Most GIST have traditionally been classified as submucosal origin by upper gastrointestinal series (UGIS) or endoscopy. However, we experienced a gastrointestinal mesenchymal origin tumor expressed by polypoid mass with a long stalk. The gastric outlet was obstructed by the polypoid mass on the duodenum. The microscopic findings of the resected mass showed a stromal cell component by immunohistochemical stain. We experienced gastric stromal tumor found as a polypoid mass with long stalk which was easily detected by endoscopy. It would not have been suspected as a stromal tumor as a result of endoscopic findings only.
Aged ; Case Report ; Duodenum/pathology* ; Human ; Male ; Stomach Neoplasms/pathology*

No abstract available.
Adult ; Duodenum/*pathology ; Endoscopy, Digestive System ; Female ; Humans ; Metaplasia/pathology

Gangliocytic paraganglioma of the duodenum is an extremely rare disease. Few cases have been reported in the literature from 1957 to 2010. We reported a 67-year-old man with gangliocytic paraganglioma of the duodenum.
Aged ; Duodenal Neoplasms ; diagnosis ; Duodenum ; pathology ; Humans ; Male ; Paraganglioma ; diagnosis

No abstract available.
Duodenal Neoplasms/pathology/*ultrasonography ; Duodenum/pathology ; Endosonography ; Female ; Humans ; Lipoma/pathology/*ultrasonography ; Middle Aged

OBJECTIVETo investigate the clinical manifestations and endoscopic features of abdominal type Henoch purpura in children and improve the diagnostic level.

METHODSRetrospective review was made on the clinical, endoscopic and histopathological features of 57 cases of children with Henoch purpura abdominal type who had been hospitalized from Jan. 2002 to May 2007. Upper gastrointestinal endoscopy was performed in all cases. All the cases had various digestive system symptoms without cutaneous purpura before endoscopy. Mucosal specimens were taken from sinus ventriculi and duodenum for histopathological analysis. Helicobacter pylori (H.pylori) infection was identified by rapid urease test and histology, and diagnosis of H.pylori infection was made when both were positive.

RESULTSThe common gastrointestinal symptoms of Henoch purpura were abdominal pain (46 cases), vomiting (32 cases), hematochezia (11 cases), diarrhea (4 cases) and abdominal distention (1 case). Three cases had arthralgia and joint swelling. The main laboratory findings were increased peripheral white blood cells (33 cases, 57.9%), 1/5 of cases had elevated C reactive protein (CRP), low serum albumin and seroperitoneum. Endoscopy demonstrated the damages to the mucosa, which varied from congestion, edema, petechia and ecchymosis (37 cases, 64.9%) to erosive and multiple ulcers (14 cases, 24.6%), granulation of mucosa in descendent duodenum (4 cases, 7.0%), and diffuse hemorrhage of mucosa (2 cases, 3.5%). The upper gastrointestinal endoscopy showed that the commonest and most serious position involved was the descendent duodenum (55 cases, 96.5%), followed by duodenal bulb (32 cases, 56.1%) and stomach (18 cases, 36.1%), esophagus was less involved (1 case, 1.8%). Histological manifestations showed swollen vascular endothelial cells of capillary vessels and small blood vessels, fibrotic necrosis of small vessels and bleeding, diffuse perivascular lymphocytic and neutrophilic infiltration and nuclear debris in mucosa and submucosa. Three cases (5.3%) were found infected with H. pylori. In 49 cases (86.0%) cutaneous purpura appeared 1 - 7 days after endoscopy. Eight cases had no cutaneous purpura until they left hospital. Two cases were lost to follow up and 6 cases (10.5%) remained free from cutaneous purpura were followed up until now (1 - 5 years).

CONCLUSIONDescending duodenum is the commonest and most serious position of upper gastrointestinal tract involved in Henoch purpura. Upper gastrointestinal endoscopy with the mucosal biopsy are useful for the early diagnosis of Henoch purpura.

Abdominal Pain ; pathology ; physiopathology ; Child ; Duodenum ; pathology ; physiopathology ; Endoscopy ; instrumentation ; Humans ; Purpura, Schoenlein-Henoch ; pathology ; physiopathology

OBJECTIVETo probe into the effect of acupuncture in imaging diagnosis on changing pyloric antrum and duodenal bulb metamorphosis, and provide reliable evidence for confirming pathological characters.

METHODSAmong 30 cases needing image examination, 18 cases had metamorphosis of duodenal bulb and 12 cases had metamorphosis of pyloric antrum. Acupuncture was given at Zusanli (ST 36) with uniform reinforcing-reducing method, and with moderate-strong stimulation. The needle was retained for 2 min. After pressing point Zhongwan (CV 12), changes of image were investigated.

RESULTSAfter acupuncture, the metamorphosis alleviated in 26 cases, with an effective rate of 86.7%.

CONCLUSIONThis method is simple, convenient and objective with no adverse effects.

Acupuncture Points ; Acupuncture Therapy ; Adolescent ; Adult ; Duodenum ; pathology ; Female ; Humans ; Male ; Middle Aged ; Pyloric Antrum ; pathology

No abstract available.
Duodenum/*pathology ; Female ; Gastric Mucosa/*pathology ; Helicobacter Infections/*diagnosis ; *Helicobacter pylori ; Humans ; Male ; Metaplasia/*diagnosis ; Pyloric Antrum/*pathology

OBJECTIVEDuodenal salami ulcer is a common disease found on routine endoscopic examination in children. The purpose of the study was to explore the characteristics and the clinicopathological features of duodenal salami ulcer in children and to deepen the understanding of duodenal salami ulcer.

METHODSThe endoscopic results of 117 cases with the duodenal salami ulcer were analyzed. The specimens of gastric antrum and duodenal bulb were subjected to HE and Giemsa staining and were examined for any alteration in histopathology and infection with Helicobacter pylori (Hp). The duodenal mucosa was stained with AB (pH 2.5)/PAS in order to diagnose the duodenal metaplasia.

RESULTSThe major endoscopic finding was a kind of hoarfrost, which was dotty or flaky, covered on the hyperemic and edematous mucosa. The detection rate of this change was 2.29% (117/5 106) of all the endoscopic examinations in children and the rate among cases with duodenal ulcer was 49.2% (117/238). The histopathology was characterized by a heavy infiltration of mainly lymphocytes, plasmocytes and neutrophilic granulocytes, frequently accompanied by superficial erosion. Sixty-one cases were pathologically diagnosed as chronic active duodenitis, superficial erosion in 45; chronic duodenitis in 50; eosinophilic duodenitis in 6. Detection rate of Hp in gastric antrum was 58% (68/117) of all cases. Detection rate of Hp infection and gastric epithelium metaplasia in duodenal bulb was 11.1% (13/117) and 31.1% (37/117), respectively. However, detection rate of Hp in gastric antrum was 25.0% (1 203/4 810) in 4 810 cases of normal duodenal bulb and chronic duodenitis in the same period. Detection rate of Hp in duodenal bulb was 0% and the detection rate of gastric epithelium metaplasia in duodenal bulb was 2.7% (128/4 810). All these detection rates were much higher than those of the specimens collected during the same period with normal duodenal bulb and chronic duodenitis (P < 0.001). Twenty-one cases were reexamined by endoscopy after having been treated with antacids or antacids and antimicrobial agents for 4 weeks. The lesions were healed up and no scars were found.

CONCLUSIONDuodenal salami ulcer in children had a special manifestation of duodenal inflammation or erosion but not a real ulcer. It was caused by the Hp infection in gastric antrum or duodenal bulb and the increase of gastric acids. The therapeutic principles were antacid and antimicrobial agents. The prognosis was good.

Adolescent ; Child ; Duodenal Ulcer ; complications ; pathology ; Duodenum ; pathology ; Female ; Helicobacter Infections ; complications ; Humans ; Male ; Pyloric Antrum ; pathology

BACKGROUND/AIMS: The incidence of duodenal tumors has increased by health surveillance. However, preoperative diagnosis of subepithelial duodenal tumors remains difficult because of the wide variety of pathologies and the location of the tumors. We analyzed endoscopic, radiological, and pathological features of subepithelial benign duodenal tumors (BDTs), which were treated by surgical resection. METHODS: Five patients with subepithelial BDTs treated by surgical resection were analyzed retrospectively. We compared the preoperative and postoperative diagnosis and evaluated the clinical presentations, endoscopic and radiological findings, surgical treatments, pathological results, and outcomes of these patients. RESULTS: All the patients underwent successful surgical resection. There were two cases of gastrointestinal stromal tumors (GISTs) treated with segmental duodenectomy, one case of carcinoid tumor treated with antrectomy, one case of gangliocytic paraganglioma treated with ampullectomy, and a lipoma removed by mass excision. The two GISTs were in the duodenal third and fourth segment close to the pancreas, and it was difficult to exclude pancreatic tumors by imaging studies. All the patients remained healthy for more than three years. CONCLUSIONS: Subepithelial BDTs are rare and difficult to diagnosis. Awareness and preoperative diagnosis of subepithelial BDTs can lead to minimally invasive treatment, including endoscopic or local surgical resection.
Carcinoid Tumor ; Diagnosis ; Duodenum ; Gastrointestinal Stromal Tumors ; Humans ; Incidence ; Lipoma ; Pancreas ; Paraganglioma ; Pathology ; Retrospective Studies

Pathological proliferation of Brgnners gland is rare, and its wide range of morphologieal variations have led to confusing the terminology with considerable lack of agreement. Six cases of duodenal nodular lesions which consisted of pathological proliferation of Brunners glands were examined by light microscopy. Polypectomy was made in two cases, and the remaining 4 cases were examined with endoscopic biopsy materials. Two polypectomy specimens, 2 cm and 3 cm each in great diameters, consisted of protruded ovoid mass with broad and short stalks. Microacopically, all of 6 cases revealed thin strands of fibrous connective tissue which separated the normal-looking Brunners glands in lobules. Individual lobules were composed of groups of acini formed by cuboidal cells admixed with occasional endocrine cells. Presence of glandular and ductal configuration of the Brunners gland aside from thick, randomly arranged bundles of smooth muscle were featured without distinct relation to interlobular septa. Also, one polypectomy case disclosed the nests of fat cells interspersed with the glandular acini. One mucosal biopsy case contained not only the smooth muscle bands but also the intimate mixture of both acini and ducts. We conclude that some of heterogeneous composition of duodenal nodular proliferation of Brunners gland is indicative of a hamartomatous growth.
Adipocytes ; Biopsy ; Brunner Glands ; Connective Tissue ; Duodenum ; Endocrine Cells ; Hamartoma* ; Microscopy ; Muscle, Smooth ; Pathology