A 53-year-old man was admitted to the local hospital with left upper abdominal pain lasting 2 weeks. A gastroscopy showed a bulging gastric lesion in the antrum. However, the pathology was benign. The patient did not receive any treatment, and still had abdominal pain. Then, he was referred to the Second Affiliated Hospital of Xi’an Jiaotong University. Physical examination revealed no mucocutaneous pigmentation, no palpable masses in the abdomen, but left upper abdominal tenderness. The patient had no family history of polyps or tumors in the gastrointestinal tract. Laboratory tests were normal, and the tumor markers were within normal limits. Abdominal computed tomography revealed that the gastric wall in the antrum was thickened (Fig. ). A gastroscopy showed a giant and extensive bulging gastric lesion located on the greater curvature and posterior and anterior walls of the gastric antrum, involving three-quarters of the gastric wall. The mucosal surface of the lesion was smooth without erosion or ulcer. Magnifying endoscopy with narrow-band imaging showed the almost normal microvascular morphology of the lesion (Fig. ). Endoscopic ultrasonography was performed, showing a low-echo area in the muscularis mucosae and no invasion into the submucosal layer, without enlarged celiac lymph nodes (Fig. ). An endoscopic mucosal resection was performed, and a bigger specimen was sent for histopathological examination to confirm the diagnosis. The final pathology report indicated a hamartomatous polyp (Fig. ). After excluding PJS, a solitary Peutz–Jeghers-type hamartomatous polyp was diagnosed. Then, the patient underwent an ESD. The resected specimen was measured in 110 × 80 × 4 mm3 (Fig. ). We treated patients with acid suppression. The patient recovered quickly, without any complications. A gastroscopy on the fourth day after endoscopic surgery showed a large postoperative artificial ulcer (Fig. ). A gastroscopy on the 40th day after endoscopic surgery showed a narrow lumen of the stomach caused by ulcer healing. Also, a polyp of 4 × 4 mm2 was observed in the lesser curvature of the gastric body (Fig. ). The patient was followed up regularly.
We report a case of a 37 year old man who admitted to our hospital with complaint of occasionally painless rectal bleeding since 8 years ago which had exacerbated with no history of weight loss, abdominal pain, loss of appetite or anal pain. He had no significant past medical history or significant family history of GI malignancy. In physical examination he did not had any pigmentation in mucocutaneous and any abnormal finding in abdomen and rectal examination.\nGastrointestinal endoscopy revealed multiple polyps located in the deuodenum and less than 100 polyps in colon with aggregation in left colon and sigmoid with pathology of juvenile polyposis.\nA barium enema he had mucosal lesions in keeping with polyps in sigmoid (). A laparotomy was performed and multiple giant polyps entire colon was found. Total abdominal proctocolectomy and J pouch ileoanal anastomosis and omentectomy was performed and a diverting ileostomy was inserted. Histopathological evaluations of the polyps revealed hamartomatous polyps in keeping with a diagnosis of Peutz Jeghers syndrome ().