Traditional serrated adenomas (TSAs) of the duodenum are rare lesions with potential for malignant transformation. We present the case of a 44-year-old female with a history of bariatric surgery who presented with worsening abdominal pain, nausea, and significant weight loss. Imaging studies, including MRI, revealed a 3.2 cm periampullary polyp in the second portion of the duodenum, with associated biliary dilatation. Endoscopic evaluation confirmed a pedunculated lesion with a villous surface, and en bloc resection was performed using a diathermic snare, followed by prophylactic hemostasis. Histopathology confirmed a TSA with low-grade dysplasia, with clear surgical margins. Postoperatively, the patient showed gradual recovery and remains asymptomatic on follow-up. Long-term endoscopic surveillance is planned due to the risk of recurrence or malignant transformation. Duodenal TSAs, though infrequent, share molecular and histopathological characteristics with their colorectal counterparts. They are typically located in the periampullary region or the second portion of the duodenum. Complete endoscopic resection is often feasible, though larger lesions may require surgical intervention. Given the potential for recurrence or malignant progression, long-term surveillance is recommended. This case underscores the importance of early detection and appropriate management to prevent cancerous transformation. Further studies are necessary to deepen the understanding of the natural history and optimal management strategies for duodenal TSAs, as current knowledge is largely extrapolated from colorectal TSA studies. This case contributes to the limited literature on duodenal TSAs and emphasizes the importance of vigilant follow-up.
Keywords: duodenum; endoscopic resection; gastrointestinal neoplasia; malignant transformation; traditional serrated adenoma.
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