A 12-year-old boy with hyperpigmented macules on the lips and oral mucosa presents with recurrent episodes of colicky central abdominal pain and bilious vomiting. CT shows a small bowel intussusception with no lead point visible beyond thickened mucosa. The most likely pathological basis is:

• A Diffuse lymphoid hyperplasia following viral infection
• B Adenomatous polyps undergoing malignant transformation
• C Hamartomatous polyps acting as a lead point ✓
• D Ischaemic strictures from prior mesenteric venous thrombosis

Explanation

Peutz-Jeghers syndrome features mucocutaneous pigmentation and multiple hamartomatous polyps throughout the gastrointestinal tract, most numerous in the jejunum and ileum. These polyps serve as lead points for recurrent intussusception, the commonest complication presenting with episodic obstruction. Although the polyps themselves have low malignant potential, patients carry elevated cancer risk from associated adenomas elsewhere; the polyp driving intussusception here is hamartomatous, not adenomatous.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.