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Year : 2010  |  Volume : 53  |  Issue : 3  |  Page : 558-559
Portal duodenopathy presenting as polyposis


1 Department of Pathology, PSG Institute of Medical Science and Research, Peelamedu, Coimbatore - 641 004, Tamil Nadu, India
2 Department of Gastroenterology, PSG Institute of Medical Science and Research, Peelamedu, Coimbatore - 641 004, Tamil Nadu, India

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Date of Web Publication22-Oct-2010
 

How to cite this article:
Pillai SB, Ram Ganesh V R, Mohanakrishnan A, Nirmala V. Portal duodenopathy presenting as polyposis. Indian J Pathol Microbiol 2010;53:558-9

How to cite this URL:
Pillai SB, Ram Ganesh V R, Mohanakrishnan A, Nirmala V. Portal duodenopathy presenting as polyposis. Indian J Pathol Microbiol [serial online] 2010 [cited 2019 Jul 20];53:558-9. Available from: http://www.ijpmonline.org/text.asp?2010/53/3/558/68271



   Introduction Top


Esophageal varices and portal hypertensive gastropathy are the common manifestations of portal hypertension. Portal hypertensive duodenopathy is an uncommon feature of the portal hypertension syndrome. [1] Endoscopic and histopathologic findings of portal hypertensive duodenopathy are not well described. Herein, we report a case where portal hypertensive duodenopathy presented as multiple sessile polyps.


   Case Report Top


A 55-year-old male with a known case of alcoholic cirrhosis was admitted with progressively increasing jaundice and ascites. He had variceal bleeding 2 years ago. On physical examination, he had jaundice and ascites. Laboratory investigations revealed elevated liver enzymes and bilirubin. Endoscopy showed grade II esophageal varices and moderate portal gastropathy. In addition, multiple sessile polyps were seen in the first part of the duodenum, which was biopsied [Figure 1]. The histopathologic examination of the specimen showed polypoid mucosa covered by small intestinal and gastric foveolar types of epithelium. The lamina propria showed proliferating ectatic capillaries [Figure 2]. Fibrosis and smooth muscle in the lamina propria were noted focally along with inflammation. A diagnosis of portal hypertensive duodenopathy was given.
Figure 1: Endoscopic image showing multi ple sessile polyps in the first part of the duodenum

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Figure 2: Polypoidal fragment of mucosa showing vascular proliferati on in the lamina propria. (H and E, ×100); Inset shows vascular proliferati on in high power (H and E, ×400)

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   Discussion Top


Portal duodenopathy perhaps is the least common gastrointestinal manifestation of portal hypertension syndrome. Only a few studies exist in the literature on the endoscopic and microscopic features of this entity. Endoscopic findings described in portal duodenopathy include erosions, ulcers, friability of the mucosa, edema, and solitary polyp, erosions and ulcers being the most common. [2] There has been one report of a solitary duodenal polyp, by David et al. [3] Multiple sessile polyps in the duodenum as in the present case have not been reported so far.

Angiogenesis, congestion, edema, apoptosis, fibrosis, and villous change are the microscopic features described in portal hypertension. Angiogenesis (neovascularization) is an important vascular phenomenon that mediates adaptation and accommodation of the high portal pressure. [2] The present case showed crowding of capillaries in the lamina propria and fibrosis. Gastric metaplasia was observed in addition, which suggested the possibility of a coexisting Helicobacter pylori gastritis.

In conclusion, this case represents a rare gastrointestinal manifestation of portal hypertension with unusual endoscopic findings of multiple sessile duodenal polyps and a microscopic picture diagnostic of portal duodenopathy.

 
   References Top

1.Menchιn L, Ripoll C, Marνn-Jimιnez I, Colσn A, Gσmez-Camarero J, Gonzαlez-Asanza C, Menchιn P, et al. Prevalence of portal hypertensive duodenopathy in cirrhosis: Clinical and haemodynamic features. Eur J Gastroenterol Hepatol 2006;18:649-53.  Back to cited text no. 1      
2.Barakat M, Mostafa M, Mahran Z, Soliman AG. Portal hypertensive duodenopathy: Clinical, Endoscopic, and Histopathologic profiles. Am J Gastroenterol 2007;102:2793-802.  Back to cited text no. 2      
3.Zeitoun JD, Chryssostalis A, Terris B, Prat F, Gaudric M, Chaussade S. Portal hypertensive duodenal polyp: A case report. World J Gastroenterol 2007;13:1451-2.  Back to cited text no. 3      

Top
Correspondence Address:
Suma Bhargavan Pillai
Department of Pathology, PSG Institute of Medical Science and Research, Peelamedu, Coimbatore - 641 004, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.68271

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    Figures

  [Figure 1], [Figure 2]

This article has been cited by
1 Portal hypertensive polyps: distinct entity
Anjali D. Amarapurkar,Deepak Amarapurkar,Mehul Choksi,Nirav Bhatt,Pooja Amarapurkar
Indian Journal of Gastroenterology. 2013; 32(3): 195
[Pubmed] | [DOI]



 

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    References
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