PMC9581254_01
The patient had black pigmented spots on his lips (A). At a previous hospital, esophagogastroduodenoscopy revealed a 20 mm stalked polyp in the descending portion of the duodenum. After endoscopic mucosal resection, hemostasis was performed at the excision site with two clips (B,C). The histopathological examination revealed dendritic growth and proliferation of the muscularis mucosae and hyperplasia of the small intestinal epithelium, all of which are consistent with Peutz-Jeghers syndrome (D).
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F1
He noticed black pigmented spots on his lips, buccal mucosa, fingertips, and soles of his feet at the time (Figure 1A). Since no obvious bleeding symptoms were observed in daily life, EMR for duodenal polyps was performed (Figure 1B), and hemostasis was performed at the excision site with two clips (Figure 1C). The histopathological examination revealed dendritic growth and proliferation of the muscularis mucosae as well as hyperplasia of the small intestinal epithelium, all of which are consistent with PJS (Figure 1D).
Small intestine fluoroscopy revealed a polyp in the jejunum (A), and abdominal computed tomography showed two polyps and intussusception (B,C). White arrow, polyp.
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F2
Small intestine fluoroscopy was conducted and revealed a polyp in the jejunum (Figure 2A), and abdominal computed tomography (CT) scan showed two polyps and intussusception (Figures 2B,C), but no gastrointestinal symptoms were experienced.
Double-balloon enteroscopy revealed two polyps with diameters of 20 and 30 mm (A,B). The pathological findings were consistent with hamartoma (C).
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F3
On double-balloon enteroscopy, the resected polyps were hamartoma with diameters of 20 and 30 mm (Figures 3A,B). The pathological findings indicated a hamartoma (Figure 3C).
After endoscopic mucosal resection:suspected post-bleeding, abdominal x-rays (A) and enhanced abdominal computed tomography scan revealed that the position of the clips had not changed from the position immediately after EMR (B), and there were no signs of gastrointestinal perforation or arterial bleeding (C,D).
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F4
Abdominal x-rays (Figure 4A) and enhanced abdominal CT scan at the time revealed that the position of the clips had not changed from the position immediately after EMR (Figure 4B), and there were no signs of gastrointestinal perforation or arterial bleeding (Figures 4C,D).