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Characteristics of Small Bowel Polyps Detected in Cowden Syndrome by Capsule Endoscopy.

Saito K, Nomura E, Sasaki Y, Abe Y, Kanno N, Mizumoto N, Shibuya R, Sakuta K, Yagi M, Yoshizawa K, Iwano D, Sato T, Nishise S, Ueno Y - Case Rep Gastrointest Med (2015)

Bottom Line: Cowden syndrome is an uncommon, autosomal dominant disease characterized by multiple hamartomas and hyperplastic lesions in the skin, mucous membrane, brain, breast, thyroid, and gastrointestinal tract.Hamartomatous polyps occur throughout the gastrointestinal tract, the most common sites being the stomach, colon, esophagus, and duodenum.The small bowel polyps of Cowden syndrome frequently occur at the oral end of the small bowel, especially in the duodenum and jejunum, and their color is similar to that of the surrounding mucosa; additionally, the polyps are relatively small (2-5 mm).

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.

ABSTRACT
Cowden syndrome is an uncommon, autosomal dominant disease characterized by multiple hamartomas and hyperplastic lesions in the skin, mucous membrane, brain, breast, thyroid, and gastrointestinal tract. About 30% of Cowden syndrome cases are reportedly complicated by malignant diseases. Hamartomatous polyps occur throughout the gastrointestinal tract, the most common sites being the stomach, colon, esophagus, and duodenum. Small bowel polyps can occur in Cowden syndrome; however, they are difficult to detect by conventional examination, including double-contrast X-ray study. Here, we report three cases of Cowden syndrome with small bowel polyps, which were detected by capsule endoscopy. The small bowel polyps of Cowden syndrome frequently occur at the oral end of the small bowel, especially in the duodenum and jejunum, and their color is similar to that of the surrounding mucosa; additionally, the polyps are relatively small (2-5 mm). Capsule endoscopy is useful for detecting small bowel polyps in Cowden syndrome.

No MeSH data available.


Related in: MedlinePlus

Endoscopic views of Case 1. (a) Colonoscopy revealed multiple rectal polyps. (b) Esophagogastroduodenoscopy (EGD) showed whitish polypoid lesions in the esophagus. (c) EGD showed multiple gastric polyps. (d) Capsule endoscopy revealed multiple polypoid lesions similar in color to the surrounding mucosa in the jejunum, with their diameters of 2–5 mm. (e) Capsule endoscopy revealed hemangiomas in the jejunum.
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fig1: Endoscopic views of Case 1. (a) Colonoscopy revealed multiple rectal polyps. (b) Esophagogastroduodenoscopy (EGD) showed whitish polypoid lesions in the esophagus. (c) EGD showed multiple gastric polyps. (d) Capsule endoscopy revealed multiple polypoid lesions similar in color to the surrounding mucosa in the jejunum, with their diameters of 2–5 mm. (e) Capsule endoscopy revealed hemangiomas in the jejunum.

Mentions: A 46-year-old man was referred to our hospital for hematochezia. He had no significant medical history and family history. He had multiple facial papules and small, whitish gingival papilloma. A colonoscopy revealed multiple rectosigmoid colon polyps, predominantly located in the lower rectum (Figure 1(a)). Esophagogastroduodenoscopy (EGD) showed whitish polypoid lesions in the esophagus (Figure 1(b)) and multiple gastric polyps (Figure 1(c)). Biopsy specimens from the gastric and rectal polyps revealed hamartomatous changes and hyperplasia. The esophageal polyps were diagnosed histopathologically as glycogenic acanthosis. The facial papules were diagnosed as trichilemmomas by histopathological examination. He was diagnosed with Cowden syndrome in accordance with the criteria of the International Cowden Consortium [7]. CE was performed to examine the small bowel and revealed multiple polypoid lesions that were similar in color to the surrounding mucosa; their diameters ranged from 2 to 5 mm at the distal end of the duodenum and jejunum (Figure 1(d)). The polyps were sparse, although their numbers were higher in the jejunum. Several hemangiomas were also observed in the jejunum (Figure 1(e)). They were more frequently observed at the oral end of the small bowel. The duodenal polyps were histopathologically diagnosed as being hamartomatous. No further malignant complications were observed; the patient was followed up in our hospital.


Characteristics of Small Bowel Polyps Detected in Cowden Syndrome by Capsule Endoscopy.

Saito K, Nomura E, Sasaki Y, Abe Y, Kanno N, Mizumoto N, Shibuya R, Sakuta K, Yagi M, Yoshizawa K, Iwano D, Sato T, Nishise S, Ueno Y - Case Rep Gastrointest Med (2015)

Endoscopic views of Case 1. (a) Colonoscopy revealed multiple rectal polyps. (b) Esophagogastroduodenoscopy (EGD) showed whitish polypoid lesions in the esophagus. (c) EGD showed multiple gastric polyps. (d) Capsule endoscopy revealed multiple polypoid lesions similar in color to the surrounding mucosa in the jejunum, with their diameters of 2–5 mm. (e) Capsule endoscopy revealed hemangiomas in the jejunum.
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4495180&req=5

fig1: Endoscopic views of Case 1. (a) Colonoscopy revealed multiple rectal polyps. (b) Esophagogastroduodenoscopy (EGD) showed whitish polypoid lesions in the esophagus. (c) EGD showed multiple gastric polyps. (d) Capsule endoscopy revealed multiple polypoid lesions similar in color to the surrounding mucosa in the jejunum, with their diameters of 2–5 mm. (e) Capsule endoscopy revealed hemangiomas in the jejunum.
Mentions: A 46-year-old man was referred to our hospital for hematochezia. He had no significant medical history and family history. He had multiple facial papules and small, whitish gingival papilloma. A colonoscopy revealed multiple rectosigmoid colon polyps, predominantly located in the lower rectum (Figure 1(a)). Esophagogastroduodenoscopy (EGD) showed whitish polypoid lesions in the esophagus (Figure 1(b)) and multiple gastric polyps (Figure 1(c)). Biopsy specimens from the gastric and rectal polyps revealed hamartomatous changes and hyperplasia. The esophageal polyps were diagnosed histopathologically as glycogenic acanthosis. The facial papules were diagnosed as trichilemmomas by histopathological examination. He was diagnosed with Cowden syndrome in accordance with the criteria of the International Cowden Consortium [7]. CE was performed to examine the small bowel and revealed multiple polypoid lesions that were similar in color to the surrounding mucosa; their diameters ranged from 2 to 5 mm at the distal end of the duodenum and jejunum (Figure 1(d)). The polyps were sparse, although their numbers were higher in the jejunum. Several hemangiomas were also observed in the jejunum (Figure 1(e)). They were more frequently observed at the oral end of the small bowel. The duodenal polyps were histopathologically diagnosed as being hamartomatous. No further malignant complications were observed; the patient was followed up in our hospital.

Bottom Line: Cowden syndrome is an uncommon, autosomal dominant disease characterized by multiple hamartomas and hyperplastic lesions in the skin, mucous membrane, brain, breast, thyroid, and gastrointestinal tract.Hamartomatous polyps occur throughout the gastrointestinal tract, the most common sites being the stomach, colon, esophagus, and duodenum.The small bowel polyps of Cowden syndrome frequently occur at the oral end of the small bowel, especially in the duodenum and jejunum, and their color is similar to that of the surrounding mucosa; additionally, the polyps are relatively small (2-5 mm).

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan.

ABSTRACT
Cowden syndrome is an uncommon, autosomal dominant disease characterized by multiple hamartomas and hyperplastic lesions in the skin, mucous membrane, brain, breast, thyroid, and gastrointestinal tract. About 30% of Cowden syndrome cases are reportedly complicated by malignant diseases. Hamartomatous polyps occur throughout the gastrointestinal tract, the most common sites being the stomach, colon, esophagus, and duodenum. Small bowel polyps can occur in Cowden syndrome; however, they are difficult to detect by conventional examination, including double-contrast X-ray study. Here, we report three cases of Cowden syndrome with small bowel polyps, which were detected by capsule endoscopy. The small bowel polyps of Cowden syndrome frequently occur at the oral end of the small bowel, especially in the duodenum and jejunum, and their color is similar to that of the surrounding mucosa; additionally, the polyps are relatively small (2-5 mm). Capsule endoscopy is useful for detecting small bowel polyps in Cowden syndrome.

No MeSH data available.


Related in: MedlinePlus