Peutz-Jeghers syndrome
Updates to Article Attributes
Peutz-Jeghers syndrome is one of the polyposis syndromes. It has an autosomal dominant inheritance and is characterised by:
- multiple hamartomatous polyps, most commonly involving the small intestine (predominantly the ileum), but also colon and stomach; mouth and oesophagus are spared
- mucocutaneous melanin pigmentation involving the mouth, fingers and toes
Epidemiology
Peutz-Jeghers syndrome has been reported to be as common as 1 in 8300 live births.
Clinical presentation
Findings on clinical examination include mucocutaneous hyperpigmented macules of the nose, buccal mucosa, axilla, hands, feet and genitalia 4. A clinical diagnosis can be made following histopathological confirmation of typical Peutz-Jeghers syndrome morphology in 2 or more intestinal polyps, or after any number of polyps or hyperpigmented macules (in a characteristic location) with a positive family history 4.
Pathology
Peutz-Jeghers polyps are non-neoplastic hamartomas due to the proliferation of all three layers of the mucosa, which have a characteristic feature of a smooth muscle core continuous with muscularis mucosa in a tree-like branching pattern. This distinguishes them from the hamartomatous polyps of Cronkhite-Canada syndrome, juvenile polyposis and Cowden disease 1.
Patients are at increased risk of:
- intussusception
- GI tract adenocarcinoma, although the polyps themselves are not premalignant
- stomach: 29% lifetime risk 4
- small intestine: 13% lifetime risk 4
- extraintestinal malignancies
- adenoma malignum (adenocarcinoma subtype of the cervix)
- breast: 45-50% lifetime risk 4, more frequently ductal
- pancreas: 11-36% lifetime risk 4
- ovary: 18-21% lifetime risk 4, mainly sex cord tumours
- uterus: 9-10% lifetime risk 4
- cervix: 10-23% lifetime risk 4
- testis: 9% lifetime risk 4, large calcifying Sertoli cell tumours
- lung: 15-17% lifetime risk 4
Genetics
It is attributed to mutations in tumour suppressor genes, most commonly STK11 (70-94%) 4.
Treatment and prognosis
Due to the increased risk of malignancy, screening is generally recommended. Examples include annual mammography and contrast-enhanced breast MRI, beginning at 25 years of age; baseline CT/MR enterography at 8-10 years of age (and every 2-3 years from 18 years of age); MRCP or endoscopic US every 1-2 years beginning from 30-35 years of age 4.
History and etymology
The syndrome is named after Jans Peutz (1886-1957), a Dutch physician and Harold Jeghers (1904-1990), an American physician who had successively described the association between polyposis and the mucocutaneous macules.
-</ul><h4>Epidemiology</h4><p>Peutz-Jeghers syndrome has been reported to be as common as 1 in 8300 live births.</p><h4>Clinical presentation</h4><p>Findings on clinical examination include mucocutaneous hyperpigmented macules of the nose, buccal mucosa, axilla, hands, feet and genitalia <sup>4</sup>. A clinical diagnosis can be made following histopathological confirmation of typical Peutz-Jeghers syndrome morphology in 2 or more intestinal polyps, or after any number of polyps or hyperpigmented macules (in a characteristic location) with a positive family history <sup>4</sup>.</p><h4>Pathology</h4><p>Peutz-Jeghers polyps are non-neoplastic <a href="/articles/hamartoma">hamartomas</a> due to the proliferation of all three layers of the mucosa, which have a characteristic feature of a smooth muscle core continuous with muscularis mucosa in a tree-like branching pattern. This distinguishes them from the hamartomatous polyps of <a href="/articles/cronkhite-canada-syndrome-1">Cronkhite-Canada syndrome</a>, <a href="/articles/juvenile-polyposis">juvenile polyposis</a> and <a href="/articles/cowden-syndrome">Cowden disease</a><sup> 1</sup>.</p><p>Patients are at increased risk of:</p><ul>- +</ul><h4>Epidemiology</h4><p>Peutz-Jeghers syndrome has been reported to be as common as 1 in 8300 live births.</p><h4>Clinical presentation</h4><p>Findings on clinical examination include mucocutaneous hyperpigmented macules of the nose, buccal mucosa, axilla, hands, feet and genitalia <sup>4</sup>. A clinical diagnosis can be made following histopathological confirmation of typical Peutz-Jeghers syndrome morphology in 2 or more intestinal polyps or after any number of polyps or hyperpigmented macules (in a characteristic location) with a positive family history <sup>4</sup>.</p><h4>Pathology</h4><p>Peutz-Jeghers polyps are non-neoplastic <a href="/articles/hamartoma">hamartomas</a> due to the proliferation of all three layers of the mucosa, which have a characteristic feature of a smooth muscle core continuous with muscularis mucosa in a tree-like branching pattern. This distinguishes them from the hamartomatous polyps of <a href="/articles/cronkhite-canada-syndrome-1">Cronkhite-Canada syndrome</a>, <a href="/articles/juvenile-polyposis">juvenile polyposis</a> and <a href="/articles/cowden-syndrome">Cowden disease</a><sup> 1</sup>.</p><p>Patients are at increased risk of:</p><ul>
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