Portal hypertensive duodenal polyp： A case report

Abnormalities of gastric mucosa in patients with portal hypertension are well documented. Manifestations of portal hypertension in small bowel and colon are less common. Colonic polypoid lesions microscopically consisting of a normal mucosa, with dilatation of submucosal vessels, have been described. We here report the first case of portal hypertensive duodenal polyp, responsible for gastro-intestinal bleeding. Endoscopic treatment turned out to be successful.     

Brunner's gland adenoma with circumferential duodenal involvement.

Brunner's gland adenoma is a benign tumor of the duodenum. We report a 58-year-old man who presented with abdominal pain, vomiting and weight loss. The patient underwent Whipple resection along with lymph node clearance. The resected tumor, 4 cm long, showed hypertrophied Brunner's glands.     

Management of the malignant polyp

Colonoscopy and endoscopic polypectomy are being utilized more frequently these days with the increased emphasis on the prevention, early detection, and treatment of colon cancer. Consequently, the problem of managing the malignant polyp is likely to be more frequently encountered. Many attempts have been made to clarify the management principles involved. Although the studies conducted have been imperfect in their design, the variety of information obtained from these studies is making the picture clearer. A more conservative approach is evolving. Many malignant polyps may be managed by endoscopic polypectomy alone. The criteria for which patients are to be managed in this fashion seem to be relatively simple ones, though technical problems with polypectomy performance and histologic evaluation are still frequently encountered. More carefully designed long-term studies are needed to create firm guidelines for the management of malignant polyps. Should screening and surveillance result in the discovery of earlier and more readily treatable forms of invasive colon cancer, endoscopic polypectomy will most certainly be a cornerstone of their treatment.     

Endoscopic mucosal resection with circumferential mucosal incision of duodenal carcinoid tumors

Duodenal carcinoids are a rare form of neuroendocrine tumors, and tend to invade the submucosa during the early stage. Endoscopic treatment is generally recommended for duodenal carcinoids less than 10 mm in diameter. Although a few reports have described the use of endoscopic resection of duodenal carcinoids, there are no published studies on endoscopic mucosal resection with circumferential mucosal incision (EMR-CMI). We performed EMR-CMI for 5 cases of duodenal carcinoids in the duodenal bulb. The mean tumor diameter was 4.6 ± 1.8 mm. Although all of the tumors were located in the submucosa, R0 resection was performed without complication in each case. EMR-CMI may thus be a safe and effective treatment for duodenal carcinoids less than 10 mm in diameter.     

Ligation-assisted endoscopic submucosal resection with circumferential mucosal incision for duodenal carcinoid tumor

Here we present the case of a 64-year-old female with a duodenal carcinoid tumor treated by ligation-assisted endoscopic submucosal resection(ESMR-L) with circumferential mucosal incision(CMI). Band ligation was effective in resecting the duodenal carcinoid tumor after CMI,with an uneventful post-procedural course. Histopathological examination showed clear tumor margins at deeper tissue levels. Thus,in the present case,ESMR-L with CMI was useful for the treatment of duodenal carcinoid tumor.     

Management of a large mucosal defect after duodenal endoscopic resection

Duodenal endoscopic resection is the most difficult type of endoscopic treatment in the gastrointestinal tract (GI) and is technically challenging because of anatomical specificities. In addition to these technical difficulties, this procedure is associated with a significantly higher rate of complication than endoscopic treatment in other parts of the GI tract. Postoperative delayed perforation and bleeding are hazardous complications, and emergency surgical intervention is sometimes required. Therefore, it is urgently necessary to establish a management protocol for preventing serious complications. For instance, the prophylactic closure of large mucosal defects after endoscopic resection may reduce the risk of hazardous complications. However, the size of mucosal defects after endoscopic submucosal dissection (ESD) is relatively large compared with the size after endoscopic mucosal resection, making it impossible to achieve complete closure using only conventional clips. The over-the-scope clip and polyglycolic acid sheets with fibrin gel make it possible to close large mucosal defects after duodenal ESD. In addition to the combination of laparoscopic surgery and endoscopic resection, endoscopic full-thickness resection holds therapeutic potential for difficult duodenal lesions and may overcome the disadvantages of endoscopic resection in the near future. This review aims to summarize the complications and closure techniques of large mucosal defects and to highlight some directions for management after duodenal endoscopic treatment.     

Management of gastric and duodenal neuroendocrine tumors

Gastrointestinal neuroendocrine tumors(GI-NETs) are rare neoplasms, like all NETs. However, the incidence of GI-NETS has been increasing in recent years. Gastric NETs(G-NETs) and duodenal NETs(D-NETs) are the common types of upper GI-NETs based on tumor location. G-NETs are classified into three distinct subgroups: type?Ⅰ, Ⅱ, and Ⅲ. Type?Ⅰ?G-NETs, which are the most common subtype(70%-80% of all G-NETs), are associated with chronic atrophic gastritis, including autoimmune gastritis and Helicobacter pylori associated atrophic gastritis. Type Ⅱ G-NETs(5%-6%) are associated with multiple endocrine neoplasia type 1 and Zollinger-Ellison syndrome(MEN1-ZES). Both type?Ⅰ?and Ⅱ G-NETs are related to hypergastrinemia, are small in size, occur in multiple numbers, and are generally benign. In contrast, type Ⅲ G-NETs(10%-15%) are not associated with hypergastrinemia, are large-sized single tumors, and are usually malignant. Therefore, surgical resection and chemotherapy are generally necessary for type Ⅲ G-NETs, while endoscopic resection and followup, which are acceptable for the treatment of most type?Ⅰ?and Ⅱ G-NETs, are only acceptable for small and well differentiated type Ⅲ G-NETs. D-NETs include gastrinomas(50%-60%), somatostatin-producing tumors(15%), nonfunctional serotonin-containing tumors(20%), poorly differentiated neuroendocrine carcinomas( 3%), and gangliocytic paragangliomas( 2%). Most D-NETs are located in the first or second part of the duodenum, with 20% occurring in the periampullary region. Therapy for D-NETs is based on tumor size, location, histological grade, stage, and tumor type. While endoscopic resection may be considered for small nonfunctional D-NETs(G1) located in the higher papilla region, surgical resection is necessary for most other D-NETs. However, there is no consensus regarding the ideal treatment of D-NETs.     

Inflammatory myoglandular polyp (Nakamura polyp): a case report

Inflammatory myoglandular polyp (IMGP) is a rare nonneoplastic polyp of the large bowel, characterized by inflammatory granulation tissue in the lamina propia, proliferation of smooth muscle and hyperplastic glands with variable degree of cystic changes. Clinical course is benign and etiology unclear, but it has been associated to chronic inflammation due to fecal stasis and abnormal colonic motility. Clinically may be asymptomatic or produce hematochezia. At endoscopy the appearance may be that of a pedunculated or semi-pedunculated polyp, with soft or lobulated surface, with hyperemia and even partial erosions. We present a 33 year-old male with hematochezia caused by an IMGP in the descending colon. Initial diagnosis was a well differentiated adenocarcinoma, which proved to be an IMGP on final pathology. Hematochezia resolved after resection.     

Appendicular intussusception into a polyp

Abstract. Intussusception of the appendix is a rare condition. We present the case of a 72–year–old woman with multiple polyps in the colon with an appendix completely intussuscepted into a polyp within the caecum. The clinical features, preoperative diagnosis, classification and treatment of this condition are discussed with reference to literature     

Spontaneous coughing up of a polyp

We report the case of an 18-year old female with right lower lobe atelectasis, who was admitted to our hospital because of a nonproductive cough. She underwent fiberoptic bronchoscopy that revealed a peduncular polyp in the right truncus intermedius or middle bronchus. Before admission for laser polypectomy, she spontaneously coughed up the tissue mass, and the right lower lobe atelectasis disappeared. We report a rare case of 'autopolypectomy' of a bronchial adenoma.