Evaluation of non-ampullary duodenal polyps: comparison of non-neoplastic and neoplastic lesions

Abstract

Aim: To evaluate duodenal polyps, divided into non-neoplastic and neoplastic lesions. In addition, the clinical characteristics of duodenal hyperplastic polyps are determined.

Methods: We analyzed medical records of 50,114 consecutive patients submitted to for first diagnostic esophago-gastroduodenoscopy between January 2004 and December 2009. We excluded lesions on the ampulla of Vater and submucosal tumors. We studied 510 cases that were diagnosed endoscopically with duodenal polyps and enrolled a total of 221 cases that had undergone tissue biopsy. We analyzed the differences between non-neoplastic and neoplastic lesions, and determined the clinical features of duodenal hyperplastic polyps.

Results: Non-neoplastic lesions were found in 196 patients and neoplastic lesions in 25 patients. On univariate analysis, there were significant differences in shape, location, and size. Polyps more than 10 mm in diameter or polyps in the second portion had independent risk factors for being neoplastic lesions, as identified by multivariate analysis. In 23 cases of hyperplastic polyps (79.3%), they were accompanied by gastro-duodenal pathology, which was possibly associated with Helicobacter pylori.

Conclusion: Polyps of more than 10 mm or polyps in the second portion of the duodenum should be evaluated by histological examination.

Figure 1

Ampullary polyps and submucosal lesions in the duodenum. A: Ampullary adenoma; B: Inflammatory myofibroblastic tumor; C: Gastrointestinal stromal tumor; D: Duodenal lipoma. The surface of the tumor was covered by a normal mucosa, but it had a yellowish coloration (D1). Endoscopic ultrasound showed a homogeneous and hyperechoic mass with post-acoustic shadowing (D2). Histopathological examination revealed the tumor that was composed of mature adipose tissue (HE, × 40) (D3); E: Duodenal lymphangiectasia. On the surface of the tumor, focal small whitish macules or nodules were observed (E1). After forceps biopsy, whitish milk-like material flowed out (E2). A dilated lymphatic duct in the subepithelial area was observed under microscopic examination (HE, × 40) (E3).

Figure 2

Endoscopic findings of duodenal adenomas. Geographic shaped flat elevated lesions (A) or semi-pedunculated polyps (B) were found in the duodenum.

Figure 3

Endoscopic findings of carcinoid tumors. A: Endoscopy revealed an elevated lesion with a central dimpling in the bulb of the duodenum; B: Endoscopic ultrasound finding showed a round-shaped homogenous hypoechoic mass in the mucosal and muscularis mucosal layer (arrow).

Figure 4

Serrated adenoma (A) and focal cancer change of adenomas (B). Large pedunculated polyps were observed in the duodenal bulb. They had multilobulated and friable surfaces.

Figure 5

Microscopic finding of serrated adenomas. A: Vascular stalk and saw-tooth appearance were observed (HE, × 40); B: At high magnification, hyperplastic foveolar cells were found. In part, epithelia with pleomorphic, stratified nuclei and irregular chromatin deposits were observed (HE, × 200).