Clinicopathological Features and Magnifying Chromoendoscopic Findings of Non-Ampullary Duodenal Epithelial Tumors

Digestion. 2018;97(3):219-227. doi: 10.1159/000485505. Epub 2018 Feb 9.


Background and aims: We aimed to investigate an association between clinicopathological features, including immunohistochemical mucin phenotypes, and magnifying chromoendoscopic findings with crystal violet staining (ME-CV) in non-ampullary duodenal epithelial tumors (NADETs).

Methods: A total of 55 patients with NADET were divided into 3 groups by mucin phenotype: intestinal, gastrointestinal, or gastric. ME-CV findings were classified into 4 patterns: convoluted, leaf-like, reticular/sulciolar, and pinecone. The clinicopathological features and ME-CV findings were compared among the mucin phenotypes.

Results: Tumors of the gastric type were located in the duodenal bulb (p < 0.001), and contained pyloric gland adenoma (p < 0.001) more frequently than the other types. White-light endoscopy indicated that milk-white mucosa was less frequent in tumors of the gastric type than in those of the gastrointestinal type (p = 0.006) and the intestinal type (p < 0.001). ME-CV findings were significantly different between the gastric type and the other type (p = 0.028). Totally, 5 of 8 tumors of the gastric type manifested a pinecone pattern, 4 of which were compatible with pyloric gland adenoma.

Conclusions: The endoscopic findings of NADETs differ according to mucin phenotype. A pinecone pattern under ME-CV may be characteristic of NADETs of the gastric type, especially pyloric gland adenoma.

Keywords: Magnifying endoscopy; Mucin phenotype; Non-ampullary duodenal epithelial tumor.

MeSH terms

  • Adenocarcinoma / diagnostic imaging
  • Adenocarcinoma / pathology*
  • Adenoma / diagnostic imaging
  • Adenoma / pathology*
  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy
  • Coloring Agents / chemistry
  • Duodenal Neoplasms / diagnostic imaging
  • Duodenal Neoplasms / pathology*
  • Duodenoscopy / methods*
  • Duodenum / diagnostic imaging
  • Duodenum / pathology
  • Female
  • Gastric Mucosa / pathology*
  • Gentian Violet / chemistry
  • Humans
  • Male
  • Middle Aged
  • Mucins / metabolism*
  • Retrospective Studies


  • Coloring Agents
  • Mucins
  • Gentian Violet