Duodenal polyposis secondary to portal hypertensive duodenopathy

Table 1 Reported small intestinal polyps secondary to portal hypertension (including current case)

Ref.	Age (yr)/gender	Location(s)	Number/sizes of polyps	Pathologic findings	Etiology of portal hypertension
Current report	52/M	Duodenal bulb to second portion	Greater than 7, majority 1-2 mm, largest 8 mm	Villiform hyperplasia of reactive intestinal and gastric foveolar epithelium, proliferating ectatic and congested lamina propria vessels	Alcoholic cirrhosis
Pillai et al[2]	55/M	1st portion of duodenum	“multiple sessile polyps”, sizes NS	Polypoid muocsa lined by small intestinal and gastric foveolar type epithelium with ectatic capillaries, fibrosis and smooth muscle proliferation of lamina propria	Alcoholic cirrhosis
Zeitoun et al[3]	70/M	2nd portion of duodenum	Single polyp, 3 cm	Numerous thick-walled capillaries with vascular ectasia in lamina propria	Alcoholic cirrhosis
1Lemmers et al[4]	50/F	Jueuno-ileal	“Several”, > 5 mm	Lamina propria vascular dilation and thrombi without epithelial atypia	Hepatitis C cirrhosis
	73/M	Jejunal	Two “bumps”, < 5 mm	Not biopsied	Cryptogenic cirrhosis
	67/M	Duodenal	“Several”, 5 mm	Lamina propria vascular dilation and inflammation with epithelial atypia and ulceration	Alcoholic cirrhosis
	74/F	Antral/duodenal	“Several”, 15 mm	Lamina propria vascular dilation and epithelium with crenellated glands	Hepatitis C cirrhosis
	66/F	Duodenal/jejuno-ileal	“Several”, 5/< 5 mm	Not biopsied	Cryptogenic cirrhosis
Devadason et al[5]	6 yr/M	1st and 2nd portion of duodenum	“polyps”, sizes NS	Lobular capillary proliferation in a hemagiomatous pattern in lamina propria	EHPVO
	4 yr/F	2nd portion of duodenum	“numerous”, sizes NS	Lobular capillary proliferation in a hemagiomatous pattern in lamina propria	EHPVO
	1 yr/F	2nd portion of duodenum	“polyps”, sizes NS	Polyp not biopsied, mucosa adjacent to polyp with ecatsia and congestion of lamina propria with smooth muscle hypertrophy	EHPVO

¹Data obtained from Table 1 (provided by Dr. Lemmers, personal communication). EHPVO: Extrahepatic portal venous obstruction; NS: Not specified.

Table 2 Histological differential diagnosis of polyps in the duodenum

Primary	Epithelial
	Duodenal adenoma/adenocarcinoma
	Ampullary adenoma/adenocarcinoma
	Hyperplasia, heterotopias, ectopias, inflammatory
	Brunners gland hyperplasia/hamartoma
	Gastric/pancreatic hetertopia/ectopia
	IBD associated inflammatory pseudopolyps
	Inflammatory fibroid polyp
	Peutz Jegher polyps
	Juvenile polyps (JPS or PTEN associated)
	Cronkhite-Canada syndrome polyps
	Neuroendocrine/neural
	Neuroendocrine tumors
	Mixed adenocarcinoma neuroendocrine carcinoma
	Gangliocytic paranglioma
	Neurofibroma
	Ganglioneuroma
	Schwannoma
	Perinerioma
	Mesenchymal
	Gastrointestinal stromal tumor
	Leiomyoma
	Lipoma
	Hemangioma
	Granular cell tumor
	Kaposi sarcoma
	Lymphoid
	Lymphoid hyperplasia
	B and T cell lymphomas
Secondary	Metastases
Miscellaneous	Malakoplakia, mucosal prolapse related, lymphangiectasia, xanthoma

IBD: Inflammatory bowel disease.