Four types of duodenal white lesions (follicular lymphoma, lymphoid hyperplasia, lymphangiectasia, and lymphangioma) : A case report

A 70-year-old Japanese man underwent esophagogastroduodenoscopy that revealed multiple whitish duodenal granules. The histopathological analysis of the biopsied specimen led to the diagnosis of duodenal-type follicular lymphoma. The lesion showed spontaneous improvement ; however, 14 months later a few small whitish granules were observed by esophagogastroduodenoscopy. Observation under magnification revealed slightly elevated opaque white spots and whitish granular protrusions of roughly the same size that were uniformly distributed in the duodenal bulb. The duodenal bulb lesions were histopathologically diagnosed as lymphoid hyperplasia. The patient also exhibited lymphangiectasia (which presented as scattered white spots) and lymphangioma (which presented as a soft submucosal tumor with white spots on the surface) in the second portion of the duodenum. This patient presented with four white lesions in the duodenum : duodenal-type follicular lymphoma, lymphoid hyperplasia, lymphangiectasia, and lymphangioma. Careful endoscopic evaluation enabled a prompt diagnosis in this case.