SMAD4 and hereditary hemorrhagic telangiectasia: Most patients with JPS who harbor SMAD4 variants might have concomitant hereditary hemorrhagic telangiectasia (HHT) or Rendu-Osler-Weber syndrome [2–4], which is characterized by vascular malformations with epistaxis, mucocutaneous telangiectasia, and arteriovenous malformations of the lungs, liver, and brain [5, 12, 13].