If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. You will then receive an email that contains a secure link for resetting your password
If the address matches a valid account an email will be sent to __email__ with instructions for resetting your password
A 68-year-old woman presented with 4 years of iron deficiency anemia, requiring intravenous
iron infusion. EGD revealed a 10-mm, cherry-red, sessile polypoid lesion on the major
duodenal papilla. EUS examination was negative for deep invasion. Endoscopic ampullectomy
was performed. A residual focus of lesion was treated with argon plasma coagulation
(APC) after placement of a protective pancreatic duct stent (Video 1, available online at www.giejournal.org). Pathologic examination revealed a proliferation of capillaries with acute and chronic
inflammation, consistent with pyogenic granuloma. Figure 1 demonstrates the lesion’s appearance (Fig. 1A) and the histology at ×100 magnification (Fig. 1B). Pyogenic granuloma is a lobular capillary hemangioma that presents as a polypoid
red mass. Most often, they occur on the skin or oral mucosa but can, rarely, be found
in the GI tract. Pyogenic granuloma of the duodenum is particularly rare. To our knowledge,
only 2 cases of pyogenic granuloma (capillary hemangioma) with major papilla involvement
have been reported, both in the Spanish language literature (de Caralt, 1986; Camacho,
2012). Pyogenic granuloma should be considered in the differential diagnosis of chronic
GI bleeding. If the major papilla is involved, ampullectomy followed by APC for any
residual lesion appears to be a safe and effective treatment.
Figure 1A, Endoscopic finding: lesion at major duodenal papilla. B, Histology (H&E, orig. mag. ×100) showing a proliferation of capillaries with acute
and chronic inflammation.
