anatomic locations and their contents in and around the oral cavity and discusses pathological processes commonly encountered in these locations. Syndromes involved with various abnormalities also are briefly mentioned. The intent of this article is to give the clinician a working knowledge of commonly occurring pathological entities.
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Affiliation(s)
- P J Louis
- Department of Oral and Maxillofacial Surgery, University of Alabama School of Dentistry, Birmingham 35294, USA
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Lynch HT, Conway T, Lynch J. Hereditary ovarian cancer. Pedigree studies, Part II. CANCER GENETICS AND CYTOGENETICS 1991; 53:161-83. [PMID: 2065292 DOI: 10.1016/0165-4608(91)90094-b] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Hereditary ovarian carcinoma is heterogenous. There are at least three genetic variants, namely, hereditary site-specific ovarian carcinoma, hereditary breast/ovarian carcinoma syndrome, and Lynch syndrome II. Early age of onset characterizes these disorders. A crucial hallmark of these disorders is the integral association of extraovarian cancers, such as carcinoma of the endometrium and colon in Lynch syndrome II. We have described 24 pedigrees of ovarian cancer-prone families in order to depict the several differing heterogenous variants. Interest in hereditary ovarian cancer has increased remarkably, due in part to the fact that its surveillance has been wholly unsatisfactory, as have therapeutic measures. Prevention through prophylactic oophorectomy offers hope. However, there is a risk for extraovarian peritoneal serous papillary carcinoma, consonant with primary cancer of the ovary. This must be discussed with these at-risk patients. Until a biomarker of acceptable sensitivity and specificity is identified, the family history must remain the key to hereditary ovarian cancer diagnosis.
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Affiliation(s)
- H T Lynch
- Dept. of Preventive Medicine, Creighton University School of Medicine, Omaha, NE 68178
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Benagiano G, Bigotti G, Buzzi M, D'Alessandro P, Napolitano C. Endocrine and morphological study of a case of ovarian sex-cord tumor with annular tubules in a woman with Peutz-Jeghers syndrome. Int J Gynaecol Obstet 1988; 26:441-52. [PMID: 2900176 DOI: 10.1016/0020-7292(88)90343-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A bilateral ovarian sex-cord tumor with annular tubules (SCTAT) was incidentally discovered in an amenorrheic patient with Peutz-Jeghers syndrome during conservative surgery in which a small non-capsulated mass was removed from each ovary. Ovulation was then induced over two consecutive cycles with urinary gonadotropins; the couple did not conceive because of a male infertility factor. Hysterectomy and bilateral oophorectomy were performed to prevent recurrence and avoid the possibility of a cervical malignant adenoma. Immunohistochemistry of the SCTAT showed positivity for estradiol and testosterone similar to that of Sertoli and granulosa cell tumors; progesterone was not detected in any cellular component of the neoplasia. Electron microscopy showed that the neoplasm consisted of numerous solid cords of cells surrounded by fibrillary layers of basal lamina, as well as central hyaline bodies. Two types of cells, clear and dark, were noted; clear cells were predominant and intermixed with scattered dark cells. No crystalloids or Charchot-Bottcher filaments were detectable in the tumors.
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Affiliation(s)
- G Benagiano
- First Institute of Obstetrics and Gynecology, University la Sapienza, Rome, Italy
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Konishi F, Wyse NE, Muto T, Sawada T, Morioka Y, Sugimura H, Yamaguchi K. Peutz-Jeghers polyposis associated with carcinoma of the digestive organs. Report of three cases and review of the literature. Dis Colon Rectum 1987; 30:790-9. [PMID: 3308369 DOI: 10.1007/bf02554629] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Three cases of Peutz-Jeghers polyposis with carcinoma of the digestive organs are studied. Although mucocutaneous pigmentation was not present in two of the three patients, the features of intestinal polyposis are consistent with those of Peutz-Jeghers syndrome. One patient had a carcinoma of the pancreas and the other two had carcinomas with colonic Peutz-Jeghers polyps. Previous reports on carcinomas associated with Peutz-Jeghers syndrome are reviewed. An unusual location in the gastrointestinal tract, together with occurrence at an early age, characterize the carcinoma in Peutz-Jeghers syndrome. In Japanese patients, the large bowel is the site of the greatest number of carcinomas. On the other hand, Western patients showed a relatively even distribution. A possible surveillance protocol for early detection of gastrointestinal carcinoma in patients with Peutz-Jeghers syndrome is discussed.
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Affiliation(s)
- F Konishi
- First Department of Surgery, University of Tokyo, Japan
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