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The '''duodenum''' is the first part of the small bowel. It is accessible by EGD (esophagogastroduodenoscopy) and frequently biopsied. | [[Image:Duodenumanatomy.jpg|thumb|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''. | The clinical history is often: ''r/o celiac'' or ''r/o giardia''. | ||
=Getting started= | |||
*Celiac | ==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).<ref name=pmid20629103>{{cite journal |author=Agarwal S, Smereka P, Harpaz N, Cunningham-Rundles C, Mayer L |title=Characterization of immunologic defects in patients with common variable immunodeficiency (CVID) with intestinal disease |journal=Inflamm Bowel Dis |volume= |issue= |pages= |year=2010 |month=July |pmid=20629103 |doi=10.1002/ibd.21376 |url=}}</ref> | |||
*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]]. | |||
===Sign out=== | |||
<pre> | |||
Duodenum, Biopsy: | |||
- Small bowel mucosa and Brunner's glands within normal limits.</pre> | |||
<pre> | |||
Duodenum, Biopsy: | |||
- Small bowel mucosa within normal limits. | |||
</pre> | |||
<pre> | |||
Duodenum, Biopsy: | |||
- Small bowel mucosa within normal limits. | |||
- NEGATIVE for findings suggestive of celiac disease. | |||
</pre> | |||
<pre> | |||
Small Bowel (Duodenum), Biopsy: | |||
- Small bowel mucosa within normal limits. | |||
- NEGATIVE for findings suggestive of celiac disease. | |||
</pre> | |||
====Block letters==== | |||
<pre> | |||
DUODENUM, BIOPSY: | |||
- SMALL BOWEL MUCOSA AND BRUNNER'S GLANDS WITHIN NORMAL LIMITS. | |||
</pre> | |||
<pre> | |||
DUODENUM, BIOPSY: | |||
- SMALL BOWEL MUCOSA WITHIN NORMAL LIMITS. | |||
</pre> | |||
<pre> | |||
DUODENUM, BIOPSY: | |||
- SMALL BOWEL MUCOSA WITHIN NORMAL LIMITS. | |||
- NEGATIVE FOR FINDINGS SUGGESTIVE OF CELIAC DISEASE. | |||
</pre> | |||
<pre> | |||
SMALL BOWEL (DUODENUM), BIOPSY: | |||
- SMALL BOWEL MUCOSA WITHIN NORMAL LIMITS. | |||
- NEGATIVE FOR FINDINGS SUGGESTIVE OF CELIAC DISEASE. | |||
</pre> | |||
==Basic DDx== | |||
*Celiac sprue. | |||
**Intraepithelial lymphocytes - '''key feature'''. | |||
**Loss of villi. | **Loss of villi. | ||
* | *Giardia. | ||
**Like celiac... but giardia organisms. | |||
**Like celiac... but | *Adenomas. | ||
*Adenomas | |||
**Too much blue - similar to colonic adenomas. | **Too much blue - similar to colonic adenomas. | ||
*Cancer | *[[Cancer]]. | ||
**Too much blue and epithelium in the wrong place. | **Too much blue and epithelium in the wrong place. | ||
====More==== | |||
*[[Helicobacter duodenitis|H. pylori]] only in areas of [[Gastric heterotopia of the duodenum|gastric metaplasia]].<ref>El-Zimaity. 18 October 2010.</ref> | |||
===Duodenal nodules DDX=== | |||
{{familytree/start}} | |||
{{familytree | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | | | | |A01=Duodenal<br>nodule}} | |||
{{familytree | | | | | |,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| | | | | | | | | | | | | |}} | |||
{{familytree | | | | | B01 | | | | | | | | | | | | | | B02 | | | | | | | | | | | | |B01=Benign<br>(common)| B02=Neoplastic}} | |||
{{familytree | |,|-|-|-|+|-|-|-|.| | | |,|-|-|-|v|-|-|-|+|-|-|-|v|-|-|-|.| | | | | |}} | |||
{{familytree | C01 | | C02 | | C03 | | C04 | | C05 | | C06 | | C07 | | C08 | | | | |C01=Brunner's<br>gland|C02=[[Gastric heterotopia of the duodenum|Heterotopic<br>gastric mucosa]]|C03=Lymphoid<br>nodule|C04=Adenoma|C05=[[Neuroendocrine tumour|NET]]|C06=[[Paraganglioma]]|C07=Prolapsed<br>gastric polyp|C08=[[Metastasis]]}} | |||
{{familytree/end}} | |||
===Infections of the duodenum<ref>{{cite journal |author=Serra S, Jani PA |title=An approach to duodenal biopsies |journal=J. Clin. Pathol. |volume=59 |issue=11 |pages=1133–50 |year=2006 |month=November |pmid=16679353 |pmc=1860495 |doi=10.1136/jcp.2005.031260 |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860495/?tool=pubmed}}</ref>=== | |||
Common: | |||
*[[Giardia]]. | |||
Rare: | |||
*[[Cryptosporidia]]. | |||
*[[Microsporidia]]. | |||
*Isospora belli. | |||
*Cyclospora. | |||
*MAC ([[Mycobacterium avium complex]]). | |||
*CMV ([[cytomegalovirus]]). | |||
*[[Cryptococcus neoformans]]. | |||
=Common stuffs= | |||
==Gastric heterotopia of the duodenum== | |||
*[[AKA]] ''heterotopic gastric mucosa''. | |||
{{Main|Gastric heterotopia of the duodenum}} | |||
==Celiac sprue== | ==Celiac sprue== | ||
=== | *[[AKA]] ''celiac disease''. | ||
* | {{main|Celiac sprue}} | ||
==Giardiasis== | |||
{{Main|Giardiasis}} | |||
==Acute duodenitis== | |||
*Abbreviated ''AD''. | |||
{{Main|Acute duodenitis}} | |||
==Chronic duodenitis== | |||
===General=== | |||
*This is not very well defined as [[plasma cell]]s 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=== | |||
<pre> | |||
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. | |||
</pre> | |||
==Peptic duodenitis== | |||
{{Main|Peptic duodenitis}} | |||
==Brunner's gland hyperplasia== | |||
:''Brunner's gland hamartoma'' redirects here. | |||
*Abbreviated ''BGH''. | |||
*[[AKA]] ''Brunneroma''.<ref name=pmid12376792>{{Cite journal | last1 = Tan | first1 = YM. | last2 = Wong | first2 = WK. | title = Giant Brunneroma as an unusual cause of upper gastrointestinal hemorrhage: report of a case. | journal = Surg Today | volume = 32 | issue = 10 | pages = 910-2 | month = | year = 2002 | doi = 10.1007/s005950200179 | PMID = 12376792 }}</ref> | |||
===General=== | |||
*Benign. | |||
*Usually asymptomatic.<ref name=pmid18583897>{{Cite journal | last1 = Lee | first1 = WC. | last2 = Yang | first2 = HW. | last3 = Lee | first3 = YJ. | last4 = Jung | first4 = SH. | last5 = Choi | first5 = GY. | last6 = Go | first6 = H. | last7 = Kim | first7 = A. | last8 = Cha | first8 = SW. | title = Brunner's gland hyperplasia: treatment of severe diffuse nodular hyperplasia mimicking a malignancy on pancreatic-duodenal area. | journal = J Korean Med Sci | volume = 23 | issue = 3 | pages = 540-3 | month = Jun | year = 2008 | doi = 10.3346/jkms.2008.23.3.540 | PMID = 18583897 }}</ref> | |||
Note: | |||
*The AFIP uses the term ''Brunner's gland hamartoma'' for lesions > 5 mm.<ref name=pmid16928936>{{Cite journal | last1 = Patel | first1 = ND. | last2 = Levy | first2 = AD. | last3 = Mehrotra | first3 = AK. | last4 = Sobin | first4 = LH. | title = Brunner's gland hyperplasia and hamartoma: imaging features with clinicopathologic correlation. | journal = AJR Am J Roentgenol | volume = 187 | issue = 3 | pages = 715-22 | month = Sep | year = 2006 | doi = 10.2214/AJR.05.0564 | PMID = 16928936 }}</ref> | |||
**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'''.<ref name=pmid4076734>{{Cite journal | last1 = Franzin | first1 = G. | last2 = Musola | first2 = R. | last3 = Ghidini | first3 = O. | last4 = Manfrini | first4 = C. | last5 = Fratton | first5 = A. | title = Nodular hyperplasia of Brunner's glands. | journal = Gastrointest Endosc | volume = 31 | issue = 6 | pages = 374-8 | month = Dec | year = 1985 | doi = | PMID = 4076734 }}</ref> | |||
*+/-Pancreatic acini and ducts.<ref name=pmid16928936/> | |||
DDx: | |||
*Foveolar metaplasia (isolated) - see [[peptic duodenitis]]. | |||
*[[Peptic duodenitis]]. | |||
Image: | |||
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2526515/figure/F3/ BGH (nih.gov)].<ref name=pmid18583897/> | |||
*[http://www.ajronline.org/content/187/3/715.full BGH (ajronline.org)].<ref name=pmid16928936/> | |||
=== | ===Sign out=== | ||
<pre> | |||
DUODENUM, BIOPSY: | |||
- CONSISTENT WITH BRUNNER'S GLAND HYPERPLASIA. | |||
- SMALL BOWEL MUCOSA WITHOUT SIGNIFICANT PATHOLOGY. | |||
</pre> | |||
<pre> | |||
DUODENUM, BIOPSY: | |||
- SMALL BOWEL MUCOSA WITHOUT SIGNIFICANT PATHOLOGY. | |||
- PROMINENT BRUNNER'S GLANDS WITH EXTENSION INTO THE LAMINA PROPRIA. | |||
</pre> | |||
====Superficial Brunner's glands==== | |||
<pre> | |||
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. | |||
</pre> | |||
=== | ====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. | |||
== | ==Helicobacter duodenitis== | ||
* | *Helicobacter is the most common cause of duodenitis.<ref>URL: [https://www.saintlukeskc.org/health-library/duodenitis https://www.saintlukeskc.org/health-library/duodenitis]. Accessed on: 2024 Feb 5.</ref><ref>URL: [https://www.webmd.com/digestive-disorders/what-is-duodenitis https://www.webmd.com/digestive-disorders/what-is-duodenitis]. Accessed on: 2024 Feb 5.</ref> | ||
** | *Overall, Helicobacter is rare in the duodenum. | ||
**Infection associated with [[Gastric heterotopia of the duodenum|gastric metaplasia]].<ref name=pmid7769188>{{cite journal |authors=Yang H, Dixon MF, Zuo J, Fong F, Zhou D, Corthésy I, Blum A |title=Helicobacter pylori infection and gastric metaplasia in the duodenum in China |journal=J Clin Gastroenterol |volume=20 |issue=2 |pages=110–2 |date=March 1995 |pmid=7769188 |doi=10.1097/00004836-199503000-00007 |url=}}</ref> | |||
=== | ===Sign out=== | ||
<pre> | |||
A. Duodenum, Biopsy: | |||
- Active duodenitis associated with foveolar epithelium and HELICOBACTER-LIKE ORGANISMS. | |||
- NEGATIVE for dysplasia. | |||
</pre> | |||
== | =Weird stuff= | ||
=== | ==Disaccharidases deficiency== | ||
* | ===General=== | ||
*Common among asians. | |||
*Includes: lactase, sucrase, and maltase. | |||
**Lactase changes seen with mild histomorphologic changes.<ref name=pmid2116456>{{cite journal |author=Langman JM, Rowland R |title=Activity of duodenal disaccharidases in relation to normal and abnormal mucosal morphology |journal=J. Clin. Pathol. |volume=43 |issue=7 |pages=537–40 |year=1990 |month=July |pmid=2116456 |pmc=502575 |doi= |url=}}</ref> | |||
**Maltase and sucrase only affected in moderate and severe lesions. | |||
=== | ===Microscopic=== | ||
Features:<ref name=pmid2116456>{{cite journal |author=Langman JM, Rowland R |title=Activity of duodenal disaccharidases in relation to normal and abnormal mucosal morphology |journal=J. Clin. Pathol. |volume=43 |issue=7 |pages=537–40 |year=1990 |month=July |pmid=2116456 |pmc=502575 |doi= |url=}}</ref> | |||
*Decreased villous-crypt ratio (mild to severe). | |||
*+/-Inflammation (only in moderate and severe). | |||
* | |||
DDx: | |||
* | *Celiac disease.<ref name=pmid11252408>{{cite journal |author=Murray IA, Smith JA, Coupland K, Ansell ID, Long RG |title=Intestinal disaccharidase deficiency without villous atrophy may represent early celiac disease |journal=Scand. J. Gastroenterol. |volume=36 |issue=2 |pages=163–8 |year=2001 |month=February |pmid=11252408 |doi= |url=}}</ref> | ||
Notes: | |||
* | *May have normal histomorphology.<ref name=pmid2116456>{{cite journal |author=Langman JM, Rowland R |title=Activity of duodenal disaccharidases in relation to normal and abnormal mucosal morphology |journal=J. Clin. Pathol. |volume=43 |issue=7 |pages=537–40 |year=1990 |month=July |pmid=2116456 |pmc=502575 |doi= |url=}}</ref> | ||
== | ==Whipple disease== | ||
{{Main|Whipple's disease}} | |||
== | ==Microvillous inclusion disease== | ||
{{Main|Microvillous inclusion disease}} | |||
This rare disease presents very shortly after birth. | |||
=== | ==Tufting enteropathy== | ||
* | *[[AKA]] ''intestinal epithelial dysplasia''. | ||
** | ===General=== | ||
*Genetic disease<ref name=omim613217>{{OMIM|613217}}</ref> - related to abnormal enterocytes (development and/or differentiation). | |||
**Gene implicated: ''EPCAM''.<ref name=omim185535>{{OMIM|185535}}</ref> | |||
=== | ===Microscopic=== | ||
Features:<ref name=pmid17448233>{{cite journal |author=Goulet O, Salomon J, Ruemmele F, de Serres NP, Brousse N |title=Intestinal epithelial dysplasia (tufting enteropathy) |journal=Orphanet J Rare Dis |volume=2 |issue= |pages=20 |year=2007 |pmid=17448233 |pmc=1878471 |doi=10.1186/1750-1172-2-20 |url=}}</ref> | |||
*Villous atrophy | |||
*Mononuclear cell infiltration of the lamina propria | |||
*Abnormal surface enterocytes: | |||
**Focal crowding -- resembling tufts. | |||
== | ==Gangliocytic paraganglioma== | ||
* | *Abbreviated ''GP''. | ||
{{Main|Gangliocytic paraganglioma}} | |||
==Pseudomelanosis duodeni== | |||
{{Main|Pseudomelanosis duodeni}} | |||
=Tumours= | |||
==Lymphoma== | ==Lymphoma== | ||
* | {{main|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: | Note: | ||
*Hodgkin's lymphoma does not arise in the GI tract. | *[[Hodgkin's lymphoma]] does not arise in the GI tract. | ||
==Adenocarcinoma of the duodenum== | |||
*[[AKA]] ''duodenal adenocarcinoma''. | |||
*[[AKA]] ''duodenal carcinoma''. | |||
{{Main|Adenocarcinoma of the duodenum}} | |||
==Duodenal neuroendocrine tumour== | |||
{{Main|Neuroendocrine tumours}} | |||
:''Duodenal NET'' redirects here. | |||
===General=== | |||
*Like [[neuroendocrine tumours]] elsewhere. | |||
*Use of the term ''carcinoid'' is discouraged.<ref name=pmid18414708>{{Cite journal | last1 = Chetty | first1 = R. | title = Requiem for the term 'carcinoid tumour' in the gastrointestinal tract? | journal = Can J Gastroenterol | volume = 22 | issue = 4 | pages = 357-8 | month = Apr | year = 2008 | doi = | PMID = 18414708 }} | |||
</ref><ref name=pmid15153416>{{Cite journal | last1 = Klöppel | first1 = G. | last2 = Perren | first2 = A. | last3 = Heitz | first3 = PU. | title = The gastroenteropancreatic neuroendocrine cell system and its tumors: the WHO classification. | journal = Ann N Y Acad Sci | volume = 1014 | issue = | pages = 13-27 | month = Apr | year = 2004 | doi = | PMID = 15153416 }} | |||
</ref><ref name=pmid14513276>{{cite journal |author=Klöppel G |title=[Neuroendocrine tumors of the gastrointestinal tract] |language=German |journal=Pathologe |volume=24 |issue=4 |pages=287–96 |year=2003 |month=July |pmid=14513276 |doi=10.1007/s00292-003-0636-7 |url=}}</ref> | |||
Associations: | |||
*[[Neurofibromatosis type 1]]. | |||
*[[MEN I]]. | |||
===Microscopic=== | |||
Features:<ref>URL: [http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/SmallbowelNET_11protocol.pdf http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/SmallbowelNET_11protocol.pdf]. Accessed on: 29 March 2012.</ref> | |||
*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]].<ref name=pmid21437171>{{Cite journal | last1 = Kim | first1 = JA. | last2 = Choi | first2 = WH. | last3 = Kim | first3 = CN. | last4 = Moon | first4 = YS. | last5 = Chang | first5 = SH. | last6 = Lee | first6 = HR. | title = Duodenal somatostatinoma: a case report and review. | journal = Korean J Intern Med | volume = 26 | issue = 1 | pages = 103-7 | month = Mar | year = 2011 | doi = 10.3904/kjim.2011.26.1.103 | PMID = 21437171 }}</ref> | |||
DDx: | |||
*[[Adenocarcinoma of the duodenum]]. | |||
====Images==== | |||
<gallery> | |||
Image:Small_intestine_neuroendocrine_tumour_low_mag.jpg | Neuroendocrine tumour - low mag. (WC) | |||
Image:Small_intestine_neuroendocrine_tumour_intermed_mag.jpg | Neuroendocrine tumour - intermed. mag. (WC) | |||
Image:Small_intestine_neuroendocrine_tumour_high_mag.jpg | Neuroendocrine tumour - high mag. (WC) | |||
</gallery> | |||
== | ===Sign out=== | ||
<pre> | |||
Duodenum, Biopsy: | |||
- Incidental neuroendocrine tumour, grade 1, see comment. | |||
- Background small bowel mucosa with Brunner's glands within normal limits. | |||
Comment: | |||
The tumour stains as follows: | |||
POSITIVE: AE1/AE3, CD56, synaptophysin. | |||
NEGATIVE: S-100, CD68. | |||
PROLIFERATION (Ki-67): <2%. | |||
</pre> | |||
== | ==Ampullary tumours== | ||
{{Main|Ampullary tumours}} | |||
===General=== | ===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.<ref name=pmid16332486>{{Cite journal | last1 = Meneghetti | first1 = AT. | last2 = Safadi | first2 = B. | last3 = Stewart | first3 = L. | last4 = Way | first4 = LW. | title = Local resection of ampullary tumors. | journal = J Gastrointest Surg | volume = 9 | issue = 9 | pages = 1300-6 | month = Dec | year = 2005 | doi = 10.1016/j.gassur.2005.08.031 | PMID = 16332486 }}</ref> | ||
===Microscopic=== | ===Microscopic=== | ||
Features: | 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. | *Ampullary carcinoma - has separate staging. | ||
==See also | ==Traditional adenoma== | ||
:''Duodenal adenoma'' redirects here. | |||
{{Main|Traditional adenoma}} | |||
===General=== | |||
*Strong association of [[familial adenomatous polyposis]]. | |||
**In one series of 208 adenomas, almost 70% were from FAP patients.<ref name=pmid16837629/> | |||
*Commonly found in association foveolar metaplasia - especially in sporadic cases ~60% of cases. | |||
**In FAP ~30% of cases have foveolar metaplasia.<ref name=pmid16837629>{{Cite journal | last1 = Rubio | first1 = CA. | title = Gastric duodenal metaplasia in duodenal adenomas. | journal = J Clin Pathol | volume = 60 | issue = 6 | pages = 661-3 | month = Jun | year = 2007 | doi = 10.1136/jcp.2006.039388 | PMID = 16837629 | PMC = 1955048}}</ref> | |||
*A colonscopy is recommended in individuals with nonampullary duodenal adenomas, as they are likely at increased risk of large bowel adenomas.<ref name=pmid26811631>{{Cite journal | last1 = Lim | first1 = CH. | last2 = Cho | first2 = YS. | title = Nonampullary duodenal adenoma: Current understanding of its diagnosis, pathogenesis, and clinical management. | journal = World J Gastroenterol | volume = 22 | issue = 2 | pages = 853-61 | month = Jan | year = 2016 | doi = 10.3748/wjg.v22.i2.853 | PMID = 26811631 }}</ref> | |||
===Sign out=== | |||
<pre> | |||
POLYP, DUODENUM, EXCISION: | |||
- TUBULAR ADENOMA. | |||
-- NEGATIVE FOR HIGH-GRADE DYSPLASIA. | |||
</pre> | |||
====Alternate==== | |||
<pre> | |||
Polyp (Nonampullary), Duodenum, Polypectomy: | |||
- Tubular adenoma, NEGATIVE for high-grade dysplasia. | |||
Comment: | |||
A colonscopy is recommended if not done recently, as individual with nonampullary duodenal adenomas are likely at increased risk of large bowel adenomas.[1] | |||
1. Therap Adv Gastroenterol. 2012 Mar; 5(2): 127138. doi: 10.1177/1756283X11429590 | |||
</pre> | |||
=See also= | |||
*[[Gastrointestinal pathology]]. | *[[Gastrointestinal pathology]]. | ||
*[[Intestinal polyps]]. | *[[Intestinal polyps]]. | ||
*[[Small bowel]]. | *[[Small bowel]]. | ||
=References= | |||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Gastrointestinal pathology]] | [[Category:Gastrointestinal pathology]] | ||
=External links= | |||
===Review article(s)=== | |||
*{{cite journal |author=Serra S, Jani PA |title=An approach to duodenal biopsies |journal=J. Clin. Pathol. |volume=59 |issue=11 |pages=1133–50 |year=2006 |month=November |pmid=16679353 |pmc=1860495 |doi=10.1136/jcp.2005.031260 |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860495/?tool=pubmed}} |
edits