Multiple duodenal polyps are a relatively rare finding, usually co-occurrent with familial adenomatous polyposis (FAP).We report a patient with multiple duodenal adenomas and a negative examination for FAP: multiple flat polyps were detected endoscopically in a 37-year-old male patient, extending from the apex of the bulb to the end of the descending part of the duodenum. In terms of histology, they were tubular adenomas with moderate dysplasia. Colonoscopy and enteroclysis were normal. Both push and capsule enteroscopy only showed multiple polyps in the area of the descending duodenum. DNA analysis of the APC gene was as follows: DGGE, exon 1–15, deletion at codons 1309 and 1061 by means of PCR for attenuated APC were negative. Afterwards we screened the patient for germline MYH mutations using the denaturing high-performance liquid chromatography (DHPLC) in combination with sequencing. No novel pathogenic mutation has been identified. Large polyps were removed by means of endoscopic polypectomy and mucosectomy, while small polyps were removed by means of argon plasma coagulation.We conduct yearly checkups, removing only sporadic polyps. The rare finding of duodenal polyposis not co-occurrent with FAP proves that multiple adenomas in the digestive tube need not necessarily co-occur with FAP. 1. Introduction Duodenal polyps are usually found in up to 4.6 percent of patients undergoing endoscopy of the upper part of the digestive tube [1]. Mostly adenomas, these polyps are the least frequent ones encountered in the descending duodenum (accounting for <0.05 percent of all intestinal adenomas) [2]. Most adenomas occur near the ampulla of Vater. Patients usually range between 30 and 90 years of age, with the highest incidence in the seventh decade [2]. Most small adenomas are asymptomatic and are usually detected accidentally by endoscopy of the upper part of the gastrointestinal tract conducted for another reason. Multiple duodenal adenomas are a rare finding, usually cooccurring with familial adenomatous polyposis (FAP) or attenuated familial adenomatous polyposis (AFAP). This special form of familial polyposis, also referred to in the literature as the hereditary flat adenoma syndrome, is due to a mutation in the proximal part of the APC gene [3, 4]. The actual incidence and frequency of AFAP are unknown [5]. The chief manifestation of this phenotypically different form of familial adenomatous polyposis is in flat adenomas of the large bowel that appear in small numbers (up to 100 polyps) [3]. In most cases, polyps of the gastric body, due to dilatation
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