Published online Jul 14, 2015. doi: 10.3748/wjg.v21.i26.8215
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
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.
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.