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Published in: Familial Cancer 2/2009

01-06-2009

Intussusception in the adult: an unsuspected case of Peutz–Jeghers syndrome with review of the literature

Authors: Jason D. Fraser, Steven E. Briggs, Shawn D. St. Peter, Giovanni De Petris, Jacques Heppell

Published in: Familial Cancer | Issue 2/2009

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Abstract

Peutz–Jeghers syndrome is an uncommon genetic defect in the signal pathways of growth. The incidence has most recently been estimated to be in the range of 1 per 120,000 live births [1]. It is characterized by hamartomas throughout the gastrointestinal tract, mucocutaneous melanotic spots and increased predisposition to malignancy. The infrequent presentation of this syndrome in most practice combined with some less well-known diagnostic features may contribute to a misdiagnosis. Further, understanding of the genetic defect leading to the phenotypic syndrome and the future implications of this defect continue to evolve. Therefore we present a review in the setting of a case of misdiagnosed Peutz–Jeghers syndrome to portray illuminating features of the syndrome and review the literature.
Literature
2.
go back to reference Peutz LJA (1921) Very remarkable case of familial polyposis of mucous membrane of intestinal tract and nasopharynx accompanied by peculiar pigmentation of skin and mucous membrane. Nederl Maandische v Geneesk 10:134–146 Peutz LJA (1921) Very remarkable case of familial polyposis of mucous membrane of intestinal tract and nasopharynx accompanied by peculiar pigmentation of skin and mucous membrane. Nederl Maandische v Geneesk 10:134–146
3.
go back to reference Bartholomew LF, Dahlin DC, Waugh JM (1957) Intestinal polyposis associated with mucocutaneous melanin pigmentation (Peutz-Jeghers syndrome). Review of the literature and report of six cases with special reference to pathologic findings. Gastroenterology 332:434–451 Bartholomew LF, Dahlin DC, Waugh JM (1957) Intestinal polyposis associated with mucocutaneous melanin pigmentation (Peutz-Jeghers syndrome). Review of the literature and report of six cases with special reference to pathologic findings. Gastroenterology 332:434–451
4.
go back to reference Dormandy TL (1957) Gastrointestinal polyposis with mucutaneous pigmentation (Peutz-Jeghers syndrome). N Engl J Med 256:1186–1190PubMed Dormandy TL (1957) Gastrointestinal polyposis with mucutaneous pigmentation (Peutz-Jeghers syndrome). N Engl J Med 256:1186–1190PubMed
5.
go back to reference Brocheriou C, Kuffer R, Verola O (1985) Pigmented lesions of the oral cavity. Ann Pathol 5(4–5):221–229PubMed Brocheriou C, Kuffer R, Verola O (1985) Pigmented lesions of the oral cavity. Ann Pathol 5(4–5):221–229PubMed
7.
go back to reference DePadova-Elder SM, Milgraum SS (1994) Q-switched ruby laser treatment of labial lentigines in Peutz-Jeghers syndrome. J Dermatol Surg Oncol 20(12):830–832PubMed DePadova-Elder SM, Milgraum SS (1994) Q-switched ruby laser treatment of labial lentigines in Peutz-Jeghers syndrome. J Dermatol Surg Oncol 20(12):830–832PubMed
8.
9.
go back to reference Utsunomiya J, Gocho H, Miyanaga T, Hamaguchi E, Kashimure A (1975) Peutz-Jeghers syndrome: its natural course and management. Johns Hopkins Med J 136(2):71–82PubMed Utsunomiya J, Gocho H, Miyanaga T, Hamaguchi E, Kashimure A (1975) Peutz-Jeghers syndrome: its natural course and management. Johns Hopkins Med J 136(2):71–82PubMed
11.
go back to reference Bartholomew LG, Moore CE, Dahlin DC, Waugh JM (1962) Intestinal polyposis associated with mucocutaneous pigmentation. Surg Gynecol Obstet 115:1–11PubMed Bartholomew LG, Moore CE, Dahlin DC, Waugh JM (1962) Intestinal polyposis associated with mucocutaneous pigmentation. Surg Gynecol Obstet 115:1–11PubMed
13.
go back to reference Hemminki A, Markie D, Tomlinson I, Avizienyte E, Roth S, Loukola A et al (1998) A serine/threonine kinase gene defective in Peutz-Jeghers syndrome. Nature 391(6663):184–187. doi:10.1038/34432 PubMedCrossRef Hemminki A, Markie D, Tomlinson I, Avizienyte E, Roth S, Loukola A et al (1998) A serine/threonine kinase gene defective in Peutz-Jeghers syndrome. Nature 391(6663):184–187. doi:10.​1038/​34432 PubMedCrossRef
14.
go back to reference Mehenni H, Gehrig C, Nezu J, Oku A, Shimane M, Rossier C et al (1998) Loss of LKB1 kinase activity in Peutz-Jeghers syndrome, and evidence for allelic and locus heterogeneity. Am J Hum Genet 63(6):1641–1650. doi:10.1086/302159 PubMedCrossRef Mehenni H, Gehrig C, Nezu J, Oku A, Shimane M, Rossier C et al (1998) Loss of LKB1 kinase activity in Peutz-Jeghers syndrome, and evidence for allelic and locus heterogeneity. Am J Hum Genet 63(6):1641–1650. doi:10.​1086/​302159 PubMedCrossRef
15.
go back to reference Wang ZJ, Ellis I, Zauber P, Iwama T, Marchese C, Talbot I et al (1999) Allelic imbalance at the LKB1 (STK11) locus in tumours from patients with Peutz-Jeghers’ syndrome provides evidence for a hamartoma-(adenoma)-carcinoma sequence. J Pathol 188(1):9–13. doi :10.1002/(SICI)1096-9896(199905)188:1<9::AID-PATH326>3.0.CO;2-EPubMedCrossRef Wang ZJ, Ellis I, Zauber P, Iwama T, Marchese C, Talbot I et al (1999) Allelic imbalance at the LKB1 (STK11) locus in tumours from patients with Peutz-Jeghers’ syndrome provides evidence for a hamartoma-(adenoma)-carcinoma sequence. J Pathol 188(1):9–13. doi :10.1002/(SICI)1096-9896(199905)188:1<9::AID-PATH326>3.0.CO;2-EPubMedCrossRef
16.
go back to reference Hemminki A, Tomlinson I, Markie D, Jarvinen H, Sistonen P, Bjorkqvist AM et al (1997) Localization of a susceptibility locus for Peutz-Jeghers syndrome to 19p using comparative genomic hybridization and targeted linkage analysis. Nat Genet 15(1):87–90. doi:10.1038/ng0197-87 PubMedCrossRef Hemminki A, Tomlinson I, Markie D, Jarvinen H, Sistonen P, Bjorkqvist AM et al (1997) Localization of a susceptibility locus for Peutz-Jeghers syndrome to 19p using comparative genomic hybridization and targeted linkage analysis. Nat Genet 15(1):87–90. doi:10.​1038/​ng0197-87 PubMedCrossRef
17.
18.
go back to reference Boardman LA, Thibodeau SN, Schaid DJ, Lindor NM, McDonnell SK, Burgart LJ et al (1998) Increased risk for cancer in patients with the Peutz-Jeghers syndrome. Ann Intern Med 128(11):896–899PubMed Boardman LA, Thibodeau SN, Schaid DJ, Lindor NM, McDonnell SK, Burgart LJ et al (1998) Increased risk for cancer in patients with the Peutz-Jeghers syndrome. Ann Intern Med 128(11):896–899PubMed
19.
go back to reference Hizawa K, Iida M, Matsumoto T, Kohrogi N, Kinoshita H, Yao T et al (1993) Cancer in Peutz-Jeghers syndrome. Cancer 72(9):2777–2781. doi :10.1002/1097-0142(19931101)72:9<2777::AID-CNCR2820720940>3.0.CO;2-6PubMedCrossRef Hizawa K, Iida M, Matsumoto T, Kohrogi N, Kinoshita H, Yao T et al (1993) Cancer in Peutz-Jeghers syndrome. Cancer 72(9):2777–2781. doi :10.1002/1097-0142(19931101)72:9<2777::AID-CNCR2820720940>3.0.CO;2-6PubMedCrossRef
20.
go back to reference Foley TR, McGarrity TJ, Abt AB (1988) Peutz-Jeghers syndrome: a clinicopathologic survey of the “Harrisburg family” with a 49-year follow-up. Gastroenterology 95(6):1535–1540PubMed Foley TR, McGarrity TJ, Abt AB (1988) Peutz-Jeghers syndrome: a clinicopathologic survey of the “Harrisburg family” with a 49-year follow-up. Gastroenterology 95(6):1535–1540PubMed
22.
go back to reference Linos DA, Dozois RR, Dahlin DC, Bartholomew LG (1981) Does Peutz-Jeghers syndrome predispose to gastrointestinal malignancy? A later look. Arch Surg 116(9):1182–1184PubMed Linos DA, Dozois RR, Dahlin DC, Bartholomew LG (1981) Does Peutz-Jeghers syndrome predispose to gastrointestinal malignancy? A later look. Arch Surg 116(9):1182–1184PubMed
23.
go back to reference Burdick D, Prior JT, Scanlon GT (1963) Peutz-Jeghers syndrome: a clinical-pathological study of a large family with a 10-year follow-up. Cancer 16:854–867. doi :10.1002/1097-0142(196307)16:7<854::AID-CNCR2820160704>3.0.CO;2-7PubMedCrossRef Burdick D, Prior JT, Scanlon GT (1963) Peutz-Jeghers syndrome: a clinical-pathological study of a large family with a 10-year follow-up. Cancer 16:854–867. doi :10.1002/1097-0142(196307)16:7<854::AID-CNCR2820160704>3.0.CO;2-7PubMedCrossRef
24.
go back to reference Burdick D, Prior JT (1982) Peutz-Jeghers syndrome. A clinicopathologic study of a large family with a 27-year follow-up. Cancer 50(10):2139–2146. doi :10.1002/1097-0142(19821115)50:10<2139::AID-CNCR2820501028>3.0.CO;2-KPubMedCrossRef Burdick D, Prior JT (1982) Peutz-Jeghers syndrome. A clinicopathologic study of a large family with a 27-year follow-up. Cancer 50(10):2139–2146. doi :10.1002/1097-0142(19821115)50:10<2139::AID-CNCR2820501028>3.0.CO;2-KPubMedCrossRef
25.
go back to reference Dozois RR, Judd ES, Dahlin DC, Bartholomew LG (1969) The Peutz-Jeghers syndrome. Is there a predisposition to the development of intestinal malignancy? Arch Surg 98(4):509–517PubMed Dozois RR, Judd ES, Dahlin DC, Bartholomew LG (1969) The Peutz-Jeghers syndrome. Is there a predisposition to the development of intestinal malignancy? Arch Surg 98(4):509–517PubMed
26.
go back to reference Miller LJ, Bartholomew LG, Dozois RR, Dahlin DC (1983) Adenocarcinoma of the rectum arising in a hamartomatous polyp in a patient with Peutz-Jeghers syndrome. Dig Dis Sci 28(11):1047–1051. doi:10.1007/BF01311735 PubMedCrossRef Miller LJ, Bartholomew LG, Dozois RR, Dahlin DC (1983) Adenocarcinoma of the rectum arising in a hamartomatous polyp in a patient with Peutz-Jeghers syndrome. Dig Dis Sci 28(11):1047–1051. doi:10.​1007/​BF01311735 PubMedCrossRef
29.
go back to reference Scully RE (1970) Sex cord tumor with annular tubules a distinctive ovarian tumor of the Peutz-Jeghers syndrome. Cancer 25(5):1107–1121. doi :10.1002/1097-0142(197005)25:5<1107::AID-CNCR2820250516>3.0.CO;2-7PubMedCrossRef Scully RE (1970) Sex cord tumor with annular tubules a distinctive ovarian tumor of the Peutz-Jeghers syndrome. Cancer 25(5):1107–1121. doi :10.1002/1097-0142(197005)25:5<1107::AID-CNCR2820250516>3.0.CO;2-7PubMedCrossRef
30.
go back to reference Dozois RR, Dahlin DC, Bartholomew LG (1973) Ovarian tumors associated with the Peutz-Jeghers syndrome. Prog Clin Cancer 5:187–193PubMed Dozois RR, Dahlin DC, Bartholomew LG (1973) Ovarian tumors associated with the Peutz-Jeghers syndrome. Prog Clin Cancer 5:187–193PubMed
31.
go back to reference Young RH, Welch WR, Dickersin GR, Scully RE (1982) Ovarian sex cord tumor with annular tubules: review of 74 cases including 27 with Peutz-Jeghers syndrome and four with adenoma malignum of the cervix. Cancer 50(7):1384–1402. doi :10.1002/1097-0142(19821001)50:7<1384::AID-CNCR2820500726>3.0.CO;2-5PubMedCrossRef Young RH, Welch WR, Dickersin GR, Scully RE (1982) Ovarian sex cord tumor with annular tubules: review of 74 cases including 27 with Peutz-Jeghers syndrome and four with adenoma malignum of the cervix. Cancer 50(7):1384–1402. doi :10.1002/1097-0142(19821001)50:7<1384::AID-CNCR2820500726>3.0.CO;2-5PubMedCrossRef
32.
go back to reference Gilks CB, Young RH, Aguirre P, DeLellis RA, Scully RE (1989) Adenoma malignum (minimal deviation adenocarcinoma) of the uterine cervix. A clinicopathological and immunohistochemical analysis of 26 cases. Am J Surg Pathol 13(9):717–729. doi:10.1097/00000478-198909000-00001 PubMed Gilks CB, Young RH, Aguirre P, DeLellis RA, Scully RE (1989) Adenoma malignum (minimal deviation adenocarcinoma) of the uterine cervix. A clinicopathological and immunohistochemical analysis of 26 cases. Am J Surg Pathol 13(9):717–729. doi:10.​1097/​00000478-198909000-00001 PubMed
33.
go back to reference Herruzo AJ, Redondo E, Perez de Avila I, Aleman M, Menjon S (1990) Ovarian sex cord tumor with annular tubules and Peutz-Jeghers syndrome. Eur J Gynaecol Oncol 11(2):141–144PubMed Herruzo AJ, Redondo E, Perez de Avila I, Aleman M, Menjon S (1990) Ovarian sex cord tumor with annular tubules and Peutz-Jeghers syndrome. Eur J Gynaecol Oncol 11(2):141–144PubMed
36.
go back to reference Niewenhuis JC, Wolf MC, Kass EJ (1994) Bilateral asynchronous sertoli cell tumor in a boy with the Peutz-Jeghers syndrome. J Urol 152(4):1246–1248PubMed Niewenhuis JC, Wolf MC, Kass EJ (1994) Bilateral asynchronous sertoli cell tumor in a boy with the Peutz-Jeghers syndrome. J Urol 152(4):1246–1248PubMed
40.
go back to reference Coen P, Kulin H, Ballantine T, Zaino R, Frauenhoffer E, Boal D et al (1991) An aromatase-producing sex-cord tumor resulting in prepubertal gynecomastia. N Engl J Med 324(5):317–322PubMed Coen P, Kulin H, Ballantine T, Zaino R, Frauenhoffer E, Boal D et al (1991) An aromatase-producing sex-cord tumor resulting in prepubertal gynecomastia. N Engl J Med 324(5):317–322PubMed
42.
43.
go back to reference Panos RG, Opelka FG, Nogueras JJ (1990) Peutz-Jeghers syndrome. A call for intraoperative enteroscopy. Am Surg 56(5):331–333PubMed Panos RG, Opelka FG, Nogueras JJ (1990) Peutz-Jeghers syndrome. A call for intraoperative enteroscopy. Am Surg 56(5):331–333PubMed
44.
go back to reference Keshtgar AS, Losty PD, Lloyd DA, Morris AI, Pierro A (1997) Recent developments in the management of Peutz-Jeghers syndrome in childhood. Eur J Pediatr Surg 7(6):367–368PubMedCrossRef Keshtgar AS, Losty PD, Lloyd DA, Morris AI, Pierro A (1997) Recent developments in the management of Peutz-Jeghers syndrome in childhood. Eur J Pediatr Surg 7(6):367–368PubMedCrossRef
45.
go back to reference van Coevorden F, Mathus-Vliegen EM, Brummelkamp WH (1986) Combined endoscopic and surgical treatment in Peutz-Jeghers syndrome. Surg Gynecol Obstet 162(5):426–428PubMed van Coevorden F, Mathus-Vliegen EM, Brummelkamp WH (1986) Combined endoscopic and surgical treatment in Peutz-Jeghers syndrome. Surg Gynecol Obstet 162(5):426–428PubMed
47.
go back to reference Taira K, Matsubara H, Isa T, Miyazato H, Hiroyasu S, Shiraishi M et al (2000) Combined endoscopic and surgical treatment for multiple polyps of the small intestine in Peutz-Jeghers syndrome: a case report. Surg Laparosc Endosc Percutan Tech 10(6):409–411. doi:10.1097/00019509-200012000-00015 PubMedCrossRef Taira K, Matsubara H, Isa T, Miyazato H, Hiroyasu S, Shiraishi M et al (2000) Combined endoscopic and surgical treatment for multiple polyps of the small intestine in Peutz-Jeghers syndrome: a case report. Surg Laparosc Endosc Percutan Tech 10(6):409–411. doi:10.​1097/​00019509-200012000-00015 PubMedCrossRef
49.
go back to reference Williams CB, Goldblatt M, Delaney PV (1982) ‘Top and tail endoscopy’ and follow-up in Peutz-Jeghers syndrome. Endoscopy 14(3):82–84PubMedCrossRef Williams CB, Goldblatt M, Delaney PV (1982) ‘Top and tail endoscopy’ and follow-up in Peutz-Jeghers syndrome. Endoscopy 14(3):82–84PubMedCrossRef
50.
go back to reference Zanoni EC, Averbach M, Borges JL, Correa PA, Cutait R (2003) Laparoscopic treatment of intestinal intussusception in the Peutz-Jeghers syndrome: case report and review of the literature. Surg Laparosc Endosc Percutan Tech 13(4):280–282. doi:10.1097/00129689-200308000-00012 PubMedCrossRef Zanoni EC, Averbach M, Borges JL, Correa PA, Cutait R (2003) Laparoscopic treatment of intestinal intussusception in the Peutz-Jeghers syndrome: case report and review of the literature. Surg Laparosc Endosc Percutan Tech 13(4):280–282. doi:10.​1097/​00129689-200308000-00012 PubMedCrossRef
51.
go back to reference Phillips RK, Wallace MH, Lynch PM, Hawk E, Gordon GB, Saunders BP et al, FAP Study Group (2002) A randomised, double blind, placebo controlled study of celecoxib, a selective cyclooxygenase 2 inhibitor, on duodenal polyposis in familial adenomatous polyposis. Gut 50(6):857–860. doi:10.1136/gut.50.6.857 PubMedCrossRef Phillips RK, Wallace MH, Lynch PM, Hawk E, Gordon GB, Saunders BP et al, FAP Study Group (2002) A randomised, double blind, placebo controlled study of celecoxib, a selective cyclooxygenase 2 inhibitor, on duodenal polyposis in familial adenomatous polyposis. Gut 50(6):857–860. doi:10.​1136/​gut.​50.​6.​857 PubMedCrossRef
53.
go back to reference Higuchi T, Iwama T, Yoshinaga K, Toyooka M, Taketo MM, Sugihara K (2003) A randomized, double-blind, placebo-controlled trial of the effects of rofecoxib, a selective cyclooxygenase-2 inhibitor, on rectal polyps in familial adenomatous polyposis patients. Clin Cancer Res 9(13):4756–4760PubMed Higuchi T, Iwama T, Yoshinaga K, Toyooka M, Taketo MM, Sugihara K (2003) A randomized, double-blind, placebo-controlled trial of the effects of rofecoxib, a selective cyclooxygenase-2 inhibitor, on rectal polyps in familial adenomatous polyposis patients. Clin Cancer Res 9(13):4756–4760PubMed
54.
go back to reference De Leng WW, Westerman AM, Weterman MA, De Rooij FW, Dekken Hv H, De Goeij AF et al (2003) Cyclooxygenase 2 expression and molecular alterations in Peutz-Jeghers hamartomas and carcinomas. Clin Cancer Res 9(8):3065–3072PubMed De Leng WW, Westerman AM, Weterman MA, De Rooij FW, Dekken Hv H, De Goeij AF et al (2003) Cyclooxygenase 2 expression and molecular alterations in Peutz-Jeghers hamartomas and carcinomas. Clin Cancer Res 9(8):3065–3072PubMed
55.
go back to reference Wei C, Amos CI, Rashid A, Sabripour M, Nations L, McGarrity TJ et al (2003) Correlation of staining for LKB1 and COX-2 in hamartomatous polyps and carcinomas from patients with Peutz-Jeghers syndrome. J Histochem Cytochem 51(12):1665–1672PubMed Wei C, Amos CI, Rashid A, Sabripour M, Nations L, McGarrity TJ et al (2003) Correlation of staining for LKB1 and COX-2 in hamartomatous polyps and carcinomas from patients with Peutz-Jeghers syndrome. J Histochem Cytochem 51(12):1665–1672PubMed
Metadata
Title
Intussusception in the adult: an unsuspected case of Peutz–Jeghers syndrome with review of the literature
Authors
Jason D. Fraser
Steven E. Briggs
Shawn D. St. Peter
Giovanni De Petris
Jacques Heppell
Publication date
01-06-2009
Publisher
Springer Netherlands
Published in
Familial Cancer / Issue 2/2009
Print ISSN: 1389-9600
Electronic ISSN: 1573-7292
DOI
https://doi.org/10.1007/s10689-008-9212-x

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