title: Colonic manifestations of PTEN hamartoma tumor syndrome: case series and systematic review.
abstract: OBJECTIVE
  To investigate our clinical experience with the colonic manifestations of phosphatase and tensin homolog on chromosome ten (PTEN) hamartoma tumor syndrome (PHTS) and to perform a systematic literature review regarding the same.
  
  
  METHODS
  This study was approved by the appropriate institutional review board prior to initiation. A clinical genetics database was searched for patients with PHTS or a component syndrome that received gastrointestinal endoscopy or pathology interpretation at our center. These patient's records were retrospectively reviewed for clinical characteristics (including family history and genetic testing), endoscopy results and pathology findings. We also performed a systematic review of the literature for case series of PHTS or component syndromes that reported gastrointestinal manifestations and investigations published after consensus diagnostic criteria were established in 1996. These results were compiled and reported.
  
  
  RESULTS
  Eight patients from our institution met initial inclusion criteria. Of these, 5 patients underwent 4.2 colonoscopies at mean age 45.8 ± 10.8 years. All were found to have colon polyps during their clinical course and polyp histology included adenoma, hyperplastic, ganglioneuroma and juvenile. No malignant lesions were identified. Two had multiple histologic types. One patient underwent colectomy due to innumerable polyps and concern for future malignant potential. Systematic literature review of PHTS patients undergoing endoscopy revealed 107 patients receiving colonoscopy at mean age 37.4 years. Colon polyps were noted in 92.5% and multiple colon polyp histologies were reported in 53.6%. Common polyp histologies included hyperplastic (43.6%), adenoma (40.4%), hamartoma (38.3%), ganglioneuroma (33%) and inflammatory (24.5%) polyps. Twelve (11.2%) patients had colorectal cancer at mean age 46.7 years (range 35-62). Clinical outcomes secondary to colon polyposis and malignancy were not commonly reported.
  
  
  CONCLUSIONS
  PHTS has a high prevalence of colon polyposis with multiple histologic types. It should be considered a mixed polyposis syndrome. Systematic review found an increased prevalence of colorectal cancer and we recommend initiating colonoscopy for colorectal cancer surveillance at age 35 years.
authors.affiliation: Peter P Stanich, Samer El-Dika, Marty M Meyer, Division of Gastroenterology, Hepatology and Nutrition, the Ohio State University Wexner Medical Center, Columbus, OH 43210, United States.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Stanich
authors.affiliation: Peter P Stanich, Samer El-Dika, Marty M Meyer, Division of Gastroenterology, Hepatology and Nutrition, the Ohio State University Wexner Medical Center, Columbus, OH 43210, United States.
authors.forename: Robert
authors.initials: R
authors.lastname: Pilarski
authors.affiliation: Peter P Stanich, Samer El-Dika, Marty M Meyer, Division of Gastroenterology, Hepatology and Nutrition, the Ohio State University Wexner Medical Center, Columbus, OH 43210, United States.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rock
authors.affiliation: Peter P Stanich, Samer El-Dika, Marty M Meyer, Division of Gastroenterology, Hepatology and Nutrition, the Ohio State University Wexner Medical Center, Columbus, OH 43210, United States.
authors.forename: Wendy L
authors.initials: WL
authors.lastname: Frankel
authors.affiliation: Peter P Stanich, Samer El-Dika, Marty M Meyer, Division of Gastroenterology, Hepatology and Nutrition, the Ohio State University Wexner Medical Center, Columbus, OH 43210, United States.
authors.forename: Samer
authors.initials: S
authors.lastname: El-Dika
authors.affiliation: Peter P Stanich, Samer El-Dika, Marty M Meyer, Division of Gastroenterology, Hepatology and Nutrition, the Ohio State University Wexner Medical Center, Columbus, OH 43210, United States.
authors.forename: Marty M
authors.initials: MM
authors.lastname: Meyer
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000150:complications / Q000175:diagnosis / Q000235:genetics / Q000628:therapy; D000328:Adult; D003106:Colon / Q000473:pathology*; D030541:Databases, Genetic; D005260:Female; D005773:Gastroscopy; D006223:Hamartoma Syndrome, Multiple / Q000150:complications / Q000175:diagnosis* / Q000235:genetics* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D051059:PTEN Phosphohydrolase / Q000235:genetics; D010641:Phenotype; D015995:Prevalence; D012189:Retrospective Studies
chemical_list: D051059:PTEN Phosphohydrolase; C494929:PTEN protein, human
keywords: Adenoma; Bannayan-Riley-Ruvalcaba syndrome; Colon polyps; Colorectal cancer; Cowden syndrome; Endoscopy; Ganglioneuroma; Hamartoma; Hyperplastic; Phosphatase and tensin homolog on chromosome ten