case_images: PMC5586825_01
case_images: a A 20-year-old female patient with multiple brown melanotic macules on the lips and mucosa. b Colonoscopy revealed a large polypoid mass 6 cm from the anal verge, and the biopsy revealed adenocarcinoma (arrow). c Abdominal computed tomography demonstrated a large mass at the rectum (arrow).
case_images: mpp-0023-0089-g01.jpg
case_images: PMC5586825_01_mpp-0023-0089-g01.jpg
case_images: F1
case_images: Physical examination revealed multiple cafe-au-lait pigmented macules on the lips and buccal mucosa (fig. 1a). Colonoscopy demonstrated 2 small polyps 20 and 40 cm from the anal verge, respectively, but a large mass 6 cm from the anal verge was also found simultaneously (fig. 1b). Abdominal computed tomography revealed rectal adenocarcinoma with perirectal invasion and multiple enlarged perirectal lymph nodes (fig. 1c).
case_images: a Multiple arborizing muscle bundles characteristic of hamartomatous PJS polyps (arrow). x40. b The lesion also showed invasive nests with pleomorphic cancerous glandular cells microscopically (arrow). x200. c The retrieved tissue showed lymph node metastases (arrow) and vascular invasion (arrowhead). x40.
case_images: mpp-0023-0089-g02.jpg
case_images: PMC5586825_01_mpp-0023-0089-g02.jpg
case_images: F2
case_images: The size of this lesion was 6 x 5.7 cm, and histology showed arborizing muscular bundles characteristic of hamartomatous polyps (fig. 2a), and invasive nests with pleomorphic cancerous glandular cells were detected microscopically (fig. 2b), as were lymph node metastases and vascular invasion (fig. 2c).