APC gene mutations in a jejunal adenoma causing intussusception in a patient with familial adenomatous polyposis.
Adenomatous polyps of the jejunum/ileum in patients with familial adenomatous polyposis (FAP) are usually small (<5 mm) and are considered to be of little clinical importance. Genetic alterations in these polyps have not previously been analyzed. We herein report an extremely rare case of FAP presenting with intussusception caused by jejunal adenomas. Both somatic and germline mutations of the APC gene were detected in one of the polyps. A 40-year-old man with FAP was admitted for closure of an ileostomy that had been created because of an anastomotic leak after subtotal proctocolectomy with ileo-anal-canal anastomosis. During the follow-up after that surgery, he had occasionally complained of colicky abdominal pain, but it had quickly subsided. At the second laparotomy, for closure of the ileostomy, jejuno-jejunal intussusception was incidentally found, and segmental resection of the jejunum, including the leading point of the intussusception, was performed. There were five polyps clustered in the resected jejunum. Histologically, the polyps, ranging from 5 to 26 mm in diameter, were adenomas with moderate to severe atypia. Genetic examinations of one of the largest polyps, using polymerase chain reaction single-strand conformation polymorphism (PCR-SSCP) and direct sequencing methods, revealed somatic (T insertion at codon 1557) and germline mutations (4 base-pair deletion at codons 181-182) of the APC gene. This is the first evidence that the coexistence of somatic and germline alterations in the APC gene is involved in the development of a jejunal adenoma causing small-bowel intussusception.
Ishida
Hideyuki
H
Department of Surgery, Saitama Medical Center, Saitama Medical School, 1981 Kamoda-Tsujidocho, Kawagoe 350-8550, Japan.
Iwama
Takeo
T
Inokuma
Shigehisa
S
Takeuchi
Ikuya
I
Hashimoto
Daijo
D
Miyaki
Michiko
M
D000236:Adenoma / Q000150:complications / Q000235:genetics* / Q000473:pathology; D011125:Adenomatous Polyposis Coli / Q000150:complications / Q000235:genetics* / Q000473:pathology; D000328:Adult; D000714:Anastomosis, Surgical; D001707:Biopsy, Needle; D003082:Colectomy / Q000379:methods; D005500:Follow-Up Studies; D017491:Genes, APC; D018095:Germ-Line Mutation; D006801:Humans; D007150:Immunohistochemistry; D007443:Intussusception / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D007580:Jejunal Neoplasms / Q000150:complications / Q000235:genetics*; D008297:Male; D016133:Polymerase Chain Reaction; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome