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Nasal polyposis in Peutz–Jeghers syndrome: a distinct histopathological and molecular genetic entity

¹ Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
² Departments of Internal Medicine and Pathology, Erasmus Medical Center, University of Rotterdam, Rotterdam, The Netherlands
³ Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
⁴ Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands

Correspondence to:
Dr J J Keller
Academic Medical Center, Department of Pathology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;j.j.keller{at}amc.uva.nl Background: Peutz–Jeghers syndrome (PJS) is an autosomal dominant hamartomatous polyposis syndrome of the gastrointestinal tract, caused by a germline STK11/LKB1 mutation. Nasal polyposis was described in the original report by Peutz. Recently, a molecular–genetic association between nasal polyposis and PJS has been reported.

Objective: To further explore the occurrence and pathogenesis of PJS-related nasal polyposis.

Methods: 51 patients with PJS, 84 unaffected family members and 36 spouses from 18 families with PJS were questioned for the presence of nasal polyposis. 12 PJS-related nasal polyps, 1 carcinoma of the nasal cavity and 28 sporadic nasal polyps were analysed for loss of (wild type) STK11/LKB1, eosinophilia, squamous metaplasia, dysplasia and expression of cyclo-oxygenase 2 and p53.

Results: Nasal polyps occurred in 8 of 51 patients with PJS, and were not reported by non-affected family members (p<0.001). Germline STK11/LKB1 mutations were identified in all patients with PJS and nasal polyposis. Loss of heterozygosity was found in four of eight PJS-related nasal polyps, but not in sporadic nasal polyps (p = 0.002). PJS-related nasal polyps showed less eosinophilia than sporadic nasal polyps (p<0.001). Expression of cyclo-oxygenase 2 was found in 11 of 12 PJS-related nasal polyps and 19 of 28 sporadic nasal polyps (p>0.05). Overexpression of p53 was not found.

Conclusions: Nasal polyposis occurs in a significant number of Dutch patients with PJS, one of whom developed a carcinoma in the nasal cavity. The loss of heterozygosity, and the absence of eosinophilia suggest a distinct pathogenesis compared with sporadic nasal polyposis.