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Barat M, Pellat A, Hoeffel C, Dohan A, Coriat R, Fishman EK, Nougaret S, Chu L, Soyer P. CT and MRI of abdominal cancers: current trends and perspectives in the era of radiomics and artificial intelligence. Jpn J Radiol 2024; 42:246-260. [PMID: 37926780 DOI: 10.1007/s11604-023-01504-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023]
Abstract
Abdominal cancers continue to pose daily challenges to clinicians, radiologists and researchers. These challenges are faced at each stage of abdominal cancer management, including early detection, accurate characterization, precise assessment of tumor spread, preoperative planning when surgery is anticipated, prediction of tumor aggressiveness, response to therapy, and detection of recurrence. Technical advances in medical imaging, often in combination with imaging biomarkers, show great promise in addressing such challenges. Information extracted from imaging datasets owing to the application of radiomics can be used to further improve the diagnostic capabilities of imaging. However, the analysis of the huge amount of data provided by these advances is a difficult task in daily practice. Artificial intelligence has the potential to help radiologists in all these challenges. Notably, the applications of AI in the field of abdominal cancers are expanding and now include diverse approaches for cancer detection, diagnosis and classification, genomics and detection of genetic alterations, analysis of tumor microenvironment, identification of predictive biomarkers and follow-up. However, AI currently has some limitations that need further refinement for implementation in the clinical setting. This review article sums up recent advances in imaging of abdominal cancers in the field of image/data acquisition, tumor detection, tumor characterization, prognosis, and treatment response evaluation.
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Affiliation(s)
- Maxime Barat
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, 75014, Paris, France
- Faculté de Médecine, Université Paris Cité, 75006, Paris, France
| | - Anna Pellat
- Faculté de Médecine, Université Paris Cité, 75006, Paris, France
- Department of Gastroenterology and Digestive Oncology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, 75014, Paris, France
| | - Christine Hoeffel
- Department of Radiology, Hopital Robert Debré, CHU Reims, Université Champagne-Ardennes, 51092, Reims, France
| | - Anthony Dohan
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, 75014, Paris, France
- Faculté de Médecine, Université Paris Cité, 75006, Paris, France
| | - Romain Coriat
- Faculté de Médecine, Université Paris Cité, 75006, Paris, France
- Department of Gastroenterology and Digestive Oncology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, 75014, Paris, France
| | - Elliot K Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Stéphanie Nougaret
- Department of Radiology, Montpellier Cancer Institute, 34000, Montpellier, France
- PINKCC Lab, IRCM, U1194, 34000, Montpellier, France
| | - Linda Chu
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, 75014, Paris, France.
- Faculté de Médecine, Université Paris Cité, 75006, Paris, France.
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2
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Yang L, Duan D, Xiong Y, Liu T, Zhao L, Lai F, Gu D, Zhou L. Preoperative multimodal ultrasonic imaging in a case of Peutz-Jeghers syndrome complicated by atypical lobular endocervical glandular hyperplasia: a case report and literature review. Hered Cancer Clin Pract 2024; 22:3. [PMID: 38419118 PMCID: PMC10900695 DOI: 10.1186/s13053-024-00275-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/13/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Peutz-Jeghers syndrome (PJS), an autosomal dominant multiple cancerous disorder, is clinically characterized by mucocutaneous macules and multiple gastrointestinal hamartomatous polyps. Gastric-type endocervical adenocarcinoma (G-EAC), a special subtype of cervical adenocarcinoma with non-specific symptoms and signs, is known to occur in approximately 11% of female patients with PJS. CASE PRESENTATION Here, we report a case of PJS in a 24-year-old female with multiple mucocutaneous black macules who complained of vaginal discharge and menorrhagia. Moreover, we first described the multimodal ultrasonographical manifestations of PJS-correlated G-EAC. The three-dimensional reconstructed view of G-EAC on 3D realisticVue exhibited a distinctive "cosmos pattern" resembling features on magnetic resonance imaging, and the contrast-enhanced ultrasound displayed a "quick-up and slow-down" pattern of the solid components inside the mixed cervical echoes. We reported the multimodal ultrasonographical characteristics of a case of PJS-related G-EAC, as well as reviewed PJS-related literature and medical imaging features and clinical characteristics of G-EAC to provide insight into the feasibility and potential of utilizing multimodal ultrasonography for the diagnosis of G-EAC. CONCLUSIONS Multimodal ultrasound can visualize morphological features, solid components inside, and blood supplies of the G-EAC lesion and distinguish the G-EAC lesion from normal adjacent tissues. This facilitates preoperative diagnosis and staging of PJS-related G-EAC, thereby aiding subsequent health and reproductive management for patients with PJS.
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Affiliation(s)
- Liwen Yang
- Department of Ultrasonography, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology, No. 1617, Riyue Avenue, Chengdu, Sichuan, 610091, China
| | - Duan Duan
- Department of Gynecology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology, Chengdu, China
| | - Ying Xiong
- Department of Gynecology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology, Chengdu, China
| | - Tianjiao Liu
- Department of Gynecology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology, Chengdu, China
| | - Lijun Zhao
- Department of Ultrasonography, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology, No. 1617, Riyue Avenue, Chengdu, Sichuan, 610091, China
| | - Fan Lai
- Department of Obstetrics, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology, Chengdu, China
| | - Dingxian Gu
- Department of Gynecology, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology, Chengdu, China
| | - Liuying Zhou
- Department of Ultrasonography, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology, No. 1617, Riyue Avenue, Chengdu, Sichuan, 610091, China.
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3
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Savelyeva ТA, Ponomarenko АA, Shelygin YA, Kuzminov АM, Vyshegorodtsev DV, Loginova АN, Pikunov DY, Goncharova ЕP, Likutov АA, Mainovskaya ОA, Tsukanov АS. The course and clinical manifestations of Peutz–Jeghers syndrome in the Russian population. TERAPEVT ARKH 2023; 95:145-151. [PMID: 37167130 DOI: 10.26442/00403660.2023.02.202059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 04/01/2023]
Abstract
Background. PeutzJeghers syndrome (PJS) is a rare hereditary syndrome characterized by the growth of hamartomatous polyps in the gastrointestinal tract, perioral pigmentation and an increased risk of malignant neoplasms. The syndrome is caused by a pathogenic variant in the STK11 gene.
Aim. To assess the clinical picture and treatment of Russian patients with PJS.
Materials and methods. A retrospective analysis of 30 patients from 25 families with an established diagnosis of PJS who were in the Ryzikh State Scientific Center for Coloproctology from 2011 to 2021 was carried out. All patients underwent instrumental examination, including esophagogastroduodenoscopy, colonoscopy, X-ray examination of the small intestine/CT-enterography, in the absence of invaginates video capsule endoscopy, as well as molecular genetic examination for the presence of pathogenic variants in the STK11 gene. All removed polyps were subjected to the histological examination.
Results. The analysis of the clinical picture allowed us to establish the following data: the first complaints in patients were noted in childhood and adolescence, while the median age was 11 [7; 19] (0.524) years; pathogenic variants in the STK11 gene were identified in 26 (87%) cases, among which 10 were described for the first time; during the initial examination, polyps in the small intestine were detected in all 30 (100%) patients, in the stomach in 23/30 (77%) patients, and in the colon in 21/30 (70%); with an age, an increase in the number of polyps in all parts of the gastrointestinal tract was noted; before the diagnosis operations were performed urgently for intestinal obstruction; after the diagnosis of PJS, when polyps were detected in the gastrointestinal tract, endoscopic polypectomies were performed; if endoscopic removal of hamartomatous polyps was impossible, patients were operated as planned; malignant diseases of the predominantly reproductive system were detected in 8/30 (27%) patients. The median age of cancer detection was 52 [31; 52] (1759) years.
Conclusion. Russian patients with PJS have population-specific features in the clinical picture of the course of the disease, which dictates the need to develop their own recommendations for monitoring and treatment of such patients.
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Imaging More than Skin-Deep: Radiologic and Dermatologic Presentations of Systemic Disorders. Diagnostics (Basel) 2022; 12:diagnostics12082011. [PMID: 36010360 PMCID: PMC9407377 DOI: 10.3390/diagnostics12082011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Cutaneous manifestations of systemic diseases are diverse and sometimes precede more serious diseases and symptomatology. Similarly, radiologic imaging plays a key role in early diagnosis and determination of the extent of systemic involvement. Simultaneous awareness of skin and imaging manifestations can help the radiologist to narrow down differential diagnosis even if imaging findings are nonspecific. Aims: To improve diagnostic accuracy and patient care, it is important that clinicians and radiologists be familiar with both cutaneous and radiologic features of various systemic disorders. This article reviews cutaneous manifestations and imaging findings of commonly encountered systemic diseases. Conclusions: Familiarity with the most disease-specific skin lesions help the radiologist pinpoint a specific diagnosis and consequently, in preventing unnecessary invasive workups and contributing to improved patient care.
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Bellamlih H, El Farouki A, Oulahyane R, Moatassim Billah N, Nassar I. Unusual case of small bowel intussusception in adult revealing a Peutz-Jeghers syndrome. BJR|CASE REPORTS 2022; 8:20210082. [PMID: 36177262 PMCID: PMC9499423 DOI: 10.1259/bjrcr.20210082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/13/2021] [Accepted: 11/08/2021] [Indexed: 11/06/2022]
Abstract
Peutz-Jeghers syndrome is a rare genetic disorder characterized by hyperpigmented
mucocutaneous macules, hamartomatous polyps of the small intestine, and family
history. These hamartomatous polyps can cause intermittent abdominal pain,
chronic anemia, or even intussusception. Imaging has an important role in the
diagnosis of this syndrome but also in the identification of complications and
periodic surveillance. Here, we present a demonstrative case of a Peutz-Jeghers
syndrome associated with intussusception in a 16-year-old patient.
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Affiliation(s)
- Habib Bellamlih
- Department of Radiology, University Hospital Center IBN SINA, Mohammed V-Souissi University, Rabat, Morocco
| | - Ayman El Farouki
- Department of Radiology, University Hospital Center IBN SINA, Mohammed V-Souissi University, Rabat, Morocco
| | - Rachid Oulahyane
- Department of Radiology, University Hospital Center IBN SINA, Mohammed V-Souissi University, Rabat, Morocco
| | - Nabil Moatassim Billah
- Department of Radiology, University Hospital Center IBN SINA, Mohammed V-Souissi University, Rabat, Morocco
| | - Ittimade Nassar
- Department of Radiology, University Hospital Center IBN SINA, Mohammed V-Souissi University, Rabat, Morocco
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6
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Sandru F, Petca A, Dumitrascu MC, Petca RC, Carsote M. Peutz-Jeghers syndrome: Skin manifestations and endocrine anomalies (Review). Exp Ther Med 2021; 22:1387. [PMID: 34650635 PMCID: PMC8506952 DOI: 10.3892/etm.2021.10823] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/27/2021] [Indexed: 12/11/2022] Open
Abstract
Peutz-Jeghers syndrome (PJS), a rare autosomal dominant serine/threonine kinase 11 (STK11)/ liver kinase B1 (LKB1) gene-related genodermatosis, is characterized by oral hyperpigmentation (OHP); multiple gastro-intestinal mucosal benign hamartomatous polyps causing local bleeding, occlusion, intussusception, post-resection small bowel syndrome, associated increased risk of small intestinal cancer (incidence during the third decade); and 76% cumulative higher risk than the global population of developing non-gastrointestinal tumors (female predominance) including ovarian/testicular neoplasia, pancreatic and gynecologic (breast, uterus, ovarian) cancers. Suggestive PJS-associated OHP requires STK11 genetic testing. Abdominal pain in an OHP patient may be related to PJS-associated polyps. Other features include focal depigmentation followed by hyperpigmentation, and xeroderma pigmentosum-like lesions. The severity of the dermatological findings is correlated with gastrointestinal polyps. The STK11 gene is linked to reserve of primordial follicles, polycystic ovary syndrome, female fertility, and spermatogenesis. PJS is associated with 2 types of ovarian sex-cord stroma tumors (SCSTs): annular tubules (SCTATs) and pure Sertoli cell tumors. SCSTs accounts for 8% of ovarian cancer and SCTATs represents 2% of SCST, which may be associated with the overproduction of progesterone. PJS-SCTAT vs. non-PJS-SCTAT reveals bilateral/multifocal, small tumors with a benign behavior vs. a unique ovarian, large tumor with increased malignant/metastasis risk. Male precocious puberty is due to large cell calcifying Sertoli cell tumors (LCCSCTs). Notably, 30-40% of LCCSCTs are caused by PJS or Carney complex. PJS-LCCSCT is not aggressive, but it may be bilateral/multifocal, with the ultrasound hallmark being micro-calcifications. Testicular, intra-tubular large cell hyalinizing Sertoli cell tumor is the second testicle neoplasia in PJS. The skin and mucosal lesions are useful markers of PJS, assisting with the early identification of hamartomatouspolyps and initiation of serial surveillance of ovarian, or testicular neoplasia.
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Affiliation(s)
- Florica Sandru
- Department of Dermatology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Dermatology, ‘Elias’ Emergency Hospital, 011461 Bucharest, Romania
| | - Aida Petca
- Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Obstetrics and Gynecology, ‘Elias’ Emergency Hospital, 022461 Bucharest, Romania
| | - Mihai Cristian Dumitrascu
- Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Razvan-Cosmin Petca
- Department of Urology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Urology, ‘Prof. Dr. Theodor Burghele’ Clinical Hospital, 061344 Bucharest, Romania
| | - Mara Carsote
- Department of Endocrinology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Endocrinology, ‘C. I. Parhon’ National Institute of Endocrinology, 011863 Bucharest, Romania
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7
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Shanbhogue KP, Prasad AS, Ucisik-Keser FE, Katabathina VS, Morani AC. Hereditary ovarian tumour syndromes: current update on genetics and imaging. Clin Radiol 2021; 76:313.e15-313.e26. [PMID: 33353730 DOI: 10.1016/j.crad.2020.11.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/20/2020] [Indexed: 01/30/2023]
Abstract
Hereditary ovarian tumour syndromes are a diverse group of hereditary syndromes characterised by the development of specific histotypes of ovarian neoplasms. While BRCA syndromes are exclusively associated with high-grade serous carcinomas, patients with Lynch syndrome show a preponderance of endometrioid subtype of ovarian and endometrial carcinomas. Distinct non-epithelial phenotypes, such as sex cord stromal tumours with annular tubules, Sertoli-Leydig cell tumours, and small cell carcinoma of the hypercalcaemic type occur in patients with Peutz-Jeghers, DICER1, and rhabdoid tumour predisposition syndromes, respectively. Gorlin-Goltz syndrome is characterised by the development of bilateral, multiple ovarian fibromas in 14-24% of patients. Ovarian steroid cell tumours and broad ligament papillary cystadenomas are characteristically found in women with von Hippel-Lindau syndrome. Recent studies have allowed the characterisation of tumour genetics and associated oncological pathways that contribute to tumourigenesis. Implications of the diagnosis of these syndromes on screening, management, and prognosis are discussed.
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Affiliation(s)
- K P Shanbhogue
- Department of Radiology at NYU Grossman School of Medicine, NY 10016, USA
| | - A S Prasad
- Department of Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX 77030, USA
| | - F E Ucisik-Keser
- Department of Radiology, The University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX 77030, USA
| | - V S Katabathina
- Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - A C Morani
- Department of Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holocombe Blvd, Houston, TX 77030, USA.
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8
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Kirakosyan E, Lokhmatov M. High-Tech Diagnostic Methods and Enteroscopic Treatment of Children with Peutz-Jeghers Syndrome. Eur J Pediatr Surg 2020; 30:529-535. [PMID: 31770782 DOI: 10.1055/s-0039-3400286] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Peutz-Jeghers syndrome (PJS) is an autosomal dominant hereditary hamartomatous polyposis with predominant localization in the jejunum and ileum and high risk of bowel perforation after traditional polypectomy. The modern enteroscopy is the only possible technique for visualizing and performing intraluminal endoscopic microsurgical manipulations in the deep sections of the small intestine. The study aims to develop an optimal method for the diagnosis and treatment of polyps in children with PJS. MATERIALS AND METHODS During 2015 to 2018 we conducted 30 comprehensive examinations of children with PJS in The Department of Endoscopic Research of the National Medical Research Center for Children's Health. We performed esophagogastroduodenoscopy and colonoscopy with removal of polyps more than 7 mm, then video capsule endoscopy and, guided by this, therapeutic single-balloon enteroscopy. Our technique for removal of polyps is general in all parts: (1) creating a "resistant pillow"; (2) electroexcision of polyp; (3) clipping the removal site. RESULTS Successfully performed electroexcision of polyps, which were located in the deep parts of the small intestine at a distance of 30 segments (one segment is 10 cm), reached a diameter of 2.5 cm, had a long pedicle. The postoperative period was uneventful. CONCLUSION We have developed an optimal method of diagnostic and therapeutic measures, the observance of which allows us to avoid delayed perforations of the small intestine in the area of polypectomy in the postoperative period in children with PJS. Thanks to this technique, modern enteroscopy is becoming the only possible alternative to bowel resection in children with PJS.
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Affiliation(s)
- Evgeniya Kirakosyan
- International School "Medicine of the Future", Sechenov University Faculty of Medicine, Moscow, Russia
| | - Maxim Lokhmatov
- Department of Pediatric Surgery and Urology-Andrology, Sechenov University, Moscow, Russia.,Department of Endoscopic Research, Scientific Center of Children's Health, Moscow, Russia
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9
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García-Márquez J, Valenzuela-de Damas M, Caballero-Mateos A. Video capsule endoscopy in the diagnosis of Peutz-Jeghers syndrome. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2020. [DOI: 10.1016/j.rgmxen.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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10
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García-Márquez J, Valenzuela-de Damas M, Caballero-Mateos AM. Video capsule endoscopy in the diagnosis of Peutz-Jeghers syndrome. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2020; 85:490-491. [PMID: 31959480 DOI: 10.1016/j.rgmx.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/23/2019] [Accepted: 10/31/2019] [Indexed: 06/10/2023]
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Abstract
This article summarises radiological imaging of the small bowel, with an emphasis on Crohn's disease. Different imaging techniques are discussed, including the advantages and disadvantages of each modality, and radiological findings for common small bowel pathologies are described, supplemented with pictorial examples.
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Affiliation(s)
- Dilane Peiris
- Department of Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark Wills
- Department of Radiology, Salisbury NHS Foundation Trust, Salisbury, UK
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12
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PIGMENTED MACULES REMOVAL WITH COSMETIC TREATMENT MAY COVER UP PEUTZ-JEGHERS SYNDROME: A CASE REPORT. Gastroenterol Nurs 2019; 42:504-507. [PMID: 31770353 DOI: 10.1097/sga.0000000000000449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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13
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Perrod G, Samaha E, Perez-Cuadrado-Robles E, Berger A, Benosman H, Khater S, Vienne A, Cuenod CA, Zaanan A, Laurent-Puig P, Rahmi G, Cellier C. Small bowel polyp resection using device-assisted enteroscopy in Peutz-Jeghers Syndrome: Results of a specialised tertiary care centre. United European Gastroenterol J 2019; 8:204-210. [PMID: 32213068 DOI: 10.1177/2050640619874525] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Enteroscopy resection of small bowel polyps in Peutz-Jeghers syndrome has only been described in small case series. Herein, we aimed to assess the efficacy of enteroscopy resection of small bowel polyps within a specialised tertiary care centre and the impact on intraoperative enteroscopy. METHODS This was an observational single-centre study. All adult Peutz-Jeghers syndrome patients followed in the Predisposition Digestive Ile-de-France network who underwent an endoscopic resection of at least one small bowel polyp ≥ 1 cm by enteroscopy between 2002-2015 were included. Small bowel polyps were detected under a dedicated screening programme by previous capsule endoscopy and/or magnetic resonance enterography, performed every 2-3 years. Complete treatment was defined as the absence of polyps ≥ 1 cm after conventional endoscopic resection. Intraoperative enteroscopy or surgical resection were indicated in incomplete treatments. The overall complete treatment rate including conventional enteroscopy and intraoperative enteroscopy was also considered. RESULTS Endoscopic resection of 216 small bowel polyps (median: 8.6 per patient, size: 6-60 mm) was performed by 50 enteroscopies in 25 patients (mean age: 36 years, range: 18-71, 56% male) with small bowel polyp ≥ 1 cm. Twenty-three patients (92%) underwent 42 screening capsule endoscopies and 14 (57%) had 23 magnetic resonance enterographies during a median follow-up of 60 months. Complete treatment was achieved in 76%. Intraoperative enteroscopy and surgical resection were performed in four (16%) and two (8%) patients. Intraoperative enteroscopy improved by 16% the complete treatment rate and the overall rate was 92%. The complication rate was 6%. CONCLUSION This long-term study confirmed the efficacy and safety of endoscopic resection of small bowel polyps in Peutz-Jeghers syndrome. Intraoperative enteroscopy can be a complementary approach in selected cases.
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Affiliation(s)
- G Perrod
- Gastroenterology and Endoscopy Unit, Georges Pompidou European Hospital, Paris, France.,Paris Descartes University, Paris, France
| | - E Samaha
- Gastroenterology and Endoscopy Unit, Georges Pompidou European Hospital, Paris, France
| | | | - A Berger
- Gastroenterology and Endoscopy Unit, Georges Pompidou European Hospital, Paris, France.,Paris Descartes University, Paris, France
| | - H Benosman
- Gastroenterology and Endoscopy Unit, Georges Pompidou European Hospital, Paris, France
| | - S Khater
- Gastroenterology and Endoscopy Unit, Georges Pompidou European Hospital, Paris, France
| | - A Vienne
- Gastroenterology and Endoscopy Unit, Georges Pompidou European Hospital, Paris, France
| | - C-A Cuenod
- Paris Descartes University, Paris, France.,Radiology Unit, Georges Pompidou European Hospital, Paris, France
| | - A Zaanan
- Paris Descartes University, Paris, France
| | - P Laurent-Puig
- Paris Descartes University, Paris, France.,Oncogenetic Department, Georges Pompidou European Hospital, Paris, France
| | - G Rahmi
- Gastroenterology and Endoscopy Unit, Georges Pompidou European Hospital, Paris, France.,Paris Descartes University, Paris, France
| | - C Cellier
- Gastroenterology and Endoscopy Unit, Georges Pompidou European Hospital, Paris, France.,Paris Descartes University, Paris, France
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14
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Katabathina VS, Menias CO, Khanna L, Murphy L, Dasyam AK, Lubner MG, Prasad SR. Hereditary Gastrointestinal Cancer Syndromes: Role of Imaging in Screening, Diagnosis, and Management. Radiographics 2019; 39:1280-1301. [DOI: 10.1148/rg.2019180185] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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15
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Kim SW, Kim HC, Oh J, Won KY, Park SJ, Yang DM. Tumors of the jejunum and ileum: a pattern-based imaging approach on CT. Abdom Radiol (NY) 2019; 44:2337-2345. [PMID: 30877330 DOI: 10.1007/s00261-019-01978-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Since a broad spectrum of tumors can occur in the small bowels, it is not easy to make a correct differential diagnosis among small bowel tumors on CT findings. Therefore, once a mass is detected on CT, the radiologist needs to analyze the mass based on presenting patterns such as location, multiplicity, morphology, and enhancement patterns. In this article, we will illustrate various kinds of small bowel tumors based on imaging patterns at CT to facilitate making a correct diagnosis.
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Affiliation(s)
- Sang Won Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 149 Sangil-Dong, Gangdong-Gu, Seoul, 134-727, Korea.
| | - Hyun Cheol Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 149 Sangil-Dong, Gangdong-Gu, Seoul, 134-727, Korea
| | - Jiyoung Oh
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 149 Sangil-Dong, Gangdong-Gu, Seoul, 134-727, Korea
| | - Kyu Yeoun Won
- Deparment of Pathology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Seong Jin Park
- Department of Radiology, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Dal Mo Yang
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 149 Sangil-Dong, Gangdong-Gu, Seoul, 134-727, Korea
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16
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Li BR, Sun T, Jiang YL, Ning SB. Pathogenesis, diagnosis, and treatment of Peutz-Jeghers syndrome. Shijie Huaren Xiaohua Zazhi 2019; 27:576-582. [DOI: 10.11569/wcjd.v27.i9.576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Peutz-Jeghers syndrome (PJS), an autosomal dominant inherited disease, is caused by germinal mutations of the STK11. It is characterized by gastrointestinal hamartomas, mucocutaneous pigmentation and increased cancer risk. Germline mutations in STK11 cause a harmful effect on cell apoptosis, G1 arrest, and cell polarization, which leads to polyp formation and cancer occurrence. Balloon-assisted enteroscopy is widely used in removal of PJS polyps in the small bowel and it is proved to be safe and effective. We suggest to screen polyps and cancer in PJS patients, which seems to benefit these patients in the long run.
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Affiliation(s)
- Bai-Rong Li
- Department of Gastroenterology, Chinese People's Liberation Army Air Force Characteristic Medical Center, Beijing 100142, China
| | - Tao Sun
- Department of Gastroenterology, Chinese People's Liberation Army Air Force Characteristic Medical Center, Beijing 100142, China
| | - Yu-Liang Jiang
- Department of Gastroenterology, Chinese People's Liberation Army Air Force Characteristic Medical Center, Beijing 100142, China
| | - Shou-Bin Ning
- Department of Gastroenterology, Chinese People's Liberation Army Air Force Characteristic Medical Center, Beijing 100142, China
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17
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Fornaroli F, Gaiani F, Vincenzi F, Bizzarri B, Ghiselli A, Kayali S, Leandro G, Di Mario F, De' Angelis GL. Applications of wireless capsule endoscopy in pediatric age: an update. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:40-46. [PMID: 30561394 PMCID: PMC6502199 DOI: 10.23750/abm.v89i9-s.7957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Indexed: 11/29/2022]
Abstract
Background: The small bowel has often been considered the mysterious “black hole” of the gastrointestinal tract. With regards to this, the development of the wireless capsule endoscopy (WCE) has represented a turning point. It is a non-invasive technique, enabling an excellent visualization of the small bowel (SB) mucosa without the use of radiation. The WCE was approved by the Food and Drug Administration (FDA) in 2001 for adults and in 2004 for children. The aim of the present review is to provide an update on indications, diagnostic yield, safety and limitations of WCE in children. Even though literature regarding the use of WCE in pediatric age is more limited than in adults,WCE is a useful and safe diagnostic tool for the exploration of the small bowel also in children. The indications for WCE are similar at any age, however the main indication in children is Crohn’s disease (CD), while in the adults is the research of SB bleeding. The main limitation in pediatric age is the possibility for younger children to swallow the capsule. WCE in pediatric is a rapidly advancing technology and has the potential to further transform the evaluation and management of SB disease. (www.actabiomedica.it)
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Affiliation(s)
- Fabiola Fornaroli
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.
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18
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Sanchez-Mete L, Stigliano V. Update on small bowel surveillance in hereditary colorectal cancer syndromes. TUMORI JOURNAL 2018; 105:12-21. [PMID: 30117372 DOI: 10.1177/0300891618792461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Despite its rarity in the general population, small bowel adenocarcinoma risk is increased in individuals with hereditary colorectal cancer syndromes (HCCS). In the last decade, the advent of capsule endoscopy and device-assisted balloon enteroscopy procedures in patients with HCCS have allowed to investigate the whole small bowel, increasing the diagnostic yield of small bowel tumor. Nonetheless, there is a significant variability in the international guideline recommendations. The aim of this review is to provide an update on surveillance of small bowel in HCCS and to identify the key points for the clinical management of these patients.
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Affiliation(s)
- Lupe Sanchez-Mete
- Division of Gastroenterology and Digestive Endoscopy, Regina Elena National Cancer Institute, Rome, Italy
| | - Vittoria Stigliano
- Division of Gastroenterology and Digestive Endoscopy, Regina Elena National Cancer Institute, Rome, Italy
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19
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Barat M, Dohan A, Dautry R, Barral M, Boudiaf M, Hoeffel C, Soyer P. Mass-forming lesions of the duodenum: A pictorial review. Diagn Interv Imaging 2017; 98:663-675. [PMID: 28185840 DOI: 10.1016/j.diii.2017.01.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 02/07/2023]
Abstract
Recent advances in imaging have resulted in marked changes in the investigation of the duodenum, which still remains primarily evaluated with videoendoscopy. However, improvements in computed tomography (CT) and magnetic resonance (MR) imaging have made detection and characterization of duodenal mass-forming abnormalities easier. The goal of this pictorial review was to illustrate the most common conditions of the duodenum that present as mass-forming lesions with a specific emphasis on CT and MR imaging. MR imaging used in conjunction with duodenal distension appears as a second line imaging modality for the characterization of duodenal mass-forming lesions. CT remains the first line imaging modality for the detection and characterization of a wide range of duodenal mass-forming lesions.
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Affiliation(s)
- M Barat
- Department of Radiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - A Dohan
- Department of Radiology, McGill University Health Centre, Montreal General and Royal Victoria Hospitals, Montreal, Canada.
| | - R Dautry
- Department of Radiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - M Barral
- Department of Radiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - M Boudiaf
- Pôle santé du plateau, 3/5, avenue de Villacoublay, 92360 Meudon-La-Forêt, France.
| | - C Hoeffel
- Department of Radiology, hôpital Robert-Debré, 11, boulevard Pasteur, 51092 Reims, France.
| | - P Soyer
- Medicine department, Université Paris-Diderot, Sorbonne Paris Cité, 10, avenue de Verdun, 75010 Paris, France.
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20
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Dohan A, Boudiaf M, Dray X, Samaha E, Cellier C, Camus M, Eveno C, Dautry R, Soyer P. Detection of small-bowel tumours with CT enteroclysis using carbon dioxide and virtual enteroscopy: A preliminary study. Eur Radiol 2017; 28:206-213. [PMID: 28710577 DOI: 10.1007/s00330-017-4927-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 05/31/2017] [Accepted: 06/05/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE The aim of this prospective study was to evaluate the feasibility, tolerance and performance of virtual enteroscopy (VE) using carbon dioxide for small-bowel distension in patients with suspected small-bowel tumours (SBTs). PATIENTS AND METHODS After IRB approval, 17 patients with suspected SBTs were prospectively included. Radiation dose was compared to 34 matched patients (2 for 1) for age, gender and body weight, who had undergone CT-enteroclysis with neutral contrast (CTE). Performance of VE was evaluated through comparison with the current standard of reference, including surgery and/or enteroscopy and/or follow-up. RESULTS Tolerance was excellent in 16/17 patients (94%). The radiation dose was lower for VE than for CTE (533 ± 282 vs. 974 ± 505 mGy.cm; p = 0.002). With VE, a total of 25 polyps >5 mm in size were depicted in 12/17 patients. On a per-lesion analysis, sensitivity and positive predictive value of VE were 92.0% and 92.0%, respectively. On a per-segment analysis VE had a sensitivity and specificity of 95.0% and 87.0%, respectively. CONCLUSION Our preliminary study suggests that VE is a feasible and well-tolerated technique with high sensitivity and specificity for the diagnosis of SBT. KEY POINTS • Virtual enteroscopy is feasible and well tolerated. • Virtual enteroscopy appears to be accurate for detection of small-bowel tumours. • Sensitivity and PPV of virtual enteroscopy is 92.0% and 92.0%. • Radiation dose is lower with virtual enteroscopy compared to MDCT-enteroclysis.
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Affiliation(s)
- Anthony Dohan
- Department of Body and Interventional Imaging, Hôpital Lariboisière - Assistance Publique-Hôpitaux de Paris, 2 Rue Ambroise Paré, 75010, Paris, France. .,Université Sorbonne Paris Cité, Paris Diderot, INSERM UMR 965, 2 Rue Ambroise Paré, 75010, Paris, France.
| | - Mourad Boudiaf
- Department of Body and Interventional Imaging, Hôpital Lariboisière - Assistance Publique-Hôpitaux de Paris, 2 Rue Ambroise Paré, 75010, Paris, France
| | - Xavier Dray
- Department of Digestive Diseases, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France.,Sorbonne Université, Paris, France
| | - Elia Samaha
- Gastroenterology and Endoscopy Unit, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, 20 Rue Leblanc, 75015, Paris, France
| | - Christophe Cellier
- Gastroenterology and Endoscopy Unit, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, 20 Rue Leblanc, 75015, Paris, France.,Université Sorbonne Paris Cité, Paris Descartes, Paris, France
| | - Marine Camus
- Université Sorbonne Paris Cité, Paris Descartes, Paris, France.,Department of Gastroenterology, Hôpital Cochin - Assistance Publique-Hôpitaux de Paris, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Clarisse Eveno
- Université Sorbonne Paris Cité, Paris Diderot, INSERM UMR 965, 2 Rue Ambroise Paré, 75010, Paris, France.,Department of Surgical Oncologic and Digestive Unit, Hôpital Lariboisière - Assistance Publique-Hôpitaux de Paris, 2 Rue Ambroise Paré, 75475, Paris, France
| | - Raphael Dautry
- Department of Body and Interventional Imaging, Hôpital Lariboisière - Assistance Publique-Hôpitaux de Paris, 2 Rue Ambroise Paré, 75010, Paris, France
| | - Philippe Soyer
- Université Sorbonne Paris Cité, Paris Diderot, INSERM UMR 965, 2 Rue Ambroise Paré, 75010, Paris, France.,Department of Body and Interventional Imaging, Hôpital Cochin - Assistance Publique-Hôpitaux de Paris, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
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21
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Zhang LJ, Su Z, Liu X, Wang L, Zhang Q. Peutz-Jeghers syndrome with early onset of pre-adolescent gynecomastia: a predigree case report and clinical and molecular genetic analysis. Am J Transl Res 2017; 9:2639-2644. [PMID: 28560011 PMCID: PMC5446543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 04/12/2017] [Indexed: 06/07/2023]
Abstract
This study reports a case of Peutz-Jeghers syndrome with early onset of gynecomastia, and discusses its clinical characteristics and genetic changes in a family. The clinical characteristics of a child diagnosed with Peutz-Jeghers syndrome in our hospital and his parents were summarized, and related genes were detected in the child and his parents. Furthermore, the therapeutic effect of letrozole was also observed. A five-year-and-three-month-old male patient visited a doctor due to "progressive painless enlargements at bilateral breast for more than two years". The mother of the patient had breast hyperplasia and ovarian cysts, had no hematemesis and hematochezia history, and had two 1-mm pigmented spots on the palm side of the left thumb. The father of the patient revealed no abnormalities. In the child, luteinizing hormone (LH) release peak induced by luteinizing hormone releasing hormone (LHRH) excitation testing was 0.29 U/l, and follicle stimulating hormone (FSH) peak was 0.41 U/l. Karyotype: 46, XY. Gene sequencing revealed a mutation c.658C>T in the serine threonine kinase 11 (STK11) gene in the child and this mother, while the child's father was normal. After one year of oral administration of letrozole, the boy's breasts reduced to stage B2, bone age was 10 years and eight months old, and ΔBA/ΔCA ratio was <1. The patient had early onset of pre-adolescent gynecomastia, had no obvious gastrointestinal symptoms, presented with a few pigmented spots in the skin mucosa, and was diagnosed with Peutz-Jeghers syndrome by genetic testing. Letrozole treatment can effectively control the development of breast and progression of bone age.
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Affiliation(s)
- Long-Jiang Zhang
- Department of Endocrine, Shenzhen Children's HospitalNo. 7019 Yitian Road, Futian District, Shenzhen 518000, Guangdong, China
| | - Zhe Su
- Department of Endocrine, Shenzhen Children's HospitalNo. 7019 Yitian Road, Futian District, Shenzhen 518000, Guangdong, China
| | - Xia Liu
- Department of Endocrine, Shenzhen Children's HospitalNo. 7019 Yitian Road, Futian District, Shenzhen 518000, Guangdong, China
| | - Li Wang
- Department of Endocrine, Shenzhen Children's HospitalNo. 7019 Yitian Road, Futian District, Shenzhen 518000, Guangdong, China
| | - Qin Zhang
- Department of Endocrine, Shenzhen Children's HospitalNo. 7019 Yitian Road, Futian District, Shenzhen 518000, Guangdong, China
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22
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Small-bowel Surveillance in Patients With Peutz-Jeghers Syndrome: Comparing Magnetic Resonance Enteroclysis and Double Balloon Enteroscopy. J Clin Gastroenterol 2017; 51:e27-e33. [PMID: 27404294 DOI: 10.1097/mcg.0000000000000592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIMS Small-bowel surveillance with polypectomy of polyps ≥15 mm prevents complications in patients with Peutz-Jeghers syndrome (PJS). We aimed to compare magnetic resonance enteroclysis (MRE) and double balloon enteroscopy (DBE) for diagnostic yield of these polyps and for patient preference. MATERIALS AND METHODS PJS patients prospectively underwent MRE followed by proximal DBE within 20 weeks. Endoscopists were blinded to the MRE results. We compared number of polyps ≥15 mm detected by MRE and DBE. Patients' perceptions of both procedures were assessed using questionnaires. RESULTS Fifteen PJS patients (67% males, median age 47 y) underwent both MRE and DBE. Polyps ≥15 mm were identified by MRE and/or DBE in 12/15 (80%) patients. There was no significant difference in the detection of polyps ≥15 mm (38 by MRE vs. 50 by DBE, P=0.37). Sensitivity for these polyps was 62% (38/61) for MRE and 82% (50/61) for DBE. Patients' perceived shame and burden did not differ significantly between MRE and DBE. Patients reported significantly more pain during preparation for MRE than for DBE (moderate vs. no pain, P=0.02), although perceived pain during the procedures was comparable (both mild, P=0.89). For future small-bowel surveillance 10/13 (77%) patients preferred DBE over MRE (P=0.09). CONCLUSIONS Our results suggest that MRE and DBE have a comparable diagnostic yield of polyps ≥15 mm. However, DBE allows for direct intervention and was preferred over MRE by most patients in this series. Larger cohorts of PJS patients are needed to fully evaluate the diagnostic yield of DBE compared with other modalities.
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23
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Zhang Y, Ke Y, Zheng X, Liu Q, Duan X. Correlation between genotype and phenotype in three families with Peutz-Jeghers Syndrome. Exp Ther Med 2016; 13:507-514. [PMID: 28352323 PMCID: PMC5348679 DOI: 10.3892/etm.2016.3980] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 11/30/2016] [Indexed: 12/26/2022] Open
Abstract
Peutz-Jeghers syndrome (PJS) is a hereditary disorder characterized by mucocutaneous pigmentations, gastrointestinal (GI) polyposis and an increased risk of certain malignancies. Little is known about the causative genes of PJS, or their association with the clinical phenotypes of PJS. The present study reports the results of clinical and genetic analysis of three Chinese families with PJS. In addition, the medical histories and clinical manifestations of these families were compared. DNA was collected from the blood samples of patients with PJS and controls. Serine/threonine kinase 11 (STK11), olfactory receptor family 4 subfamily C member 45 (OR4C45) and zonadhesin (ZAN) were amplified by polymerase chain reaction, and analyzed by sequencing and cloning. Two PJS-affected members of one family had a de novo single base deletion (NM_000455.4:c.842delC) in the STK11 gene, and their clinical presentations reflected the quantity of mutant STK11 copies in a dose-dependent manner. No pathogenic variants of OR4C45 or ZAN were found in the patients with PJS, although a new single nucleotide polymorphism (NM_003386.2:c.5768delG) of ZAN was identified. The results of the current study identified that a STK11 mutation dose-dependent genotype-phenotype relationship exists in patients with PJS. In addition, an early onset and high severity of oral pigmentations in PJS was indicative of serious GI phenotypes. These findings may aid the diagnosis and treatment of PJS.
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Affiliation(s)
- Yanli Zhang
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Oral Diseases, Department of Oral Biology, Clinic of Oral Rare and Genetic Diseases, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Yao Ke
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral Medicine, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Xueni Zheng
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Oral Diseases, Department of Oral Biology, Clinic of Oral Rare and Genetic Diseases, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Qing Liu
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral Medicine, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Xiaohong Duan
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Oral Diseases, Department of Oral Biology, Clinic of Oral Rare and Genetic Diseases, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
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Panta OB, Maharjan S, Manandhar S, Paudel S, Ghimire RK. A rare case of synchronous colocolic intussusception in association with Peutz-Jeghers syndrome. BJR Case Rep 2016; 3:20150314. [PMID: 30363296 PMCID: PMC6159284 DOI: 10.1259/bjrcr.20150314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 06/28/2016] [Indexed: 11/29/2022] Open
Abstract
Adult intussusception is rare and is almost always associated with a lead point. Polyposis syndromes are a common cause of adult intussusceptions, with polyps acting as lead points. Peutz–Jeghers syndrome is associated with benign hamartomatous polyps and mucocutaneous pigmentation. Although hamartomatous polyps are not premalignant, there is an increased risk of gastrointestinal and non-gastrointestinal malignancy, most commonly involving the small bowel. Most patients with Peutz–Jeghers syndrome with acute abdomen are diagnosed to have intussusceptions, mostly of the enteroenteric type. Colocolic intussusceptions are rare in Peutz–Jeghers syndrome. To the best of our knowledge, synchronous colocolic intussusception in association with Peutz–Jeghers syndrome has not been previously reported. Here we present a case of malignant jejunal mass and synchronous colocolic intussusceptions in a patient with Peutz–Jeghers syndrome.
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Affiliation(s)
- Om Biju Panta
- Department of Radiology and Imaging, Tribhuwan University Teaching Hospital, Kathmandu, Nepal
| | - Santosh Maharjan
- Department of Radiology and Imaging, Tribhuwan University Teaching Hospital, Kathmandu, Nepal
| | - Sujan Manandhar
- Gastrointestinal Surgery Unit, Department of Surgery, Tribhuwan University Teaching Hospital, Kathmandu, Nepal
| | - Sharma Paudel
- Department of Radiology and Imaging, Tribhuwan University Teaching Hospital, Kathmandu, Nepal
| | - Ram Kumar Ghimire
- Department of Radiology and Imaging, Tribhuwan University Teaching Hospital, Kathmandu, Nepal
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25
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Cano-Contreras AD, Meixueiro-Daza A, Grube-Pagola P, Remes-Troche JM. Giant rectal polyp prolapse in an adult patient with the Peutz-Jeghers syndrome. BMJ Case Rep 2016; 2016:bcr-2016-215629. [PMID: 27444139 DOI: 10.1136/bcr-2016-215629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Peutz-Jeghers Syndrome (PJS) is an autosomal dominant intestinal polyposis syndrome characterised by the presence of hamartomatous polyps and mucocutaneous pigmentation. Prolapse of the polyps through the anus is an infrequent manifestation in children with PJS, and this complication is extremely rare in adult patients. We report the case of a 30-year-old man recently diagnosed with PJS who was seen at the emergency department because of the abrupt onset of severe anal pain with a foreign body sensation in the anal canal and rectal bleeding.Physical examination revealed a giant prolapsed polyp.
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Affiliation(s)
- Ana Delfina Cano-Contreras
- Labortorio de Fisiologia DIgestiva y Motilidad, Instituto de Investigaciones Medico Biologicas, Veracruz, Mexico
| | - Arturo Meixueiro-Daza
- Laboratorio de Motilidad y Fisiologia DIgestiva, Instituto de Investigaciones Medico Biologicas, Boca del Rio, Mexico
| | | | - Jose Maria Remes-Troche
- Labortorio de Fisiologia DIgestiva y Motilidad, Instituto de Investigaciones Medico Biologicas, Veracruz, Mexico Instituto de Investigaciones Medico Biologicas, Veracruz, Mexico
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26
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Yu H, Pu W, Liu J, Huang MM, Wang XJ. Multiple Intussusceptions in Peutz-Jeghers Syndrome: Detection through Multidetector Computerized Tomography Enterography. Chin Med J (Engl) 2016; 129:1511-2. [PMID: 27270555 PMCID: PMC4910383 DOI: 10.4103/0366-6999.183415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hui Yu
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, China
| | - Wei Pu
- Department of Radiology, Affiliated People's Hospital of Guizhou Medical University, Guiyang, Guizhou 550002, China
| | - Jing Liu
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, China
| | - Ming-Ming Huang
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, China
| | - Xue-Jian Wang
- Department of Radiology, Affiliated Guihang 300 Hospital of Zunyi Medical University, Guiyang, Guizhou 550009, China
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27
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Dohan A, Taylor S, Hoeffel C, Barret M, Allez M, Dautry R, Zappa M, Savoye-Collet C, Dray X, Boudiaf M, Reinhold C, Soyer P. Diffusion-weighted MRI in Crohn's disease: Current status and recommendations. J Magn Reson Imaging 2016; 44:1381-1396. [PMID: 27249184 DOI: 10.1002/jmri.25325] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/12/2016] [Indexed: 12/19/2022] Open
Abstract
Over the past years, technological improvements and refinements in magnetic resonance imaging (MRI) hardware have made high-quality diffusion-weighted imaging (DWI) routinely possible for the bowel. DWI is promising for the detection and characterization of lesions in Crohn's disease (CD) and has been advocated as an alternative to intravenous gadolinium-based contrast agents. Furthermore, quantification using the apparent diffusion coefficient may have value as a biomarker of CD activity and has shown promise. In this article we critically review the literature pertaining to the value of DWI in CD for detection, characterization, and quantification of disease activity and complications. Although the body of supportive evidence is growing, it is clear that well-designed, multicenter studies are required before the role of DWI in clinical practice can be fully established. J. Magn. Reson. Imaging 2016;44:1381-1396.
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Affiliation(s)
- Anthony Dohan
- McGill University Health Center, Department of Radiology, McGill University Health Center, Montreal, QC, Canada
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
- INSERM UMR 965, Paris, France
| | - Stuart Taylor
- Centre for Medical Imaging, University College London, Podium Level 2, University College Hospital, London, UK
| | | | - Maximilien Barret
- Department of Gastroenterology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Matthieu Allez
- Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
- Department of Gastroenterology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Raphael Dautry
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Magaly Zappa
- Department of Radiology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | | | - Xavier Dray
- Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
- Department of Gastroenterology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mourad Boudiaf
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Caroline Reinhold
- McGill University Health Center, Department of Radiology, McGill University Health Center, Montreal, QC, Canada
| | - Philippe Soyer
- Department of Body and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
- INSERM UMR 965, Paris, France
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28
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Contrast-Enhanced Cross Sectional Imaging and Capsule Endoscopy: New Perspectives for a Whole Picture of the Small Bowel. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2015; 23:28-35. [PMID: 28868427 PMCID: PMC5580122 DOI: 10.1016/j.jpge.2015.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 07/09/2015] [Indexed: 11/22/2022]
Abstract
Small bowel evaluation is a challenging task and has been revolutionized by high-quality contrasted sectional imaging (CT enterography - CTE) and magnetic resonance enterography (MRE) as well as by small bowel capsule endoscopy (SBCE). The decision of which technique to employ during the investigation of small bowel diseases is not always simple or straightforward. Moreover, contraindications may preclude the use of these techniques in some patients, and although they are noninvasive procedures, may present with various complications. SBCE plays a crucial role in the investigation of both obscure gastrointestinal bleeding and Crohn's disease, but it is also useful for surveillance of patients with Peutz-Jeghers syndrome, while CTE is very accurate in small bowel tumours and in established Crohn's Disease, and its use in patients presenting with gastrointestinal bleeding is increasing. MRE, an expensive and not widely available technique, is essential for the study of patients with Crohn's Disease, and presents an attractive alternative to SBCE in Peutz-Jeghers syndrome surveillance. These diagnostic modalities are often not competitive but synergistic techniques. Knowing their characteristics, strengths and limitations, indications, contraindications and potential complications, as well as the adaptation to local availability and expertise, is essential to better select which procedures to perform in each patient, both safely and effectively, in order to optimize management and improve patient outcomes.
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Abstract
Wireless capsule endoscopy (CE) for the diagnosis of small-bowel disease has been in clinical use for more than a decade, and is no longer an emerging technology, but rather one that has reached fruition. This noninvasive technology has been readily embraced by both physicians and patients. Used in the diagnosis of inflammatory bowel disease, for locating sources of obscure gastrointestinal bleeding, and for assessing small-bowel polyp burden in polyposis syndromes as well as for less common indications, CE has transformed the diagnostic algorithms of small-bowel investigations. Although already in widespread use, the technology incorporated into the various CE platforms continues to improve and expand. Here, we briefly review the indications, limitations, and advances in video capsule technology, with an emphasis on its use in pediatrics.
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