Click on thumbnails to see full sized pictures.Gastrointestinal Pathology- Clinicopathologic Correlation in Mucosal Biopsy
Case #1 (question #1 and #2):
A 35 year-old gentleman with a history of familial adenomatous polyposis (FAP), status post colectomy and now with duodenal polyps. Representative images are illustrated below:
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Question No. 1. The Answer is: (A) Polyps develop preferentially in the duodenum.
Discussion: This is an adenoma with low-grade dysplasia arising in familial adenomatous polyposis (FAP). FAP is associated with adenomatous polyps of the small intestine, which occur most frequently in the duodenum. FAP patients with multiple duodenal adenomas have 100- to 300-fold increased lifetime risk of duodenal or periampullary adenocarcinoma. The small bowel adenomas in FAP tend to cluster around ampulla of Vater, are usually multiple, and tend to become evident 10 years later than the colorectal polyps.
Question No. 2. The Answer is: (E) All of the above.
Discussion: Risk factors for developing adenocarcinoma of the small bowel include FAP, HNPCC, Peutz-Jeghers syndrome, Crohn’s disease, and celiac disease. Of note, FAP patients with multiple duodenal adenomas have 100- to 300-fold increased lifetime risk of duodenal or periampullary adenocarcinoma.