A Case of Pedunculated Tubulovillous Adenoma of the Duodenum

Ikeda, Koh; Miyauchi, Kuranosuke; Fujimoto, Akira; Hayashi, Toshiyuki; Kogure, Michio; Ohgoshi, Eiki

doi:10.1111/j.1572-0241.1998.00353.x

Cited by 4 publications

(1 citation statement)

References 23 publications

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“…[1][2][3] Duodenal polyps are most commonly sessile but may also be pedunculated in nature. 4 Ectopic gastric mucosa and polyps related to Brunner's gland hyperplasia are among the most commonly encountered in routine surgical practice. Adenomas are often situated at or adjacent to the ampulla of Vater and may be associated with underlying invasive carcinoma that is not apparent in superficial biopsy specimens.…”

Section: Discussionmentioning

confidence: 99%

Hyperplastic polyps of the duodenum: an unusual histological finding

Roche

Carr²,

Laing

et al. 2006

J Clin Pathol

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A 58-year-old man underwent upper gastrointestinal surveillance endoscopy for Barrett's oesophagus. This showed a possible gastric ulcer, although histological examination was normal. Follow-up endoscopy showed white ridges in the distal duodenum and these were subjected to biopsy. Histological examination of the biopsy specimens showed polypoid duodenal mucosa showing features similar to those of a hyperplastic polyp of the colon. In addition, the mucosal surface was focally of gastric surface type. The features were interpreted overall as most likely to represent an unusual form of regenerative change in the setting of previous chronic inflammatory mucosal damage. The case is presented as an unusual histological phenomenon at this site; it would be important not to overdiagnose neoplasia in this situation.A 58-year-old man with a 2-year history of Barrett's oesophagus underwent routine upper gastrointestinal surveillance endoscopy for this condition. This showed an endoscopic mucosal abnormality thought clinically most likely to represent a gastric antral ulcer, but gastric biopsy showed normal gastric mucosa with no evidence of Helicobacter-like organisms. He was treated with a protonpump inhibitor. A CLOtest was not carried out but was negative at follow-up endoscopy 3 months later, which showed endoscopically normal gastric mucosa. However, at this time the distal duodenum showed an unusual appearance, with white ridges on the tops of the mucosal folds ( fig 1A). Further biopsy specimens were taken from the gastric antrum and from the distal duodenum. PathologyThe repeat gastric antral biopsy specimens showed normal appearances; no Helicobacter-like organisms were identified. The duodenal biopsy specimens showed an unusual appearance, with one polypoid fragment showing an area of elongated crypts and villi with serrated profiles (fig 1B,C). The appearances were similar to those of a hyperplastic polyp of the colon. The duodenal mucosa in this area was also focally covered by gastric-type surface epithelium-apical diastase-periodic acid-Schiff-positive mucin glands were present ( fig 1D)

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Section: Discussionmentioning

confidence: 99%

Hyperplastic polyps of the duodenum: an unusual histological finding

Roche

Carr²,

Laing

et al. 2006

J Clin Pathol

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Reconstruction of a Large Duodenal Defect Created by Resection of a Duodenal Tubulovillous Adenoma Using a Double-Tract Anastomosis to a Retrocolic Roux-en-Y Loop: Report of a Case

et al. 2002

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Adenomas arising in the duodenum are uncommon. The surgical approach to adenoma of the duodenum remains controversial. We herein report the successful closure of a large defect after a partial duodenectomy for an adenoma. A 60-year-old man developed duodenal adenoma. An upper gastrointestinal roentgenographic series and endoscopy revealed a 2.5-cm tumor located adjacent to the duodenal papilla. The tumor was too large to be removed endoscopically, and therefore it was resected en bloc by a partial duodenectomy. Histology confirmed the diagnosis of benign tubulovillous adenoma. The large duodenal defect created by resection of the tumor was closed with double-tract anastomosis to a retrocolic Roux-en-Y loop. Large duodenal defects represent difficult surgical problems. Closure by direct anastomosis to a Roux-en-Y loop side-to-side is thus considered to be the procedure of choice.

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