Karam Karam¹*, Houssein Chebbo², Sarah Saleh², Sarah Jalloul³, Johny Salem⁴, Georges El Hashem⁵, Elias Saikaly⁶, Charbel Fares⁷, Elias Fiani⁸, Pierre Hani⁹*

¹Department of Gastroenterology, University of Balamand, Dekweneh, Beirut, Lebanon
²Department of Internal Medicine, University of Balamand, Dekweneh, Beirut, Lebanon
³Department of Gastroenterology, University of Balamand, Dekweneh, Beirut, Lebanon
⁴Department of internal medicine, University of Balamand, Dekweneh, Beirut, Lebanon
⁵Associate professor, Department of Hematology and Oncology, Faculty of Medicine, Saint George University of Beirut
⁶Associate professor, Department of General Surgery, Saint George University of Beirut
⁷Department of Radiology, University of Balamand, Dekweneh, Beirut, Lebanon
⁸Associate professor, Department of Gastroenterology, University of Balamand, Dekweneh, Beirut, Lebanon
⁹Associate professor, Department of Gastroenterology, Faculty of Medicine, University of Balamand, Dekweneh, Beirut, Lebanon

*Corresponding Author: Karam Karam, Department of Gastroenterology, University of Balamand, Dekweneh, Beirut, Lebanon

Received: June 13, 2024; Published: July 04, 2024

Abstract

Background: This is the case of a 25-year-old female patient with no known past medical history presenting for esophagogastroduodenoscopy (EGD) for intractable reflux symptoms. Endoscopy revealed a carpet-like distribution of innumerable sub-centimetric polyps protruding into the duodenal lumen between 2 to 5 mm in size. The mucosa of the duodenal bulb was devoid of any polypoid or nodular features. Similarly, the esophageal and gastric mucosa were normal upon direct endoscopic visualization.

Summary: A previously healthy 25-year-old female patient presented for EGD due to refractory reflux symptoms. Of note, Nodular lymphoid hyperplasia (NLH) was previously thought to be heralding an early manifestation of familial adenomatous polyposis (FAP). Upon endoscopic visualization, innumerable polyps were seen in the second part of the duodenum ranging in size between 2- and 5-mm. Biopsies were taken from the polyps and sent to pathology which revealed reactive lymphoid follicles corroborating a diagnosis of diffuse duodenal nodular lymphoid hyperplasia (DDNLH). Gastric biopsies were normal and negative for Helicobacter pylori.

Conclusion: DDNLH is a form of NLH characterized by a diffuse distribution of polyps in a carpet-like pattern throughout the duodenal mucosa and sparing the duodenal bulb. Biopsy reveals reactive lymphoid follicles. NLH is a common finding in children whereby it exhibits a spontaneous regression. Conversely, NLH is seldom seen in adults and it is usually considered a precursor of mucosal associated lymphoid tissue (MALT) lymphoma.

Keywords: Diffuse Duodenal Nodular Lymphoid Hyperplasia; MALT-type Lymphoma; Germinal Center Hyperplasia

References

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Citation

Citation: Karam Karam., et al. “Diffuse Duodenal Nodular Lymphoid Hyperplasia in A Young Adult: A Case Report". Acta Scientific Gastrointestinal Disorders 7.8 (2024): 08-11.

Copyright

Copyright: © 2024 Karam Karam., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.