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Nakamura K, Kubota K, Shimizu A, Notake T, Ikehara T, Umemura K, Kamachi A, Goto T, Tomida H, Takahashi Y, Nagaya T, Umemura T, Soejima Y. Juvenile polyposis syndrome with gastric and duodenal polyposis presenting with refractory anemia and protein-leakage gastroenteropathy in a patient with SMAD4 mutation: a case report. Surg Case Rep 2024; 10:11. [PMID: 38191939 PMCID: PMC10774325 DOI: 10.1186/s40792-023-01796-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 12/18/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Juvenile polyposis syndrome (JPS) is an autosomal dominant, inherited disorder characterized by multiple hyperproliferative polyps of the gastrointestinal tract, particularly of the colon, rectum, and stomach. SMAD4 mutations are frequently associated with multiple polyposis of the stomach; the condition causes severe bleeding and hypoproteinemia, which may progress to severe dysplasia and adenocarcinoma formation. We report our experience with the first case of total gastrectomy with pancreaticoduodenectomy following two partial jejunectomies for JPS, who presented with refractory anemia and protein-losing gastroenteropathy due to polyposis of the stomach and duodenum. CASE PRESENTATION A 33-year-old Japanese man presented with the chief complaint of shortness of breath on exertion. His family history included gastric polyposis (mother, aunt, and cousin) and cerebral infarction (grandmother). Blood testing at the initial visit indicated iron-deficiency anemia, whereas endoscopy revealed multiple polyps in the duodenum and jejunum. Genetic testing revealed a 4 bp deletion (TGAA) in exon 5 of the SMAD4 gene; two partial small bowel resections were performed, but polyps grew in the remaining stomach, duodenum, and small intestine. The patient developed hypoalbuminemia and anemia, and required central venous nutrition and blood transfusion. However, because the hyponutrition and anemia remained poorly controlled, a total gastrectomy with concomitant pancreaticoduodenectomy was performed. Malnutrition and anemia improved, and there was no polyp recurrence in the remaining intestinal tract at 18 months after the surgery. CONCLUSIONS We report a case of JPS with refractory anemia and protein-losing gastroenteropathy that was treated with total gastrectomy with concomitant pancreaticoduodenectomy. Although the surgery was highly invasive, the patient's nutritional status and anemia improved postoperatively, and the treatment was successful. However, to determine the appropriate surgical procedure, a detailed examination of the gastrointestinal lesions and the effects of the surgical invasion on nutritional status must be undertaken.
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Affiliation(s)
- Kenya Nakamura
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Koji Kubota
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Akira Shimizu
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Tsuyoshi Notake
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Tomohiko Ikehara
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Kentaro Umemura
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Atsushi Kamachi
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Takamune Goto
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hidenori Tomida
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yoshiyuki Takahashi
- Department of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tadanobu Nagaya
- Department of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takeji Umemura
- Department of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuji Soejima
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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Utsunomiya H, Akazawa Y, Ueyama H, Iwano T, Yamamoto M, Uchida R, Oki S, Suzuki N, Abe D, Ikeda A, Takeda T, Ueda K, Hojo M, Yube Y, Kaji S, Okano S, Tsuyama S, Eguchi H, Okazaki Y, Arai M, Fukunaga T, Yao T, Nagahara A. Gastric Juvenile Polyposis with Intramucosal Cancer Diagnosed by Magnifying Endoscopy with Narrow-band Imaging. Intern Med 2023; 62:3333-3339. [PMID: 37005260 PMCID: PMC10713360 DOI: 10.2169/internalmedicine.1612-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/05/2023] [Indexed: 04/04/2023] Open
Abstract
Although gastric juvenile polyposis (GJP) often coexists with gastric cancer, a preoperative accurate diagnosis is still difficult to obtain. A 70-year-old woman was referred for epigastralgia and anemia. Esophagogastroduodenoscopy with a conventional endoscope showed numerous gastric polyps with no cancerous findings. Magnifying endoscopy with narrow-band imaging (M-NBI) showed cancerous findings, and a target biopsy revealed adenocarcinoma. Histopathological findings after endoscopic resection confirmed a diagnosis of juvenile polyposis with intramucosal adenocarcinoma. Genetic analyses revealed a germline pathogenic variant of SMAD4. A target biopsy using M-NBI and endoscopic resection proved useful for confirming the preoperative diagnosis of coexisting cancerous lesions in GJP.
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Affiliation(s)
- Hisanori Utsunomiya
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Yoichi Akazawa
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Hiroya Ueyama
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Tomoyo Iwano
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Momoko Yamamoto
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Ryota Uchida
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Shotaro Oki
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Nobuyuki Suzuki
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Daiki Abe
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Atsushi Ikeda
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Tsutomu Takeda
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Kumiko Ueda
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Mariko Hojo
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Yukinori Yube
- Department of Esophageal and Gastroenterological Surgery, Juntendo University School of Medicine, Japan
| | - Sanae Kaji
- Department of Esophageal and Gastroenterological Surgery, Juntendo University School of Medicine, Japan
| | - Soh Okano
- Department of Human Pathology, Juntendo University Graduate School of Medicine, Japan
| | - Sho Tsuyama
- Department of Human Pathology, Juntendo University School of Medicine, Japan
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Japan
| | - Hidetaka Eguchi
- Intractable Disease Research Center/Diagnostics and Therapeutics of Intractable Diseases, Juntendo University Graduate School of Medicine, Japan
| | - Yasushi Okazaki
- Intractable Disease Research Center/Diagnostics and Therapeutics of Intractable Diseases, Juntendo University Graduate School of Medicine, Japan
| | - Masami Arai
- Department of Clinical Genetics, Juntendo University, Graduate School of Medicine, Japan
| | - Tetsu Fukunaga
- Department of Esophageal and Gastroenterological Surgery, Juntendo University School of Medicine, Japan
| | - Takashi Yao
- Department of Human Pathology, Juntendo University Graduate School of Medicine, Japan
| | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
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Ito M, Onozawa H, Saito M, Ami H, Ohki S, Koyama Y, Koji K. Laparoscopic total gastrectomy performed for juvenile polyposis of the stomach: A case report. Int J Surg Case Rep 2022; 97:107368. [PMID: 35841758 PMCID: PMC9403026 DOI: 10.1016/j.ijscr.2022.107368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Juvenile polyposis of the stomach (JPST) is a very rare disease and has been reported to have malignant potential. Total gastrectomy has been recommended as a standard treatment. Recently, the usefulness of laparoscopic surgery for this disease has been reported; however, in laparoscopic surgery, maintaining the surgical space is difficult because of the distended and thickened stomach wall that polyposis causes. CASE PRESENTATION A 64-year-old woman was admitted to our hospital because she became malnourished due to loss of appetite. She had no family history of gastrointestinal polyposis and was diagnosed with gastric polyposis and polyp-related anemia eight years previously. She received endoscopic submucosal dissection of early gastric cancer twice in another hospital. Thereafter, the patient received an annual upper gastrointestinal endoscopy and took iron supplements for anemia due to occasional bleeding from polyps. However, the number of polyps increased over time. Enhanced computed tomography showed gastric wall thickening and multiple gastric polyps. She was diagnosed as having JPST and underwent laparoscopic total gastrectomy. She was discharged on postoperative Day 10. CLINICAL DISCUSSION In the present case, similar to previous cases, standard laparoscopic surgery could be performed although the patient had excessive distention and congestion of the stomach. This report suggests that laparoscopic surgery is a safe and feasible option for patients with JPST and is preferable because of better cosmetic effects, especially for young female patients. CONCLUSION We successfully performed laparoscopic surgery to treat a rare case of JPST.
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Affiliation(s)
- Misato Ito
- Department of Gastrointestinal Tract Surgery, Fukushima medical university, Fukushima, Japan,Department of Surgery, Ohara General Hospital, Fukushima, Japan
| | - Hisashi Onozawa
- Department of Gastrointestinal Tract Surgery, Fukushima medical university, Fukushima, Japan,Department of Surgery, Ohara General Hospital, Fukushima, Japan,Corresponding author at: Department of Gastrointestinal Tract Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima-shi, Fukushima-ken 960-1295, Japan.
| | - Masaru Saito
- Department of Surgery, Ohara General Hospital, Fukushima, Japan
| | - Hirofumi Ami
- Department of Surgery, Ohara General Hospital, Fukushima, Japan
| | - Shinji Ohki
- Department of Gastrointestinal Tract Surgery, Fukushima medical university, Fukushima, Japan
| | | | - Kono Koji
- Department of Gastrointestinal Tract Surgery, Fukushima medical university, Fukushima, Japan
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