ISOLATED PEUTZ JEGHERS GALL

BLADDER POLYP
PRASHANTH KOYYODA, G R Mallikarjuna, B Moksha
Prasuna,
Ch Madhusudhan, R Pratap Reddy

Osmania Medical College, Hyderabad

INTRODUCTION : Hamartomatous polyp is an extremely
rare polypoidal lesion of the gallbladder, with the first case
having been reported in 1998(1). Fewer than 10
hamartomatous gallbladder polyps have been reported in
patients with Peutz-Jeghers syndrome (PJS)(2). Only a single
case report of isolated peutz jeghers polyp in gall bladder
has been reported in a patient without PJS like in the
present case.

CASE REPORT : 64year old female presented with

abdominal pain and was found to have a polypoid
mass in the gall bladder and multiple filling defects in
the
CBD.
Patient
underwent
extended
cholecystectomy in view of suspected carcinoma gall
bladder. On examination there was a large friable
polyp in the gall bladder and multiple CBD stones.
Microscopic examination revealed a hamartomatous
(peutz jegher) polyp. Post operatively screening was
done by endoscopy, colonoscopy and CT enteroclysis
to look for polyps elsewhere and no such lesions were
DISCUSSION
:
Peutz-Jeghers
syndrome
(PJS)
is
an
found. There was no significant family history in this
autosomal-dominant inherited syndrome characterized by
case

MRCP showing polypoidal mass in

the Gallbladder , with filling defects
in Common Bile Duct

Resected specimen of
extended
cholecystectomy showing
distended gall bladder

Absent
perioral
pigmentatio
n

Polypoid
pedunculated growth
inside the resected
gall bladder

4x view showing arborizing

pattern of
smooth muscle surrounding the
lobules of hyperplastic mucosal
glands

hamartomatous polyps in the gastrointestinal tract,

pigmented macules of mucous membranes and skin, and a
predisposition to gastrointestinal and other tumors . The
small bowel is the most common affected site followed by
colon, stomach, duodenum, and appendix. Extra intestinal
polyps may occur rarely and the possible sites include the
respiratory tract, urogenital tract and biliary tract.Fewer than
10 cases
of gall bladder
hamartomatous polyps are
described in peutz jeghers syndrome. The largest series
40x
view
showing
splaying
of
smooth
evaluating
extraintestinal polyps in patients with PJS
muscle
bundles
and
hyperplastic
revealed 3 patients with a gallbladder polyp among 72
glandular epithelium
patients with 1 pathologically proven
hamartomatous
(2)
polyp . Only 1 case of isolated peutz jeghers polyp in non
(3)
CONCLUSION
: Extra
intestinal
isolated
hamartomatous
peutz jeghers
syndromic case has
been reported
till date
. SolitaryPJP
do
not carry have
a risk been
of gastrointestinal
and are
notin
anPJS. This case is an isolated
polyps
describedcancer
in biliary
tree
(4)
indication
for
specific
high-risk
screening
.
peutz
jeghers polyp in gall bladder in a non PJS patient.
REFERENCES:
1.
2.
3.

Guzmn P, Roa I, Villaseca M, Roa JC, Araya JC. Peritoneal pseudomyxoma in a child with a gallbladder Peutz-Jeghers like hamartomatous polyp: a case report. J
PediatricsSurg 1998; 33:13201322
Vogel T, Schumacher V, Saleh A, et al. Extraintestinal polyps in Peutz-Jeghers syndrome: presentation of four cases and review of the literature. Deutsche PeutzJeghers-Studiengruppe.Int J Colorectal Dis. 2000 Apr;15(2):118-23.
A.DevrimKaraosmaniglu,MD,Michael Blake, MD, Hamartomatous polyp of the gall bladder with an associated choledochal cyst by American Institute of Ultrasound in
Medicine.J Ultrasound Med 2010;29:1663-1666.