Duodenal polyposis secondary to portal hypertensive duodenopathy

Abstract

Portal hypertensive duodenopathy (PHD) is a recognized, but uncommon finding of portal hypertension in cirrhotic patients. Lesions associated with PHD include erythema, erosions, ulcers, telangiectasia, exaggerated villous pattern and duodenal varices. However, duodenal polyposis as a manifestation of PHD is rare. We report a case of a 52-year-old man who underwent esophagogastroduodenoscopy and was found with multiple small duodenal polyps ranging in size from 1-8 mm. Biopsy of the representative polyps revealed polypoid fragments of duodenal mucosa with villiform hyperplasia lined by reactive duodenal/gastric foveolar epithelium and underlying lamina propria showed proliferating ectatic and congested capillaries. The features were diagnostic of polyps arising in the setting of PHD.

Keywords: Cirrhosis; Polyposis; Portal duodenopathy; Portal hypertension.

Figure 1

Duodenal polyposis under esophagogastroduodenoscopy. A 6 mm, sessile polyp was seen [prior to removal (A); immediately after removal (B)] in the mid duodenal bulb. A separate 8 mm polyp was seen along the lateral aspect of the second part of the duodenum (C).

Figure 2

Histopathologic findings. Biopsies from the mid duodenal bulb polyp showed villiform hyperplasia of intestinal and gastric foveolar epithelium with numerous capillaries demonstrating congestion and vascular ectasia (A and B). Similar changes seen in the polyp from the second part of the duodenum (D-E). The epithelium lining the surface and crypts focally (arrows) showing cells with mucin depletion and slightly pencillate nuclei with hyperchromasia (C and F). Representative images of hematoxylin and eosin stained slides taken at 40 × (A, D: 4 × objective and 10 × ocular magnification), 100 × (B, E: 10 × objective and 10 × ocular magnification) and 200 × (C, F: 20 × objective and 10 × ocular magnification).