Solitary gastric Peutz-Jeghers type stomach polyp mimicking a malignant gastric tumor

Abstract

Most cases of Peutz-Jeghers type polyps of the stomach are associated with mucocutaneous pigmentation and multiple intestinal polyposis. A solitary Peutz-Jeghers type polyp of the stomach is rare. We here report a case of a 71-year-old woman with a solitary Peutz-Jeghers type polyp of the stomach who presented with intolerable epigastric pain and weight loss of 5 kg over the prior two months. During the hospital treatment course for this patient, endoscopic examination revealed a bulging lesion with a central hole, mucosal ulceration, an asymmetrical wall thickness and a narrowing of the gastric lumen. A gastric biopsy further revealed ulceration with moderate dysplasia. The patient received endoscopic ultrasonography which showed a second subepithelial lesion that measured 4 cm × 3 cm. Computed tomography of the abdomen subsequently showed a thickened gastric wall with three visibly enlarged lymph nodes, all greater than 1 cm. The suspected diagnosis was malignant gastric cancer with lymph node metastases. The other lesion, which measured 2 cm × 2 cm × 1 cm was noted in the submucosa of the jejunum during surgery. The patient was treated using a subtotal gastrectomy and partial resection of the jejunal tumor. The final pathological report indicated a gastric Peutz-Jeghers type polyp with proliferation of smooth muscle bundles in the submucosal layer, and hyperplastic glands in the mucosal layer and ectopic pancreas of the jejunum. This is the first reported clinical case of a solitary Peutz-Jeghers type polyp of the stomach accompanying a lymph node enlargement and ectopic pancreas in the jejunum that simulates stomach cancer with lymph node metastases.

Keywords: Ectopic pancreas; Endoscopic ultrasonography; Peutz-Jeghers type polyp; Stomach cancer; Submucosa lesion.

Figure 1

Image findings of gastric Peutz-Jeghers type stomach polyp. A: Abdominal computed tomography scans of the patient revealing a thickened gastric wall over the antrum of the stomach (arrow); B: Gastroendoscopy revealing a bulging lesion (4 cm × 3 cm) of the antrum (arrow); C: The bulging lesion displayed a central hole (arrow); D: Endoscopic ultrasonography demonstrating that the appearance of a lesion was due to a thickened subepithelial layer (second layer lesion), submucosal layer thickened (third layer, green arrow), and corresponding hole (red arrow) over the antrum of the stomach.

Figure 2

Pathological findings of gastric Peutz-Jeghers type stomach polyp. A: Gross examination of a stomach specimen from the patient showed a polyp-like lesion (4 cm × 3 cm) over the antrum following endoscopic mucosectomy; B: Immunohistochemical stains of smooth muscle actin in the mucosal layer revealed a proliferation of smooth muscle bundles (× 200); C: Submucosal layer of the lesion revealed a proliferation of smooth muscle bundles (× 200); D: Photomicrogram demonstrating the presence of an ectopic pancreas in the submucosa of the jejunum and of pancreatic ducts, acini and islet cells (hematoxylin and eosine staining, original magnification × 200).