[Highlights of the dyspeptic syndrome in 1985].

Many hypotheses have been proposed to explain the development of non-lesional dyspepsia: various authors suggest an excessively delayed gastric emptying, or excessive gastric secretions or an intestinal cause. The actual pathophysiology of these disorders is probably multifactorial. In the absence of more precise data, we nevertheless have a symptomatic treatment which is often effective.

Peutz-Jeghers syndrome with metastasizing carcinoma arising from a jejunal hamartoma.

The association of Peutz-Jeghers (P-J) syndrome and gastrointestinal carcinoma is well documented, but an unequivocal histologic demonstration that malignancy may originate in a hamartomatous polyp has been very rarely given. A patient with the P-J syndome is described, in whom a definite intestinal adenocarcinoma with metastases to omentum and celiac lymph nodes was shown to originate in a jejunal hamartoma. Evidence that malignancy was derived from hamartomatous structures was given by the following observations: (a) Adenocarcinoma was intimately intricated with smooth muscle bands, and well-defined transitional zone of malignant cells could be observed in several glands of the degenerated P-J polyp; and (b) close to malignant areas, glands of this polyp exhibited a less-differentiated epithelium, but were still intermixed with nonstriated muscle bundles, which strongly suggest dedifferentiation of hamartomatous structures.