Duodenal Epithelial Polyps: A Clinicopathologic Review

Abstract

Context.— Duodenal epithelial polyps are reported in 1.5% to 3% of individuals referred for upper endoscopy. Most duodenal epithelial polyps are asymptomatic and nonneoplastic; however, a small subset is neoplastic and may progress to adenocarcinoma. Recent advances in immunohistochemical and molecular techniques have helped further characterize these polyps, shedding light on their origin, classification, and risk of progression to adenocarcinoma. Objective.— To provide a comprehensive clinicopathologic review of nonneoplastic and neoplastic duodenal epithelial polyps, with particular emphasis on recent developments in classification schemes and risk stratification based upon immunohistochemical and molecular profiles. Data Sources.— This review is based on peer-reviewed literature and the authors' experiences. Conclusions.— In this review we provide an update on the clinicopathologic, immunohistochemical, and molecular features of duodenal epithelial polyps and discuss the surveillance recommendations and treatment options available. Particular attention should be placed on recognizing duodenal adenomas with intestinal, gastric, and serrated phenotype, as they have an increased risk of malignant transformation if not completely excised.

Acute pancreatitis after the removal of a hyperplastic duodenal polyp: a case report

“…The former can be subdivided into hyperplastic polyps, hamartomas, or cysts of Brunner's glands, gastric or pancreatic heterotopia, and hyperplastic, inflammatory, or hamartomatous polyps; and the latter into intestinal or gastric-type adenomas, serrated adenomas, and neuroendocrine tumors. 4 The natural history of duodenal polyps is poorly understood, and therefore removal is indicated when they are large or symptomatic, or when histological examination reveals the presence of dysplasia or cancer. 5 Endoscopic polypectomy, the mainstay of the treatment of these lesions, achieves complete resection in most cases.…”

A giant Brunner’s gland hamartoma being treated as a pedunculated polyp: a case report

“…The benign hyperplastic lesions of Brunner glands are described as Brunner gland hyperplastic nodules/polyps or Brunner gland hamartomas [10]. As a rule, lesions smaller than 2 cm defined as Brunner’s gland hyperplastic nodules/polyps, while lesions larger than 2 cm termed Brunner’s gland hamartoma [11]. The pathogenesis of BGH remains obscure.…”

“…Usually, asymptomatic small Brunner’s gland hamartomas require no treatment. While symptomatic and larger lesions leading to bleeding or obstruction should be excised either endoscopically or surgically [11].…”

A Rare Manifestation of a Bleeding Tubulovillous Duodenal Polyp Presenting as an Upper Gastrointestinal Hemorrhage

“…Patients present with symptoms of dyspepsia, abdominal discomfort, mechanical obstruction, and sometimes jaundice. Other atypical and rare symptoms include hematemesis, which was seen in this case [2].…”

“…They are histologically classified according to mucin phenotype into intestinal (89.1%) and gastric type (10.9%); the intestinal-type polyps are morphologically subdivided into tubular and tubulovillous adenomas. These polyps grossly present as sessile or pedunculated polyps, nodules, excrescences, or subtle abnormalities of mucosa; they can be located either in the duodenal bulb, ampullary region, or distal duodenum [2]. Duodenal polyps are generally benign and carry a low probability for malignant transformation, and around 90% are nonneoplastic [3].…”