Multiple Adenomatous Duodenal Polyposis

Abstract

Multiple duodenal polyps are a relatively rare finding, usually co-occurrent with familial adenomatous polyposis (FAP).We report a patient with multiple duodenal adenomas and a negative examination for FAP: multiple flat polyps were detected endoscopically in a 37-year-old male patient, extending from the apex of the bulb to the end of the descending part of the duodenum. In terms of histology, they were tubular adenomas with moderate dysplasia. Colonoscopy and enteroclysis were normal. Both push and capsule enteroscopy only showed multiple polyps in the area of the descending duodenum. DNA analysis of the APC gene was as follows: DGGE, exon 1–15, deletion at codons 1309 and 1061 by means of PCR for attenuated APC were negative. Afterwards we screened the patient for germline MYH mutations using the denaturing high-performance liquid chromatography (DHPLC) in combination with sequencing. No novel pathogenic mutation has been identified. Large polyps were removed by means of endoscopic polypectomy and mucosectomy, while small polyps were removed by means of argon plasma coagulation.We conduct yearly checkups, removing only sporadic polyps. The rare finding of duodenal polyposis not co-occurrent with FAP proves that multiple adenomas in the digestive tube need not necessarily co-occur with FAP.

Isolated Duodenal Adenoma Presenting as Gastrointestinal Bleed - A Case Report

“…Such an operation has considerable potential morbidity and mortality which makes the indication for and the timing of surgery extremely difficult. In addition to standard surgical resection, the literature describes other options of endoscopic therapy like polypectomy,mucosectomy as well as argon plasma coagulation (APC) -that all show good results with few complications [6].…”

Brunner’s Gland Hamartoma of the Duodenum: A Literature Review

“…If duodenal polyps were found on EGD, the physicians would differentiate the Brunner's gland hamartoma from other types of multiple and sporadic polyps located at the duodenum according to the age of onset, distribution at the duodenum, endoscopic appearance, histological characteristics, and immunohistochemical markers (Table 3) [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63]. Nearly all cases with familial adenomatous polyposis can be accompanied by duodenal adenomas, and some of them have extraintestinal manifestations, such as jaw and tooth abnormalities, nasopharyngeal angiofibromas, and cutaneous lesions (i.e., lipomas, fibromas, and sebaceous and epidermoid cysts) [58].…”