Case Report
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World J Gastroenterol. Apr 21, 2012; 18(15): 1845-1848
Published online Apr 21, 2012. doi: 10.3748/wjg.v18.i15.1845
Solitary gastric Peutz-Jeghers type stomach polyp mimicking a malignant gastric tumor
Jong-Shiaw Jin, Ji-Kuen Yu, Tang-Yi Tsao, Lien-Fu Lin
Jong-Shiaw Jin, Tang-Yi Tsao, Department of Pathology, Tungs’ Taichung MetroHarbor Hospital, Wuqi Township, Taichung County 435, Taiwan, China
Ji-Kuen Yu, Department of General Surgery, Tungs’ Taichung MetroHarbor Hospital, Wuqi Township, Taichung County 435, Taiwan, China
Lien-Fu Lin, Department of Gastroenterology, Tungs’ Taichung MetroHarbor Hospital, Wuqi Township, Taichung County 435, Taiwan, China
Author contributions: Jin JS wrote the paper; Yu JK wrote the surgical findings; Tsao TY interpreted the pathological findings; Lin LF approved the final version of the manuscript.
Correspondence to: Lien-Fu Lin, MD, Department of Gastroenterology, Tungs’ Taichung MetroHarbor Hospital, No.699, Sec.1, Zhongqi Rd., Wuqi Township, Taichung County 435, Taiwan, China. aucardla@yahoo.com.tw
Telephone: +886-4-26581919 Fax: +886-4-26582193
Received: November 2, 2011
Revised: January 9, 2012
Accepted: February 8, 2012
Published online: April 21, 2012
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: Peutz-Jeghers type polyp; Submucosa lesion; Stomach cancer; Ectopic pancreas; Endoscopic ultrasonography