Revision as of 16:41, 13 August 2015

Schematic of the duodenum. (WC/Luke Guthmann)

The duodenum is the first part of the small bowel and receives food from the stomach. It is accessible by EGD (esophagogastroduodenoscopy) and frequently biopsied.

An introduction to gastrointestinal pathology is in the gastrointestinal pathology article.

The clinical history is often: r/o celiac or r/o giardia.

Getting started

Normal duodenum

Abbreviated ND.

General

Very common.

Microscopic

Three tall villi.
Few intraepithelial lymphocytes; < 1 lymphocyte / 4 epithelial cells.
No (pink) subepithelial collagen band.
Predominant lamina propria cell: plasma cells.
- Lack of plasma cells suggests common variable immunodeficiency (CVID).^[1]
No organisms in lumen.

DDx:

Intestinal metaplasia of the stomach - foveolar epithelium + other histologic components of the stomach.
Chronic duodenitis - foveolar epithelium, Brunner's gland hyperplasia.

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DUODENUM, BIOPSY: 
- SMALL BOWEL MUCOSA AND BRUNNER'S GLANDS WITHIN NORMAL LIMITS.

DUODENUM, BIOPSY: 
- SMALL BOWEL MUCOSA WITHIN NORMAL LIMITS.

DUODENUM, BIOPSY: 
- SMALL BOWEL MUCOSA WITHIN NORMAL LIMITS.
- NEGATIVE FOR FINDINGS SUGGESTIVE OF CELIAC DISEASE.

SMALL BOWEL (DUODENUM), BIOPSY: 
- SMALL BOWEL MUCOSA WITHIN NORMAL LIMITS.
- NEGATIVE FOR FINDINGS SUGGESTIVE OF CELIAC DISEASE.

Basic DDx

Celiac sprue.
- Intraepithelial lymphocytes - key feature.
- Loss of villi.
Giardia.
- Like celiac... but giardia organisms.
Adenomas.
- Too much blue - similar to colonic adenomas.
Cancer.
- Too much blue and epithelium in the wrong place.

More

H. pylori only in areas of gastric metaplasia.^[2]

Duodenal nodules DDX

Duodenal
nodule

Benign
(common)

Neoplastic

Brunner's
gland

Heterotopic
gastric mucosa

Lymphoid
nodule

Adenoma

NET

Paraganglioma

Prolapsed
gastric polyp

Metastasis

Infections of the duodenum^[3]

Common:

Giardia.

Rare:

Common stuffs

Gastric heterotopia of the duodenum

AKA heterotopic gastric mucosa.

General

Common ~15% of cases in one series.^[4]
Probably not related to Helicobacter pylori.^[5]

Gross

Typically nodules/polyps.^[6]

Microscopic

Features:

Foveolar epithelium.
Gastric glands - body-type or antral-type.

DDx:

Foveolar metaplasia (isolated) - see chronic duodenitis.
Foveolar gastric-type dysplasia.^[7]

Images

GH - low mag. (WC)
GH - intermed. mag. (WC)
GH - high mag. (WC)

www:

Gastric heterotopia (nih.gov).^[4]

Sign out

 DUODENUM, BIOPSY:
- SMALL BOWEL MUCOSA WITH GASTRIC (BODY-TYPE) HETEROTOPIA.
- NEGATIVE FOR SIGNIFICANT PATHOLOGY.

Alternate

DUODENUM, BIOPSY:
- SMALL BOWEL MUCOSA AND BRUNNER'S GLANDS WITHIN NORMAL LIMITS.
- GASTRIC HETEROTOPIA, BODY-TYPE MUCOSA.

Celiac sprue

Main article: Celiac sprue

General

Etiology: autoimmune.

Epidemiology

Associated with:
- The skin condition dermatitis herpetiformis.^[8]
- IgA deficiency - 10-15X more common in celiac disease vs. healthy controls.^[9]
- Risk factor for gastrointestinal T cell lymphoma - known as: enteropathy-associated T cell lymphoma (EATL).

Clinical

Treatment:

Gluten free diet.
- Mnemonic: BROW = barley, rye, oats, wheat.

Serologic testing:

Anti-transglutaminase antibody.
- Alternative test: anti-endomysial antibody.
IgA -- assoc. with celiac sprue.

Microscopic

Features:^[10]

Intraepithelial lymphocytes (IELs) - key feature.
- Should be more pronounced at tips of villi.^[11]
- Criteria for number varies:
  - > 40 IELs / 100 enterocytes (epithelial cells).^[12]
  - > 25 IELs / 100 enterocytes (epithelial cells).^[13]
Loss of villi - important feature.
- Normal duodenal biopsy should have 3 good villi.
Plasma cells - abundant (weak feature).
Macrophages.
Mitosis increased (in the crypts).
+/-Collagen band (pink material in mucosa) - "Collagenous sprue"; must encompass ~25% of mucosa.

Image:

Celiac sprue (WC).

Notes:

If you see acute inflammatory cells, i.e. neutrophils, consider Giardiasis and other infectious etiologies.
Biopsy should consist of 2-3 sites. In children it is important to sample the duodenal cap, as it is the only affected site in ~10% of cases.
Flat lesions without IELs are unlikely to be celiac sprue.
Mucosa erosions are rare in celiac sprue; should prompt consideration of an alternate diagnosis (infection, medications, Crohn's disease).

Grading

Rarely done - see celiac sprue article.

Giardiasis

Main article: Giardiasis

Acute duodenitis

Abbreviated AD.

Main article: Acute duodenitis

Chronic duodenitis

General

This is not very well defined as plasma cells are present in a normal duodenum.

Gross

Duodenal erythema.

Microscopic

Features:

"Abundant" lamina propria plasma cells.
Villous blunting.
Brunner's gland hyperplasia.

DDx:

Normal duodenum.

Sign out

DUODENUM, BIOPSY:
- MODERATE NON-SPECIFIC CHRONIC DUODENTIS (SMALL BOWEL MUCOSA WITH VILLOUS
  BLUNTING, PROMINENT BRUNNER'S GLANDS, ABUNDANT LAMINA PROPRIA PLASMA CELLS
  AND OCCASIONAL INTRAEPITHELIAL LYMPHOCYTES, WITHOUT FOVEOLAR METAPLASIA).
- NEGATIVE FOR DYSPLASIA.

Peptic duodenitis

General

A somewhat controversial type of chronic duodenitis.
Considered to be a consequence of peptic ulcer disease (Helicobacter gastritis).
One of the key components of the diagnosis is foveolar metaplasia and it is disputed that this is really due to Helicobacter.
- Genta et al. consider gastric foveolar metaplasia a congenital lesion.^[5]

Microscopic

Features:^[14]

Gastric foveolar metaplasia - key feature.
Brunner's gland hyperplasia.
+/-Inflammation - neutrophils.^{[citation needed]}
Ulceration.^{[citation needed]}

DDx:

Chronic duodenitis not otherwise specified - no foveolar metaplasia, abundant plasma cells.
Acute duodenitis.
Brunner's gland hyperplasia.
Gastric heterotopia of the duodenum.

Images

Duodenum with foveolar metaplasia - low mag. (WC/Nephron)
Duodenum with foveolar metaplasia - intermed. mag. (WC/Nephron)
Duodenum with foveolar metaplasia - very high mag. (WC/Nephron)

Stains

Foveolar metaplasia:

PAS stain +ve.^[14]
Mucicarmine stain +ve.

Sign out

Foveolar metaplasia only

DUODENUM, BIOPSY:
- SMALL BOWEL MUCOSA WITH FOCAL GASTRIC FOVEOLAR METAPLASIA.
- BRUNNER'S GLANDS NOT IDENTIFIED.
- VILLI AND INTRAEPITHELIAL LYMPHOCYTES WITHIN NORMAL LIMITS (NEGATIVE FOR CELIAC DISEASE).
- NEGATIVE FOR ACUTE DUODENITIS.
- NEGATIVE FOR DYSPLASIA.

DUODENUM, BIOPSY:
- SMALL BOWEL MUCOSA WITH FOCAL GASTRIC FOVEOLAR METAPLASIA.
- BRUNNER'S GLANDS NOT IDENTIFIED.
- NEGATIVE FOR ACUTE DUODENITIS.
- NEGATIVE FOR DYSPLASIA.

Chronic duodenitis

Duodenum, Biopsy:
- Small bowel mucosa with Brunner’s gland in the lamina propria and gastric foveolar metaplasia, consistent with chronic duodenitis.
- NEGATIVE for acute duodenitis.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.

DUODENUM, BIOPSY:
- SMALL BOWEL MUCOSA WITH BRUNNER'S GLAND IN THE LAMINA PROPRIA AND
  GASTRIC FOVEOLAR METAPLASIA -- CONSISTENT WITH CHRONIC DUODENITIS.
- NEGATIVE FOR ACUTE DUODENITIS.
- NEGATIVE FOR MALIGNANCY.

 DUODENUM, BIOPSY:
- SMALL BOWEL MUCOSA WITH PROMINENT BRUNNER'S GLANDS AND FOCAL GASTRIC
  FOVEOLAR METAPLASIA.
- NEGATIVE FOR ACUTE INFLAMMATION.
- NEGATIVE FOR DYSPLASIA.

Micro

The sections show small bowel mucosa and a small amount of submucosa. Brunner's glands are abundant and found focally in the lamina propria. Gastric foveolar-type epithelium is identified. Intraepithelial neutrophils are not identified.

The epithelium matures appropriately. There is no increase in intraepithelial lymphocytes.

Brunner's gland hyperplasia

Brunner's gland hamartoma redirects here.

Abbreviated BGH.
AKA Brunneroma.^[15]

General

Benign.
Usually asymptomatic.^[16]

Note:

The AFIP uses the term Brunner's gland hamartoma for lesions > 5 mm.^[17]
- Multiple lesions less than 5 mm are hyperplasia.

Gross

Nodularity of the duodenum.

Microscopic

Features:

Prominent Brunner's gland.
- Tubular structures - formed by cells abundant cytoplasm that is clear with eosinophilic "cobwebs" and a round, small basal nucleus without a nucleolus.
- Brunner's glands close to the surface epithelium - key feature.^[18]
+/-Pancreatic acini and ducts.^[17]

DDx:

Foveolar metaplasia (isolated) - see peptic duodenitis.
Peptic duodenitis.

Image:

Sign out

DUODENUM, BIOPSY:
- CONSISTENT WITH BRUNNER'S GLAND HYPERPLASIA.
- SMALL BOWEL MUCOSA WITHOUT SIGNIFICANT PATHOLOGY.

 DUODENUM, BIOPSY:
- SMALL BOWEL MUCOSA WITHOUT SIGNIFICANT PATHOLOGY.
- PROMINENT BRUNNER'S GLANDS WITH EXTENSION INTO THE LAMINA PROPRIA.

Superficial Brunner's glands

DUODENUM, BIOPSY:
- SMALL BOWEL MUCOSA WITH BRUNNER'S GLANDS THAT ARE FOCALLY SUPERFICIAL.
- NO FINDINGS SUGGESTIVE OF CELIAC DISEASE.
- NEGATIVE FOR ACTIVE INFLAMMATION.
- NEGATIVE FOR DYSPLASIA.

Micro

The sections show small bowel mucosa and a small amount of submucosa. Brunner's glands are abundant and found focally in the lamina propria.

The epithelium matures appropriately. There is no increase in intraepithelial lymphocytes. No foveolar metaplasia of the epithelium is identified.

Weird stuff

Disaccharidases deficiency

General

Common among asians.
Includes: lactase, sucrase, and maltase.
- Lactase changes seen with mild histomorphologic changes.^[19]
- Maltase and sucrase only affected in moderate and severe lesions.

Microscopic

Features:^[19]

Decreased villous-crypt ratio (mild to severe).
+/-Inflammation (only in moderate and severe).

DDx:

Celiac disease.^[20]

Notes:

May have normal histomorphology.^[19]

Whipple disease

Main article: Whipple's disease

Microvillous inclusion disease

Main article: Microvillous inclusion disease

This rare disease presents very shortly after birth.

Tufting enteropathy

AKA intestinal epithelial dysplasia.

General

Genetic disease^[21] - related to abnormal enterocytes (development and/or differentiation).
- Gene implicated: EPCAM.^[22]

Microscopic

Features:^[23]

Villous atrophy
Mononuclear cell infiltration of the lamina propria
Abnormal surface enterocytes:
- Focal crowding -- resembling tufts.

Gangliocytic paraganglioma

Abbreviated GP.

Main article: Gangliocytic paraganglioma

Pseudomelanosis duodeni

General

Rare.
Consists of iron and lipofuscin.^[24]

Associations:^[25]

Hypertension ~90% of cases.
Iron supplementation ~75% of cases.
End-stage renal disease ~60% of cases.

Note:

The associations are different than for melanosis coli.

Gross/endoscopic

Dark spots ~35% of cases.^[25]

Microscopic

Features:

Dark pigment in the lamina propria macrophages.

Images:

Pseudomelanosis duodeni - several images (upmc.edu).

Stains

Prussian blue +ve ~80% of cases.^[25]

Tumours

Lymphoma

Main article: Lymphoma

Non-Hodgkin's lymphoma.
- Enteropathy-associated T-cell lymphoma (EATL) - due to celiac sprue.
- MALT lymphoma - common GI tract lymphoma.
- Mantle cell lymphoma.
- Diffuse large B cell lymphoma.

Note:

Hodgkin's lymphoma does not arise in the GI tract.

Adenocarcinoma of the duodenum

AKA duodenal adenocarcinoma.
AKA duodenal carcinoma.

Main article: Adenocarcinoma of the duodenum

Duodenal neuroendocrine tumour

Main article: Neuroendocrine tumours

General

Like neuroendocrine tumours elsewhere.
Use of the term carcinoid is discouraged.^[26]^[27]^[28]

Associations:

Microscopic

Features:^[29]

Usu. nests of cells - may be:
- Trabecular.
- Glandular - common in stomatostatin producing tumours.
Stippled chromatin - (AKA salt-and-pepper chromatin, coarse chromatin).
Classically subepithelial/mural.
+/-Psammoma bodies - suggestive of somatostatinoma and NF1.^[30]

DDx:

Adenocarcinoma of the duodenum.

Images

Neuroendocrine tumour - low mag. (WC)
Neuroendocrine tumour - intermed. mag. (WC)
Neuroendocrine tumour - high mag. (WC)

Ampullary tumours

Main article: Ampullary tumours

General

Individuals with high-grade dysplasia (on biopsy) are usually treated with a pancreaticoduodenectomy (Whipple procedure), as local resections have a very high recurrence rate.^[31]

Microscopic

Features:

See ampullary tumours.

DDx:

Intraductal papillary mucinous tumour (IPMT) - a pancreatic tumour, see pancreas article.
Invasive ductal carcinoma of the pancreas.

Sign out

Ampullary carcinoma - has separate staging.

Traditional adenoma

Duodenal adenoma redirects here.

Main article: Traditional adenoma

General

Strong association of familial adenomatous polyposis.
- In one series of 208 adenomas, almost 70% were from FAP patients.^[32]
Commonly found in association foveolar metaplasia - especially in sporadic cases ~60% of cases.
- In FAP ~30% of cases have foveolar metaplasia.^[32]

Sign out

POLYP, DUODENUM, EXCISION:
- TUBULAR ADENOMA.
-- NEGATIVE FOR HIGH-GRADE DYSPLASIA.

References

↑ Agarwal S, Smereka P, Harpaz N, Cunningham-Rundles C, Mayer L (July 2010). "Characterization of immunologic defects in patients with common variable immunodeficiency (CVID) with intestinal disease". Inflamm Bowel Dis. doi:10.1002/ibd.21376. PMID 20629103.
↑ El-Zimaity. 18 October 2010.
↑ Serra S, Jani PA (November 2006). "An approach to duodenal biopsies". J. Clin. Pathol. 59 (11): 1133–50. doi:10.1136/jcp.2005.031260. PMC 1860495. PMID 16679353. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860495/?tool=pubmed.
↑ ^4.0 ^4.1 Terada, T. (2012). "Pathologic observations of the duodenum in 615 consecutive duodenal specimens: I. benign lesions.". Int J Clin Exp Pathol 5 (1): 46-51. PMID 22295146.
↑ ^5.0 ^5.1 Genta, RM.; Kinsey, RS.; Singhal, A.; Suterwala, S. (Nov 2010). "Gastric foveolar metaplasia and gastric heterotopia in the duodenum: no evidence of an etiologic role for Helicobacter pylori.". Hum Pathol 41 (11): 1593-600. doi:10.1016/j.humpath.2010.04.010. PMID 20656325.
↑ Shousha, S.; Spiller, RC.; Parkins, RA. (Jan 1983). "The endoscopically abnormal duodenum in patients with dyspepsia: biopsy findings in 60 cases.". Histopathology 7 (1): 23-34. PMID 6840712.
↑ Park, do Y.; Srivastava, A.; Kim, GH.; Mino-Kenudson, M.; Deshpande, V.; Zukerberg, LR.; Song, GA.; Lauwers, GY. (Apr 2008). "Adenomatous and foveolar gastric dysplasia: distinct patterns of mucin expression and background intestinal metaplasia.". Am J Surg Pathol 32 (4): 524-33. doi:10.1097/PAS.0b013e31815b890e. PMID 18300795.
↑ TN 2007 D22
↑ Kumar, V.; Jarzabek-Chorzelska, M.; Sulej, J.; Karnewska, K.; Farrell, T.; Jablonska, S. (Nov 2002). "Celiac disease and immunoglobulin a deficiency: how effective are the serological methods of diagnosis?". Clin Diagn Lab Immunol 9 (6): 1295-300. PMID 12414763.
↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 843. ISBN 0-7216-0187-1.
↑ Biagi F, Luinetti O, Campanella J, et al. (August 2004). "Intraepithelial lymphocytes in the villous tip: do they indicate potential coeliac disease?". J. Clin. Pathol. 57 (8): 835–9. doi:10.1136/jcp.2003.013607. PMC 1770380. PMID 15280404. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1770380/.
↑ Oberhuber G, Granditsch G, Vogelsang H (October 1999). "The histopathology of coeliac disease: time for a standardized report scheme for pathologists". Eur J Gastroenterol Hepatol 11 (10): 1185–94. PMID 10524652.
↑ Corazza GR, Villanacci V, Zambelli C, et al. (July 2007). "Comparison of the interobserver reproducibility with different histologic criteria used in celiac disease". Clin. Gastroenterol. Hepatol. 5 (7): 838–43. doi:10.1016/j.cgh.2007.03.019. PMID 17544877.
↑ ^14.0 ^14.1 Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 145. ISBN 978-0443066573.
↑ Tan, YM.; Wong, WK. (2002). "Giant Brunneroma as an unusual cause of upper gastrointestinal hemorrhage: report of a case.". Surg Today 32 (10): 910-2. doi:10.1007/s005950200179. PMID 12376792.
↑ ^16.0 ^16.1 Lee, WC.; Yang, HW.; Lee, YJ.; Jung, SH.; Choi, GY.; Go, H.; Kim, A.; Cha, SW. (Jun 2008). "Brunner's gland hyperplasia: treatment of severe diffuse nodular hyperplasia mimicking a malignancy on pancreatic-duodenal area.". J Korean Med Sci 23 (3): 540-3. doi:10.3346/jkms.2008.23.3.540. PMID 18583897.
↑ ^17.0 ^17.1 ^17.2 Patel, ND.; Levy, AD.; Mehrotra, AK.; Sobin, LH. (Sep 2006). "Brunner's gland hyperplasia and hamartoma: imaging features with clinicopathologic correlation.". AJR Am J Roentgenol 187 (3): 715-22. doi:10.2214/AJR.05.0564. PMID 16928936.
↑ Franzin, G.; Musola, R.; Ghidini, O.; Manfrini, C.; Fratton, A. (Dec 1985). "Nodular hyperplasia of Brunner's glands.". Gastrointest Endosc 31 (6): 374-8. PMID 4076734.
↑ ^19.0 ^19.1 ^19.2 Langman JM, Rowland R (July 1990). "Activity of duodenal disaccharidases in relation to normal and abnormal mucosal morphology". J. Clin. Pathol. 43 (7): 537–40. PMC 502575. PMID 2116456. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC502575/.
↑ Murray IA, Smith JA, Coupland K, Ansell ID, Long RG (February 2001). "Intestinal disaccharidase deficiency without villous atrophy may represent early celiac disease". Scand. J. Gastroenterol. 36 (2): 163–8. PMID 11252408.
↑ Online 'Mendelian Inheritance in Man' (OMIM) 613217
↑ Online 'Mendelian Inheritance in Man' (OMIM) 185535
↑ Goulet O, Salomon J, Ruemmele F, de Serres NP, Brousse N (2007). "Intestinal epithelial dysplasia (tufting enteropathy)". Orphanet J Rare Dis 2: 20. doi:10.1186/1750-1172-2-20. PMC 1878471. PMID 17448233. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1878471/.
↑ Lin, HJ.; Tsay, SH.; Chiang, H.; Tsai, YT.; Lee, SD.; Yeh, YS.; Lo, GH. (Apr 1988). "Pseudomelanosis duodeni. Case report and review of literature.". J Clin Gastroenterol 10 (2): 155-9. PMID 2458404.
↑ ^25.0 ^25.1 ^25.2 Giusto, D.; Jakate, S. (Feb 2008). "Pseudomelanosis duodeni: associated with multiple clinical conditions and unpredictable iron stainability - a case series.". Endoscopy 40 (2): 165-7. doi:10.1055/s-2007-995472. PMID 18253910.
↑ Chetty, R. (Apr 2008). "Requiem for the term 'carcinoid tumour' in the gastrointestinal tract?". Can J Gastroenterol 22 (4): 357-8. PMID 18414708.
↑ Klöppel, G.; Perren, A.; Heitz, PU. (Apr 2004). "The gastroenteropancreatic neuroendocrine cell system and its tumors: the WHO classification.". Ann N Y Acad Sci 1014: 13-27. PMID 15153416.
↑ Klöppel G (July 2003). "[Neuroendocrine tumors of the gastrointestinal tract]" (in German). Pathologe 24 (4): 287–96. doi:10.1007/s00292-003-0636-7. PMID 14513276.
↑ URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/SmallbowelNET_11protocol.pdf. Accessed on: 29 March 2012.
↑ Kim, JA.; Choi, WH.; Kim, CN.; Moon, YS.; Chang, SH.; Lee, HR. (Mar 2011). "Duodenal somatostatinoma: a case report and review.". Korean J Intern Med 26 (1): 103-7. doi:10.3904/kjim.2011.26.1.103. PMID 21437171.
↑ Meneghetti, AT.; Safadi, B.; Stewart, L.; Way, LW. (Dec 2005). "Local resection of ampullary tumors.". J Gastrointest Surg 9 (9): 1300-6. doi:10.1016/j.gassur.2005.08.031. PMID 16332486.
↑ ^32.0 ^32.1 Rubio, CA. (Jun 2007). "Gastric duodenal metaplasia in duodenal adenomas.". J Clin Pathol 60 (6): 661-3. doi:10.1136/jcp.2006.039388. PMC 1955048. PMID 16837629. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1955048/.

External links

Review article(s)

Serra S, Jani PA (November 2006). "An approach to duodenal biopsies". J. Clin. Pathol. 59 (11): 1133–50. doi:10.1136/jcp.2005.031260. PMC 1860495. PMID 16679353. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860495/?tool=pubmed.

[pmid20629103-1] Agarwal S, Smereka P, Harpaz N, Cunningham-Rundles C, Mayer L (July 2010). "Characterization of immunologic defects in patients with common variable immunodeficiency (CVID) with intestinal disease". Inflamm Bowel Dis. doi:10.1002/ibd.21376. PMID 20629103.

[2] El-Zimaity. 18 October 2010.

[3] Serra S, Jani PA (November 2006). "An approach to duodenal biopsies". J. Clin. Pathol. 59 (11): 1133–50. doi:10.1136/jcp.2005.031260. PMC 1860495. PMID 16679353. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860495/?tool=pubmed.

[pmid22295146-4] 4.0 ^4.1 Terada, T. (2012). "Pathologic observations of the duodenum in 615 consecutive duodenal specimens: I. benign lesions.". Int J Clin Exp Pathol 5 (1): 46-51. PMID 22295146.

[pmid20656325-5] 5.0 ^5.1 Genta, RM.; Kinsey, RS.; Singhal, A.; Suterwala, S. (Nov 2010). "Gastric foveolar metaplasia and gastric heterotopia in the duodenum: no evidence of an etiologic role for Helicobacter pylori.". Hum Pathol 41 (11): 1593-600. doi:10.1016/j.humpath.2010.04.010. PMID 20656325.

[pmid6840712-6] Shousha, S.; Spiller, RC.; Parkins, RA. (Jan 1983). "The endoscopically abnormal duodenum in patients with dyspepsia: biopsy findings in 60 cases.". Histopathology 7 (1): 23-34. PMID 6840712.

[7] Park, do Y.; Srivastava, A.; Kim, GH.; Mino-Kenudson, M.; Deshpande, V.; Zukerberg, LR.; Song, GA.; Lauwers, GY. (Apr 2008). "Adenomatous and foveolar gastric dysplasia: distinct patterns of mucin expression and background intestinal metaplasia.". Am J Surg Pathol 32 (4): 524-33. doi:10.1097/PAS.0b013e31815b890e. PMID 18300795.

[8] TN 2007 D22

[pmid12414763-9] Kumar, V.; Jarzabek-Chorzelska, M.; Sulej, J.; Karnewska, K.; Farrell, T.; Jablonska, S. (Nov 2002). "Celiac disease and immunoglobulin a deficiency: how effective are the serological methods of diagnosis?". Clin Diagn Lab Immunol 9 (6): 1295-300. PMID 12414763.

[Ref_PBoD843-10] Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 843. ISBN 0-7216-0187-1.

[pmid15280404-11] Biagi F, Luinetti O, Campanella J, et al. (August 2004). "Intraepithelial lymphocytes in the villous tip: do they indicate potential coeliac disease?". J. Clin. Pathol. 57 (8): 835–9. doi:10.1136/jcp.2003.013607. PMC 1770380. PMID 15280404. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1770380/.

[pmid10524652-12] Oberhuber G, Granditsch G, Vogelsang H (October 1999). "The histopathology of coeliac disease: time for a standardized report scheme for pathologists". Eur J Gastroenterol Hepatol 11 (10): 1185–94. PMID 10524652.

[pmid17544877-13] Corazza GR, Villanacci V, Zambelli C, et al. (July 2007). "Comparison of the interobserver reproducibility with different histologic criteria used in celiac disease". Clin. Gastroenterol. Hepatol. 5 (7): 838–43. doi:10.1016/j.cgh.2007.03.019. PMID 17544877.

[Ref_GLP145-14] 14.0 ^14.1 Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 145. ISBN 978-0443066573.

[pmid12376792-15] Tan, YM.; Wong, WK. (2002). "Giant Brunneroma as an unusual cause of upper gastrointestinal hemorrhage: report of a case.". Surg Today 32 (10): 910-2. doi:10.1007/s005950200179. PMID 12376792.

[pmid18583897-16] 16.0 ^16.1 Lee, WC.; Yang, HW.; Lee, YJ.; Jung, SH.; Choi, GY.; Go, H.; Kim, A.; Cha, SW. (Jun 2008). "Brunner's gland hyperplasia: treatment of severe diffuse nodular hyperplasia mimicking a malignancy on pancreatic-duodenal area.". J Korean Med Sci 23 (3): 540-3. doi:10.3346/jkms.2008.23.3.540. PMID 18583897.

[pmid16928936-17] 17.0 ^17.1 ^17.2 Patel, ND.; Levy, AD.; Mehrotra, AK.; Sobin, LH. (Sep 2006). "Brunner's gland hyperplasia and hamartoma: imaging features with clinicopathologic correlation.". AJR Am J Roentgenol 187 (3): 715-22. doi:10.2214/AJR.05.0564. PMID 16928936.

[pmid4076734-18] Franzin, G.; Musola, R.; Ghidini, O.; Manfrini, C.; Fratton, A. (Dec 1985). "Nodular hyperplasia of Brunner's glands.". Gastrointest Endosc 31 (6): 374-8. PMID 4076734.

[pmid2116456-19] 19.0 ^19.1 ^19.2 Langman JM, Rowland R (July 1990). "Activity of duodenal disaccharidases in relation to normal and abnormal mucosal morphology". J. Clin. Pathol. 43 (7): 537–40. PMC 502575. PMID 2116456. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC502575/.

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[omim613217-21] Online 'Mendelian Inheritance in Man' (OMIM) 613217

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Difference between revisions of "Duodenum"

Revision as of 16:41, 13 August 2015

Getting started

Normal duodenum

General

Microscopic

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Basic DDx

More

Duodenal nodules DDX

Infections of the duodenum[3]

Common stuffs

Gastric heterotopia of the duodenum

General

Gross

Microscopic

Images

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Alternate

Celiac sprue

General

Epidemiology

Clinical

Microscopic

Grading

Giardiasis

Acute duodenitis

Chronic duodenitis

General

Gross

Microscopic

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Peptic duodenitis

General

Microscopic

Images

Stains

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Foveolar metaplasia only

Chronic duodenitis

Micro

Brunner's gland hyperplasia

General

Gross

Microscopic

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Superficial Brunner's glands

Micro

Weird stuff

Disaccharidases deficiency

General

Microscopic

Whipple disease

Microvillous inclusion disease

Tufting enteropathy

General

Microscopic

Gangliocytic paraganglioma

Pseudomelanosis duodeni

General

Gross/endoscopic

Microscopic

Stains

Tumours

Lymphoma

Adenocarcinoma of the duodenum

Duodenal neuroendocrine tumour

General

Microscopic

Images

Ampullary tumours

General

Microscopic

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Traditional adenoma

General

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See also

References

External links

Infections of the duodenum^[3]