Apparent 8mm polypoid lesion in duodenal bulb on MR Enterography

[mbaud]

I've had a 3 week history of vague abdominal pain with some stool irregularities (namely, foul odor and soft texture).

All blood tests (CBC, CMP, pancreatic enzymes, CRP, ESED, LDH) have been normal.
Abdominal ultrasound was normal.

I had an MR Enterography a few days ago. The impression was that there was an "Apparent 8mm polypoid lesion in the right wall of the duodenal bulb. Otherwise, normal MR Enterography." No other abnormalities were noted.

The recommended follow-up was upper endoscopy, which I have scheduled for Tuesday. But in the mean time, I am petrified. From what I've read, 90% of the polyps in the duodenal bulb are benign. I don't know what that makes the other 10%--because I've seen them described as adenomas and carcinoid tumors, in addition to the clearly malignant adenocarcinoma. I know the adenomas and carcinoids can possess characteristics of precancerous growths.

Maybe I misunderstand this all. 90% benign may mean 90% non-neoplastic, and 10% neoplastic? I don't know. My head is spinning with worry.

My doctors seem unconcerned, and noted that on my last upper endoscopy (3/2012), nothing was seen there. So there is a possibility that the MR picked up a piece of food or something; moreover, if it is something, it is still likely nothing to worry about.

All I know is that this is apparently considered a small polypoid lesion at 0.8 cm, and that I have some symptoms anyway, I don't know what to make of that.

Does anyone have any insight?

[Dr. Kokil Mathur]

Well, a new growth always ups one suspicion of cancer, but as I said earlier, most duodenal polyps are benign. Please do not get so worked up--it will only add to the acidity ):--and anyways--nothing can be done until the endoscopy results are available--so all the best for it--hope all goes well! Take care!

[mbaud]

Thank you for your reply. As a follow-up, I'm curious about the fact that this was not seen on my last endoscopy 1.5 years ago. Would this be considered favorable or unfavorable? Further, the MR Ent made no notation of ulceration (but I'm not sure if it can even detect such things). I would think that in the case of gastrinomas that lead to Zollinger Ellison Syndrome, the absence of obvious ulceration is a good thing?

[Dr. Kokil Mathur]

Hi!
I can understand your worry as it is scary to find a polyp or polyp like growth in your duodenum. As you have read, in most cases (am not adding percentage as this varies with ethnicity, food habits, geographical locations etc), the duodenal polyp is benign. The most common cause is gastritis or excess acid production (may have genetic cause, or due to wrong food habits, smoking, drinking alcohol, abusing medication, or taking prescription medications for long). Other causes are vitamin B 12 deficiency, food allergy, inflammatory bowel disease. Very few duodenal polyps are cancerous. Also a cancerous polyp is generally larger in size, has irregular or rough surface, and often bleeds.
Without looking at the films, it is difficult to say whether the MR findings are really positive for duodenal polyp or not. Yes, artefacts or false positives are possible.

Long standing duodenal polyps do have an increased risk of turning malignant due to onslaught of acid and irritation.  So, usually, during the endoscopy they are removed and sent for biopsy.
Regarding the foul smell and soft stools: Certain food items like cabbage, radish, turnip and certain meat products too cause a foul smell in stool.  Foods which cause excess formation of hydrogen sulfide gas from the sulfites present in them too could be the cause. Sulfites are present in all juices, molasses, yellow dye in ready made food stuffs, and red wine. Sulfites are present in lesser amounts in mashed potatoes made from dry powder, pickles, tinned shrimp, cookies, crackers, and readymade pie dough. If you have been taking these things in a good amount, then cut down the intake.
Other causes of foul smell with soft stool will have to be looked into such as intestinal infection, celiac disease, Crohn’s disease, short bowel syndrome, malabsorption syndromes, chronic pancreatitis or hepatitis and cystic fibrosis. Blood enzyme panel in chronic pancreatitis is often normal, so other tests like ERCP etc will have to be carried out. Please discuss with your doctor.

I sincerely hope you will find this information useful in your journey towards better health.
Good Luck and take care!

[mbaud]

Additional note of symptomology: weight loss. About 8 pounds in 14 days.