Our case was a 2-year-old boy who was incidentally diagnosed with anemia during the evaluation of an upper respiratory tract infection. There was no history of hematemesis, melena, or abdominal pain. The child was evaluated by the pediatric gastroenterologist with an upper gastrointestinal endoscopy and was found to have a large sessile gastric polyp that was not amenable to endoscopic resection. Physical examination was insignificant except for a few melanotic spots over the lower lip []. Radiological imaging revealed a large hyper-enhancing mass lesion in the lumen of the stomach, measuring about 8 cm in greatest dimension along with multiple small intestinal polyps. Laparotomy revealed a large sessile polyp involving the greater curvature and posterior wall of the stomach measuring about 10 cm × 8 cm along with multiple small sessile polyps involving the corpus of the stomach sparing the antrum and pylorus, requiring partial gastrectomy []. There were two more polyps, one each in the duodenum and distal jejunum in their antimesenteric border and they could be excised by enterotomy. The child had an uneventful postoperative course. The histopathology revealed the features of tubulovillous adenoma in all the resected polyps. At 36 months of follow-up, the child is asymptomatic and disease-free.
Case 2 is a 76-year-old Japanese man who had been treated for prostate, rectal and lung cancer, with no mucocutaneous pigmentation or family history of PJS. An upper gastrointestinal endoscopy revealed a duodenal polyp measuring 15 mm in diameter in the second part of his duodenum (Figure ). Endoscopic mucosal resection was performed, and histological examination showed findings suggestive of a hamartomatous polyp (Figure ). A colonoscopy and small-intestinal follow-through showed no other polyps. After the endoscopic treatment, concomitant liver and thyroid cancers were found.