Intestinal neoplasms

Penetrance appears to be high, and both sexes are equally affected {691}. Polyps are most common in the small intestine,

Fig. 4.06 Peutz-Jeghers polyp of the colon. Arborizing smooth muscle separating colonic glands into lobules (Masson trichrome stain).

Fig. 4.07 A A lobulated pedunculated Peutz-Jeghers polyp of the small intestine. B This small intestinal Peutz-Jeghers polyp exhibits haemorraghic infarction due to intussusception.

but may occur anywhere in the gastrointestinal tract.

Signs and symptoms

These include abdominal pain, intestinal bleeding, anaemia, and intussusception. Typical age at clinical manifestation is from two to twenty years. Characteristic pigmentation allows diagnosis of asymptomatic patients in familial cases.


The presence of polyps may be demonstrated by upper gastrointestinal and small bowel contrast radiography, and by air contrast barium enema. Periodic small bowel X-ray examination at two to five-year intervals is advisable in the follow-up of the affected patients. Endoscopy is superior to radiological imaging in that it enables polypectomy for diagnostic and therapeutic purposes. Upper gastrointestinal tract endoscopy and colonoscopy every two years with snare excision of all polyps detected is presently recommended. Small bowel polyps may be reached by an entero-scope but rarely for the full bowel length; thus, imaging remains an integral component of clinical management.

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