Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2015; 21(26): 8215-8220
Published online Jul 14, 2015. doi: 10.3748/wjg.v21.i26.8215
Endoscopic snare papillectomy for a solitary Peutz-Jeghers-type polyp in the duodenum with ingrowth into the common bile duct: Case report
Keiichi Suzuki, Hajime Higuchi, Sayaka Shimizu, Masaru Nakano, Hiroshi Serizawa, Shojiro Morinaga
Keiichi Suzuki, Department of Surgery, Kitasato Institute Hospital, Tokyo 108-8642, Japan
Hajime Higuchi, Sayaka Shimizu, Masaru Nakano, Hiroshi Serizawa, Department of Internal Medicine, Kitasato Institute Hospital, Tokyo 108-8642, Japan
Shojiro Morinaga, Department of Diagnostic Pathology, Kitasato Institute Hospital, Tokyo 108-8642, Japan
Author contributions: Suzuki K and Higuchi H participated in endoscopic treatment; Shimizu S was the physician in charge; Morinaga S made the histopathologic diagnosis; Nakano M and Serizawa H contributed as administrators of the endoscopic center; Suzuki K performed data analysis and wrote the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Kitasato Institute Hospital Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Keiichi Suzuki, MD, PhD, Department of Surgery, Kitasato Institute Hospital, 5-9-1, Shirogane, Minato-ku, Tokyo 108-8642, Japan. k1suzuki@me.com
Telephone: +81-3-34446161 Fax: +81-3-34480553
Received: February 6, 2015
Peer-review started: February 9, 2015
First decision: April 13, 2015
Revised: May 7, 2015
Accepted: May 27, 2015
Article in press: May 27, 2015
Published online: July 14, 2015
Processing time: 157 Days and 18.4 Hours
Abstract

Solitary duodenal Peutz-Jeghers (PJ)-type hamartomatous polyps are rare and considered a different disease entity than classic PJ syndrome. We describe the case of an 89-year-old man admitted to our emergency department with symptoms of acute cholangitis, liver dysfunction, and slight jaundice. Magnetic resonance imaging showed multiple signal voids, reflecting choledocholithiasis, and an oval-shaped tumor in the common bile duct (CBD). Following endoscopic retrograde cholangiopancreatography, the patient was diagnosed with a lower CBD tumor 20 mm in diameter. Endoscopic sphincterotomy was performed for choledocholithotomy, resulting in the expulsion of a large tumor with a stalk connected to the papilla of Vater. The tumor was successfully excised en bloc by endoscopic snare papillectomy. Histopathologic examination showed that the tumor was a PJ-type hamartomatous polyp. No mucocutaneous pigmentation of the skin was evident and the patient’s family history was negative. Solitary duodenal PJ-type hamartomatous polyps are usually diagnosed incidentally during endoscopy for other indications because most of these tumors are asymptomatic or have nonspecific presentations. To our knowledge, this is the first reported solitary PJ-type polyp with intra-CBD growth treated by endoscopic snare papillectomy.

Keywords: Acute cholangitis; Hamartoma; Jaundice; Peutz-Jeghers polyp; Duodenum polyp

Core tip: Solitary duodenal Peutz-Jeghers (PJ)-type hamartomatous polyps are rare. This polyp is usually diagnosed incidentally during endoscopy because its presentation is nonspecific. Thus, it is interesting that acute cholangitis was shown as initial symptoms of PJ-type hamartomatous polyp due to intra-common bile duct growth. This is the first reported solitary duodenal PJ-type hamartomatous polyp treated by endoscopic snare papillectomy. PJ-type polyps should be distinguished as solitary or an incomplete type of PJ syndrome. These polyps should be treated by endoscopic or surgical resection due to their malignant potential.