Peutz Jeghers syndrome (PJS) is an autosomal dominant genetic condition characterized by multiple benign polyps called hamartomas on the mucous lining in the gastrointestinal system. These polyps occur most often in the small intestine but also occur in the stomach and large intestine. Affected individuals also have dark skin discoloration, especially around the eyes, nostrils, mucous membranes of the mouth, perianal area and inside the mouth. Affected individuals have an increased risk for intestinal and other cancers.
PJS is characterized by multiple benign polyps called hamartomas on the mucous lining in the gastrointestinal system. These polyps occur most often in the small intestine but also occur in the stomach and large intestine and may cause chronic rectal bleeding, anemia and bowel collapse or obstruction.
Affected individuals also have dark skin discoloration, especially around the eyes, nostrils, mucous membranes of the mouth, perianal area and inside the mouth and on the fingers. Hyperpigmentation may fade in adolescent or adulthood.
Affected females have an increased risk for a benign ovarian tumor called SCTAT (sex cord tumors with annular tumors) for which symptoms may include irregular or heavy periods or early puberty. Affected males can develop a tumor in the testes that secretes estrogen and can lead to breast development (gynecomastia). Individuals with PJS have an increased risk for intestinal and other cancers.
Peutz-Jeghers syndrome is an autosomal dominant genetic condition. Dominant genetic disorders occur when only a single copy of an abnormal gene is necessary for the appearance of the disease. The abnormal gene can be inherited from either parent, or can be the result of a new mutation (gene change) in the affected individual. Approximately 50% of individuals with PJS have an affected parent. Approximately 70% of affected individuals with a family history of PJS have a mutation in the STK11/LKB1 gene, whereas 20-70% of affected individuals without family history have a mutation in this gene. The risk of passing the abnormal gene from affected parent to offspring is 50% for each pregnancy. If a mutation has not been found and there is no family history, the risk to offspring is unknown.
Peutz Jeghers syndrome is a rare disorder that affects males and females in equal numbers and can occur in any racial or ethnic group. The birth prevalence for PJS is estimated to be between 1/25,000 and 1/280,000.
PJS is diagnosed based on the presence of polyps in the GI tract in combination with at least two of the following. polyps in the small intestine, melanin spots and/or a family history of PJS. Molecular genetic testing for the STK11/LKB1 gene is available to confirm the diagnosis. Individuals with PJS may consider genetic testing for their children in order to determine if monitoring for polyps is indicated.
Regular examinations help to prevent intestinal obstruction and cancer. Visualization of the interior walls of the intestines (endoscopy. is recommended and large (>1 cm) polyps should be removed during the procedure. The age to begin screening and the frequency of examinations depend on family history and symptoms. Periodic x-rays or endoscopy should be done beginning in adolescence and throughout adulthood. At-risk women should begin clinical breast examination and mammography beginning in the twenties. At-risk men should routinely conduct a testicular examination.
Genetic counseling is recommended for individuals with PJS and their family members.
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