title: Endoscopic snare papillectomy for a solitary Peutz-Jeghers-type polyp in the duodenum with ingrowth into the common bile duct: Case report.
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.
authors.affiliation: Keiichi Suzuki, Department of Surgery, Kitasato Institute Hospital, Tokyo 108-8642, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Keiichi Suzuki, Department of Surgery, Kitasato Institute Hospital, Tokyo 108-8642, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Higuchi
authors.affiliation: Keiichi Suzuki, Department of Surgery, Kitasato Institute Hospital, Tokyo 108-8642, Japan.
authors.forename: Sayaka
authors.initials: S
authors.lastname: Shimizu
authors.affiliation: Keiichi Suzuki, Department of Surgery, Kitasato Institute Hospital, Tokyo 108-8642, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Nakano
authors.affiliation: Keiichi Suzuki, Department of Surgery, Kitasato Institute Hospital, Tokyo 108-8642, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Serizawa
authors.affiliation: Keiichi Suzuki, Department of Surgery, Kitasato Institute Hospital, Tokyo 108-8642, Japan.
authors.forename: Shojiro
authors.initials: S
authors.lastname: Morinaga
mesh_terms: D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery*; D001706:Biopsy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000473:pathology / Q000601:surgery*; D019160:Endosonography; D006801:Humans; D008297:Male; D010580:Peutz-Jeghers Syndrome / Q000473:pathology / Q000601:surgery*; D016717:Sphincterotomy, Endoscopic; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Acute cholangitis; Duodenum polyp; Hamartoma; Jaundice; Peutz-Jeghers polyp