Clinical Presentation

A 47-year-old man presents to the gastroenterology clinic with abdominal pain and recurrent gastrointestinal bleeding.

(A) Contrast-enhanced computed tomography (CT) shows a soft-tissue filling defect (arrow) originating from the immediate postbulbar duodenal wall. No adjacent wall thickening and no lymphadenopathy are present. (B) The soft-tissue filling defect (arrow) is polypoid and terminates in the distal descending duodenum.

Differential Diagnosis

• Adenoma: This is the most likely diagnosis as it is commonly solitary and periampullary in origin.

• Brunner gland hamartoma: This is also solitary and well circumscribed, in the proximal duodenum, and either homogeneous or heterogeneous on CT, depending on the amount of cystic degeneration and fat.

• Lymphoma: This is a third option. It may be polypoid, but this presentation is less common than invasive lymphoma.