Duodenal Polyps



Duodenal Polyps


Michael P. Federle, MD, FACR





Key Facts


Imaging



  • Duodenal polyps are much less common than gastric


  • Epithelial polyps (mucosal lesions)


  • Classified into 3 types


  • Adenomatous polyps (most common)



    • Single, lobulated or cauliflower-like surface


  • Hyperplastic polyps



    • Multiple, small, sessile polyps of uniform size


  • Hamartomas: Cluster of broad-based polyps



    • Can occur as part of Peutz-Jeghers syndrome


  • Submucosal (intramural) lesions


  • Duodenal GI stromal tumor (GIST)



    • Soft tissue density mass that deforms lumen


    • Lesions ≥ 2 cm often have central necrosis


  • Duodenal lipoma



    • Characteristic fat density on CT


  • Other mesenchymal tumors (rare)


  • Carcinoid tumor



    • Single or multiple; may ulcerate → “target” lesions


Top Differential Diagnoses



  • Brunner gland hyperplasia


  • Duodenal flexure pseudotumor


  • Ectopic gastric mucosa


  • Duodenal carcinoma


  • Intestinal metastases and lymphoma


  • Duodenal hematoma


  • Kaposi sarcoma


  • Ampullary carcinoma


Diagnostic Checklist



  • Check for family history of GI tract polyps



    • e.g., familial polyposis or Peutz-Jeghers


  • Lipomas can be diagnosed with confidence on CT


  • Most other polyps have nonspecific imaging features






(Left) Upper GI series shows a large adenomatous polyp image as a radiolucent filling defect within the duodenum. (Right) Spot film from an upper GI series demonstrates a polypoid mass image within the duodenal bulb. Endoscopic biopsy and resection revealed a hamartoma of the Brunner gland. Brunner gland hamartomas (hyperplasia) are usually multiple, smaller lesions. Larger, isolated lesions, as in this case, are indistinguishable from many other duodenal masses and require biopsy.






(Left) Axial CECT in a middle-aged man with vague abdominal pain shows a subtle heterogeneous mass image within the lumen of the 2nd part of the duodenum without signs of luminal obstruction. There was also no biliary or pancreatic ductal obstruction. (Right) Gross pathology in the same case shows the mass image previously identified on CT. After endoscopic confirmation of a villous tumor at this location, a pancreaticoduodenectomy (Whipple procedure) was performed.



TERMINOLOGY


Definitions



  • Protruding, space-occupying masses within duodenum


IMAGING


General Features



  • Best diagnostic clue



    • Radiolucent filling defects, ring shadows, or contour defect on barium study


    • CT signs of intraluminal &/or intramural mass


  • Size



    • Adenomatous and hamartomatous polyps: Several mm to 2 cm


  • Morphology



    • Epithelial polyps (mucosal lesions)


    • Adenomatous polyps (most common)



      • Usually single, lobulated or cauliflower-like surface


      • More evident on upper GI series than on CT


    • Hyperplastic polyps: Smooth, sessile, pedunculated



      • Much less common in duodenum than in stomach


    • Hamartomas: Cluster of broad-based polyps



      • Can occur as part of Peutz-Jeghers syndrome


  • General features

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Jun 13, 2016 | Posted by in GASTROINTESTINAL IMAGING | Comments Off on Duodenal Polyps

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