Giant Solitary Gastric Peutz-Jeghers Polyp Mimicking a Malignant Gastric Tumor: the Largest Described in Literature

Abstract

A solitary Peutz-Jeghers polyp is defined as a unique polyp occurring without associated mucocutaneous pigmentation or a family history of Peutz-Jeghers syndrome. Gastric solitary localization is a rare event, with only eight reported cases to date. We report herein the case of a 43-year old woman who presented with upper gastrointestinal bleeding, severe anemia, weight loss and asthenia. Endoscopy revealed a giant polypoid tumor with signs of neoplastic invasion of the cardia, with pathological aspect suggesting a Peutz-Jeghers hamartomatous polyp. Computed tomography suggested a malignant gastric tumor and a total gastrectomy was performed. The pathological specimen showed a giant 150/70/50 mm polypoid tumor and immunochemistry established the final diagnostic of a Peutz-Jegers type polyp. This is the largest solitary Peutz-Jeghers gastric polyp reported until now, and the second one mimicking a gastric malignancy with lymph node metastasis.

Differential diagnosis of solitary gastric Peutz-Jeghers-type polyp with stomach cancer: a case report

“…Moderate dysplasia may be diagnosed [ 8 ], because the fragile superficial area is prone to inflammatory erosion. Two patients had swollen lymph nodes [ 8 , 9 ] that were finally diagnosed as reactive hyperplasia without tumor metastasis. Reactive lymph-node swelling is probably due to inflammatory changes on the surfaces of polyps.…”

A giant and extensive solitary Peutz–Jeghers-type polyp in the antrum of stomach

“…The solitary gastric Peutz–Jeghers-type polyps are the rarest. [ 6 ] Kuwano et al [ 7 ] reported a case of solitary gastric hamartomatous polyp in 1989 for the first time. So far, only 9 cases of the solitary gastric Peutz–Jeghers-type polyp were reported abroad (Table 1 ), and a few cases were reported in China, some of which were not adequately detailed.…”

“…[ 8 ] A few cases are similar to the tumor, even with similar performance of tumor metastasis such as enlarged lymph nodes. [ 6 , 9 ] Therefore, the doctor must be very careful during diagnosis. The diagnosis of solitary Peutz–Jeghers-type polyps should be based on pathology.…”

Report of a case combining solitary Peutz-Jeghers polyp, colitis cystica profunda, and high-grade dysplasia of the epithelium of the colon

“…Knowing the existence of this pathological entity is of great importance since it can emulate clinically and histologically a malignant lesion of the colon, leading to unnecessary operative management [ 1 , 6 , 8 ]. Solitary Peutz-Jeghers-type polyp is an uncommon hamartomatous lesion without associated mucocutaneous pigmentation, any other gastrointestinal polyp or a family history of Peutz-Jeghers syndrome [ 9 – 11 ]. To the best of our insight, its association with CCP and dysplastic changes in the overlying epithelium has never been reported again in the English scientific writings.…”