|
1
|
Xiang Y, Liu J, Wang NY, Tang D, Wang L, Zou PX, Xu G, Huang Q. The Characteristics and Treatment Outcomes of 71 Duodenal Brunner's Gland Adenomas with Endoscopic Submucosal Dissection. Dig Dis 2023; 41:852-859. [PMID: 37591214 DOI: 10.1159/000531231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 05/09/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION The aim of this study was to investigate outcomes of patients with duodenal Brunner's gland adenomas (BGAs) that were treated endoscopically. METHODS We identified 71 consecutive patients treated at our center with endoscopic submucosal dissection (ESD) for their duodenal tumors diagnosed pathologically as BGAs over the period between January 1, 2011 and December 31, 2021. We retrospectively analyzed our experience and short- and long-term outcomes of ESD therapy on patients with BGAs. RESULTS Among 71 BGA patients with an average age of 57 ± 11.7 years (range: 30-82), 48 (67.6%) were male and 23 (32.4%) were female. The accuracy of preoperative diagnosis with endoscopic ultrasonography was 44.0% (22/50). The H. pylori infection was found in 29 patients (29/71, 40.8%). The median size of BGAs was 1.5 cm (interquartile range [IQR] 0.8-2.7 cm). The most common location was the duodenum bulb (50/71, 64.8%). For the ESD procedure, the median operation time was 15.0 min (IQR 9.5-25.5 min). The en bloc and the complete resection rates were 97.2% and 92.3%, respectively. ESD-related mild acute obstructive pancreatitis was present in 2 patients (2/4, 50%) with BGAs located in the ampulla region. During the follow-up period, 1 patient with a positive peripheral margin experienced tumor recurrence 2 years after the initial ESD. There was no disease-related death for the cohort. CONCLUSION ESD was an effective and safe therapeutic option for BGA patients with excellent outcomes. Long-term follow-up is needed.
Collapse
Affiliation(s)
- Ying Xiang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China,
| | - Jinyan Liu
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Nan Ya Wang
- Department of Gastroenterology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Dehua Tang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Lei Wang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Ping Xiao Zou
- Department of Gastroenterology, Taikang Xianlin Drum Tower Hospital, Nanjing, China
| | - Guifang Xu
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Qin Huang
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
|
2
|
A 10 cm pedunculated duodenal Brunner gland hamartoma, case report and literature review. Int J Surg Case Rep 2022; 100:107747. [PMID: 36270207 PMCID: PMC9587310 DOI: 10.1016/j.ijscr.2022.107747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/09/2022] [Accepted: 10/10/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Brunner gland hamartoma is rare duodenal neoplasm. These benign lesions are usually presented by upper gastrointestinal bleeding and sometimes extend to cause intestinal obstruction. PRESENTATION OF THE CASE We report a case of a 43-year-old male patient manifested with iron deficiency anemia. Upon investigations, computed topography (CT) scan found a dilated first part of the duodenum with presence of large pedunculated polyp. The histopathological examination revealed a submucosal lobular proliferation of duodenal Brunner's gland separated by a fine fibrous septum. No dysplastic signs were observed. Immunohistochemical studies confirmed the nature of the glands and reveled absence of Helicobacter pylori gastritis. Diagnosis was confirmed. DISCUSSION Brunner glands hamartomas are rare tumors. They are commonly presented by upper GI bleeding and intestinal obstruction. The pathogenesis remains unclear. They are usually located in the first part (bulb) of the duodenum. Mucosal irritation and Helicobacter pylori infection are suggested causes. Different surgical and endoscopical modalities are applied in the management depending on the size and location of the mass. In our case, the tumor was removed by Endoscopic submucosal dissection. CONCLUSION Brunner gland hamartoma is a rare usually benign tumor. Presented clinically by upper GI bleeding and obstruction. Histopathologically Brunner gland Hamartoma characterized by lobular proliferation of Brunner gland associated with presence of other mature tissues. Although these tumors are benign it carries a minor risk of malignant transformation.
Collapse
|
|
3
|
Zhu M, Li H, Wu Y, An Y, Wang Y, Ye C, Zhang D, Ma R, Wang X, Shao X, Guo X, Qi X. Brunner's Gland Hamartoma of the Duodenum: A Literature Review. Adv Ther 2021; 38:2779-2794. [PMID: 33914269 PMCID: PMC8189944 DOI: 10.1007/s12325-021-01750-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/15/2021] [Indexed: 02/07/2023]
Abstract
Brunner's gland hamartoma is a benign tumor of the duodenum, but has malignant potential with a very low risk of progression into adenocarcinoma. It is uncommon with a frequency of less than 1.0% among the primary tumors of the small intestine. In addition, its clinical manifestations are nonspecific, etiology remains unclear, and treatment strategy needs to be further refined. This literature review mainly discusses the epidemiology, clinical features, possible etiology and pathogenesis, diagnostic methods, malignant potential, treatment, and prognosis of Brunner's gland hamartoma.
Collapse
Affiliation(s)
- Menghua Zhu
- Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China
- Postgraduate College, Jinzhou Medical University, Jinzhou, People's Republic of China
| | - Hongyu Li
- Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China
| | - Yanyan Wu
- Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China
- Postgraduate College, Jinzhou Medical University, Jinzhou, People's Republic of China
| | - Yang An
- Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China
- Postgraduate College, Shenyang Pharmaceutical University, Shenyang, People's Republic of China
| | - Yuye Wang
- Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China
- Postgraduate College, Jinzhou Medical University, Jinzhou, People's Republic of China
| | - Chun Ye
- Department of General Surgery, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China
| | - Dan Zhang
- Department of General Surgery, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China
| | - Rui Ma
- Department of General Surgery, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China
| | - Xuehan Wang
- Department of Pathology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China
| | - Xiaodong Shao
- Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China.
| | - Xiaozhong Guo
- Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China.
| | - Xingshun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China.
| |
Collapse
|
|
4
|
Yi L, Cheng Z, Qiu H, Yang J, Wang T, Liu K. A giant Brunner's gland hamartoma being treated as a pedunculated polyp: a case report. BMC Gastroenterol 2019; 19:151. [PMID: 31443637 PMCID: PMC6708166 DOI: 10.1186/s12876-019-1074-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/19/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND With the development and application of endoscopic technology, most pedunculated polyps can be absolutely resected with a complete specimen by hot snare polypectomy (HSP). Brunner's gland hamartoma (BGH) is a rare benign small bowel tumor. The majority of BGH measuring about 2 cm in diameter, rarely larger than 5 cm. Most patients are asymptomatic, some may present with gastrointestinal hemorrhage or intestinal obstruction. Symptomatic larger lesions leading to bleeding or obstruction should be excised either endoscopically or surgically. Whether it is safe and effective that removing a BGH measuring about 7 cm by HSP is not known. CASE PRESENTATION Here, we reported a rare case of a proximal duodenum pedunculated mass measuring about 7 cm which was responsible for the patient's severe anemia. we treated it as a pedunculated polyp. After being pretreated the stalk with an endoloop which was placed around the base of the mass to prevent post-polypectomy bleeding (PPB), the pedunculated BGH was removed by HSP completely. The stalk of the mass was negative. We achieved a curative resection. CONCLUSION It is a safe and effective for our patient to treat the pedunculated BGH measuring about 7 cm as a pedunculated polyp and remove it by HSP. And future prospective studies in larger cohorts are needed to confirm it.
Collapse
Affiliation(s)
- Lizhi Yi
- Department of Gastroenterology, People's Hospital of Leshan, 238 Baita Street, Leshan, Sichuan, 614000, People's Republic of China.
| | - Zhengyu Cheng
- Department of Gastroenterology, People's Hospital of Leshan, 238 Baita Street, Leshan, Sichuan, 614000, People's Republic of China
| | - Huarong Qiu
- Department of Gastroenterology, People's Hospital of Leshan, 238 Baita Street, Leshan, Sichuan, 614000, People's Republic of China
| | - Jianjun Yang
- Department of pathology, People's Hospital of Leshan, Leshan, City, 614000, Sichuan province, People's Republic of China
| | - Tao Wang
- Department of radiology, People's Hospital of Leshan, Leshan, City, 614000, Sichuan province, People's Republic of China
| | - Ke Liu
- Department of Gastroenterology, People's Hospital of Leshan, 238 Baita Street, Leshan, Sichuan, 614000, People's Republic of China
| |
Collapse
|
|
5
|
Bojanapu S, Mangla V, Mehrotra S, Lalwani S, Mehta N, Nundy S. Brunner's gland hyperplasia: an unusual duodenal submucosal lesion seen in four patients. J Surg Case Rep 2018; 2018:rjy305. [PMID: 30515293 PMCID: PMC6267341 DOI: 10.1093/jscr/rjy305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/27/2018] [Indexed: 01/18/2023] Open
Abstract
Brunner’s gland hyperplasia is an extremely rare benign hamartomatous lesion seen in proximal duodenum. Difficulty in diagnosing the condition pre-operatively puts the surgeon in dilemma for deciding appropriate management. We retrieved details from prospectively maintained retrospective data from January 2014 to April 2018. Four patients were identified of which three were males and one was female. Symptoms ranged from 4 days to 4 years, with abdominal pain, vomiting and malena being predominant. No patients were identified with diagnosis pre-operatively. Diagnosis was made on histopathological examination of the resected specimen and none of them were having malignant features. At a median follow up of 11 months, no patient had recurrence and were symptom free. Brunner’s gland hyperplasia is a rare elusive duodenal pathology, symptomatically mimicking alarming duodenal lesions and mostly diagnosed on histopathology of specimen. Patients may harbour the lesion for long periods with little symptoms and upon treatment have good outcomes.
Collapse
Affiliation(s)
- Srinivas Bojanapu
- Department of Surgical Gastroenterology and Liver Transplantation, Old Rajinder Nagar, New Delhi, India
| | - Vivek Mangla
- Department of Surgical Gastroenterology and Liver Transplantation, Old Rajinder Nagar, New Delhi, India
| | - Siddharth Mehrotra
- Department of Surgical Gastroenterology and Liver Transplantation, Old Rajinder Nagar, New Delhi, India
| | - Shailendra Lalwani
- Department of Surgical Gastroenterology and Liver Transplantation, Old Rajinder Nagar, New Delhi, India
| | - Naimish Mehta
- Department of Surgical Gastroenterology and Liver Transplantation, Old Rajinder Nagar, New Delhi, India
| | - Samiran Nundy
- Department of Surgical Gastroenterology and Liver Transplantation, Old Rajinder Nagar, New Delhi, India
| |
Collapse
|
|
6
|
Bostanci H, Dikmen K, Ekinci O, Buyukkasap C, Kerem M. A case of Brunner's gland adenoma mimicking tumors induced from head of the pancreas. Pan Afr Med J 2018; 29:78. [PMID: 29875959 PMCID: PMC5987158 DOI: 10.11604/pamj.2018.29.78.11502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 01/08/2018] [Indexed: 01/19/2023] Open
Abstract
Brunner's Gland Adenoma is a very rarely seen benign tumor of duodenum. While it generally leads to obstruction and bleeding complaints, it may very rarely occur by mimicking a pancreatic tumor. A 48 years old male patient admitted to the gastroenterology clinic due to the epigastric pain spreading dorsally. No significant feature is present in his clinical history. A lesion containing cystic solid components in the size of 30x40 mm was detected in the head of pancreas as a result of the abdominal tomography. In the light of these findings, pancreaticoduodenectomy is applied to the patient. It is observed that tumor is in submucosal location and widely invaded the pancreatic head. In the histopathological examination, Brunner's Gland Adenoma is reported in pancreatic head localization. In this manuscript a case of Brunner's gland adenoma diagnosed by performing pancreaticoduodenectomy due to the mass in the head of the pancreas is presented.
Collapse
Affiliation(s)
- Hasan Bostanci
- Department of General Surgery, Gazi University Medical Faculty, Besevler, Ankara, Turkey
| | - Kursat Dikmen
- Department of General Surgery, Gazi University Medical Faculty, Besevler, Ankara, Turkey
| | - Ozgur Ekinci
- Department of Pathology, Gazi University Medical Faculty, Besevler, Ankara, Turkey
| | - Cagrι Buyukkasap
- Department of General Surgery, Gazi University Medical Faculty, Besevler, Ankara, Turkey
| | - Mustafa Kerem
- Department of General Surgery, Gazi University Medical Faculty, Besevler, Ankara, Turkey
| |
Collapse
|
|
7
|
de Bakker BS, Phoa SSKS, Kara M, Al-Eryani S, Gielen ME, Ponsioen CIJ, de Bakker HM, van Gulik TM. The vanishing duodenal polyp: mesenteric invagination presenting as duodenal pseudopolyp. BMJ Case Rep 2017; 2017:bcr-2016-214998. [PMID: 28501824 DOI: 10.1136/bcr-2016-214998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Duodenal polypoid masses are an uncommon finding mainly diagnosed incidentally at endoscopy or surgery. We report a 39-year-old female patient with symptoms of intermittent stabbing pain in the upper right abdominal quadrant and an iron deficiency anaemia, without complaints of weight loss, haematemesis or melaena. A duodenal polyp and acute duodenitis have been described during endoscopic examinations and CT and ultrasound. Surgical excision of the polyp was advised. Intraoperatively, an elongated duodenum was remarkable; however, at duodenotomy, no polyp was found, nor during intraoperative endoscopy. Looking back at the endoscopy and imaging results, it was noted that the polyp varied in size and location. It was therefore concluded that we dealt with the pseudopolyp phenomenon, caused by invagination of the duodenal wall and its mesentery into the duodenum, presenting as a lipomatous pseudopolyp. Telescopic invagination of the duodenal wall was facilitated by the elongated hypermobile duodenum.
Collapse
Affiliation(s)
- Bernadette S de Bakker
- Division of Anatomy, Embryology and Physiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Saffire S K S Phoa
- Division of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Mohammed Kara
- Department of Gastroenterology, MC Zuiderzee, Lelystad, The Netherlands
| | - Sabaa Al-Eryani
- Department of Gastroenterology, MC Zuiderzee, Lelystad, The Netherlands
| | - Marieke E Gielen
- Division of Gastroenterology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Cyriel I J Ponsioen
- Division of Gastroenterology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Henri M de Bakker
- Department of Radiology, Groene Hart Hospital, Gouda, The Netherlands
| | - Thomas M van Gulik
- Division of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
|
8
|
A Giant Brunneroma Causing Gastrointestinal Bleeding and Severe Anemia Requiring Transfusion and Surgery. Case Rep Surg 2017; 2017:6940649. [PMID: 28299229 PMCID: PMC5337360 DOI: 10.1155/2017/6940649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 01/26/2017] [Accepted: 01/29/2017] [Indexed: 12/29/2022] Open
Abstract
Brunner's gland hamartoma, also called hyperplasia, adenoma, and Brunneroma, is an extremely rare benign proliferative lesion of Brunner's glands in the duodenum. While being mostly small and asymptomatic, they can result in gastrointestinal bleeding and obstruction. We report the case of a 54-year-old man presenting with melena and severe anemia requiring blood transfusion. CT scans showed a large mass of 8 cm in diameter, presumably arising in the duodenum. Endoscopic biopsies were not conclusive. As we were unable to determine the nature of the mass preoperatively and due to the severe symptoms, its size, and the uncertain malignant potential, a classic Whipple procedure was performed. The resected specimen showed extensive proliferation of Brunner's glands without signs of malignancy.
Collapse
|
|
9
|
Görtz RS, Wacker J, Agaimy A, Neurath MF, Siebler J. [Weakness, dizziness, cough, and dyspnea in a previously healthy woman]. Med Klin Intensivmed Notfmed 2014; 109:625-6. [PMID: 25256149 DOI: 10.1007/s00063-014-0422-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 08/25/2014] [Accepted: 08/26/2014] [Indexed: 10/24/2022]
Affiliation(s)
- R S Görtz
- Innere Medizin 1 - Gastroenterologie, Pneumologie, Endokrinologie, Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Deutschland,
| | | | | | | | | |
Collapse
|
|
10
|
Serum gastrin levels and gastroduodenal lesions in children with chronic renal failure on continuous ambulatory peritoneal dialysis: a single-center experience. Eur J Gastroenterol Hepatol 2012; 24:924-8. [PMID: 22569084 DOI: 10.1097/meg.0b013e3283543ee7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to determine serum gastrin levels and gastroduodenal lesions in children with chronic renal failure (CRF) on continuous ambulatory peritoneal dialysis (CAPD). METHODS A total of 19 patients (mean age: 11.7±3.9 years, M/F: 1.37) with CRF on CAPD and 20 age-matched and sex-matched patients (mean age: 10.2±1.4 years, M/F: 1.5) with peptic ulcers were included in the study. Serum gastrin, creatinine, phosphate, and parathormone levels were determined. Upper gastrointestinal endoscopy was performed in all patients. RESULTS The basal gastrin concentrations of CAPD patients were significantly higher than those of patients with peptic ulcer disease without CRF (124.2±59.1 and 53.0±9.4 pg/ml, respectively) (P<0.001). A significant correlation was found between age, duration of uremia, and serum gastrin levels (r=0.59, P<0.01; r=0.60, P<0.01, respectively). No correlation was found between the duration of CAPD and serum gastrin levels in the patient group. Of the patients, 73.6% had abnormal upper gastrointestinal endoscopic findings. The gastroduodenal lesion observed was hemorrhagic gastritis (31.5%), followed by hemorrhagic gastroduodenitis (26.3%), gastric nodular gastritis (10.5%), and polyps (10.5%). CONCLUSION On the basis of our findings, such as higher serum gastrin levels in patients with CRF than those of the control group and the frequent endoscopic findings of gastroduodenal lesions in most of the patients, we recommend that an endoscopic examination should be considered for all the children with CRF on CAPD awaiting renal transplantation even if they are asymptomatic.
Collapse
|
|
11
|
Giant Brunner's gland adenoma as an unusual cause of anaemia: report of a case. Radiol Oncol 2011. [PMID: 22933946 DOI: 10.2478/v10019-010-0053-5.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Brunner's gland adenoma (BGA) is a rare benign duodenal tumour proliferating from Brunner's glands. Here, we present a giant BGA leading to anaemia, with its clinical, endoscopic, radiological, surgical and pathological findings. CASE REPORT A 48-year-old Turkish man complained of a six months history of vague epigastric discomfort, loss of appetite and nausea after meals without vomiting. The physical examination had no unremarkable finding. Laboratory findings, including liver function tests, were within normal limits except a hypochromic, microcytic anaemia. The upper gastrointestinal endoscopic examination revealed a lobulated, red, polypoid tumour with a smooth surface covered with normal mucosa. The tumour was located on the anterior surface of duodenal bulb and had a wide base measuring 3.5 × 4 cm in size. Endoscopic ultrasonography revealed a submucosal polypoid mass located at the anterior surface of duodenal bulb. The endoscopic excision was tried but was not successful. The patient was operated and transduodenal polypectomy was done. The postoperative period was uneventful and the pathologic diagnosis was assessed as Brunner's gland adenoma. During the follow-up period, the endoscopic examination was normal at 12th month postoperatively. CONCLUSIONS BGA is a rare benign cause of anaemia that can be treated with excellent results.
Collapse
|
|
12
|
Coskun A, Erkan N. Giant Brunner's gland adenoma as an unusual cause of anaemia: report of a case. Radiol Oncol 2011; 45:129-131. [PMID: 22933946 PMCID: PMC3423726 DOI: 10.2478/v10019-010-0053-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 09/14/2010] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Brunner's gland adenoma (BGA) is a rare benign duodenal tumour proliferating from Brunner's glands. Here, we present a giant BGA leading to anaemia, with its clinical, endoscopic, radiological, surgical and pathological findings. CASE REPORT A 48-year-old Turkish man complained of a six months history of vague epigastric discomfort, loss of appetite and nausea after meals without vomiting. The physical examination had no unremarkable finding. Laboratory findings, including liver function tests, were within normal limits except a hypochromic, microcytic anaemia. The upper gastrointestinal endoscopic examination revealed a lobulated, red, polypoid tumour with a smooth surface covered with normal mucosa. The tumour was located on the anterior surface of duodenal bulb and had a wide base measuring 3.5 × 4 cm in size. Endoscopic ultrasonography revealed a submucosal polypoid mass located at the anterior surface of duodenal bulb. The endoscopic excision was tried but was not successful. The patient was operated and transduodenal polypectomy was done. The postoperative period was uneventful and the pathologic diagnosis was assessed as Brunner's gland adenoma. During the follow-up period, the endoscopic examination was normal at 12th month postoperatively. CONCLUSIONS BGA is a rare benign cause of anaemia that can be treated with excellent results.
Collapse
Affiliation(s)
- Ali Coskun
- Department of Surgery, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Nazif Erkan
- Department of Surgery, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
- Department of Emergency Medicine, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| |
Collapse
|
|
13
|
Dhinakar M, Allaya DJ, Golash V. A Rare Case of Brunneroma Duodenum causing Gastric Outlet Obstraction. Oman Med J 2010; 25:44-6. [PMID: 22125698 PMCID: PMC3215388 DOI: 10.5001/omj.2010.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2009] [Accepted: 10/19/2009] [Indexed: 01/29/2023] Open
Abstract
A case of Brunneroma causing gastric outlet obstruction is presented with radiological, endoscopical findings which was removed laparoscopically.
Collapse
Affiliation(s)
- Manjula Dhinakar
- Department of Radiology, Sultan Qaboos Hospital, Salalah, Sultanate of Oman
| | - Dhia J. Allaya
- Department of Gastroenterology, Sultan Qaboos Hospital, Salalah, Sultanate of Oman
| | - Viswanathan Golash
- Department of Surgery, Sultan Qaboos Hospital, Salalah, Sultanate of Oman
| |
Collapse
|
|
14
|
Lee WC, Yang HW, Lee YJ, Jung SH, Choi GY, Go H, Kim A, Cha SW. Brunner's gland hyperplasia: treatment of severe diffuse nodular hyperplasia mimicking a malignancy on pancreatic-duodenal area. J Korean Med Sci 2008; 23:540-3. [PMID: 18583897 PMCID: PMC2526515 DOI: 10.3346/jkms.2008.23.3.540] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Brunner's gland hyperplasia is a benign tumor of the duodenum and it is rarely associated with clinical symptoms. We report on a 64-yr-old man with Brunner's gland hyperplasia who had undergone a duodenocephalo-pancreatectomy. The reason is that he presented upper gastrointestinal obstructive symptoms and the esophagogastroduodenoscopic finding revealed the lesion to be an infiltrating type mass on the second portion of the duodenum with luminal narrowing. An abdominal computed tomography showed a 2.5 cm-sized mass in the duodenal second portion with a suspicious pancreatic invasion and 7 mm-sized lymph node around the duodenum. Duodenocephalopancreatectomy was successfully performed. Histological examination revealed a Brunner's gland hyperplasia. The final diagnosis was the coexistence of Brunner's gland hyperplasia and pancreatic heterotopia with a pancreatic head invasion. The literature on Brunner's gland hyperplasia is reviewed.
Collapse
Affiliation(s)
- Woong Chul Lee
- Division of Gastroenterology, Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Hyeon Woong Yang
- Division of Gastroenterology, Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Yun Jung Lee
- Division of Gastroenterology, Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Sung Hee Jung
- Division of Gastroenterology, Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Gi Young Choi
- Division of Gastroenterology, Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Hoon Go
- Division of Gastroenterology, Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Anna Kim
- Division of Gastroenterology, Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Sang Woo Cha
- Division of Gastroenterology, Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| |
Collapse
|
|
15
|
Rocco A, Borriello P, Compare D, De Colibus P, Pica L, Iacono A, Nardone G. Large Brunner’s gland adenoma: Case report and literature review. World J Gastroenterol 2006; 12:1966-8. [PMID: 16610009 PMCID: PMC4087528 DOI: 10.3748/wjg.v12.i12.1966] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Brunner’s gland adenoma (BGA）is a very rare benign tumour of the duodenum, which is usually asymptomatic and discovered incidentally at endoscopy. Occasionally, this lesion may be large, causing upper gastrointestinal haemorrhage or intestinal obstruction. The case had a large Brunner’s gland adenoma, presenting melena that was managed by endoscopic excision.
Collapse
Affiliation(s)
- Alba Rocco
- Department of Clinical and Experimental Medicine, Gastroenterology Unit, University Federico II, via S. Pansini no. 5, 80131 Naples, Italy
| | | | | | | | | | | | | |
Collapse
|
|
16
|
Sakurai T, Sakashita H, Honjo G, Kasyu I, Manabe T. Gastric foveolar metaplasia with dysplastic changes in Brunner gland hyperplasia: possible precursor lesions for Brunner gland adenocarcinoma. Am J Surg Pathol 2006; 29:1442-8. [PMID: 16224210 DOI: 10.1097/01.pas.0000180449.15827.88] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cases of adenocarcinomas developed in Brunner gland hyperplasia (BGH) have been sporadically reported. Herein, we report the morphologic spectrum of hyperplastic changes culminating into dysplasia and carcinoma in 722 cases of BGH listed in our files. Fifteen of these cases showed dysplastic changes, with 8 graded as low-grade dysplasia, 5 as high-grade dysplasia, 11 as atypical hyperplasia, and 2 as invasive carcinoma, although each frequently coexisted in the same tumor. In two carcinomas, one had high-grade dysplasia in the mucosa, and another had only atypical hyperplasia. Interestingly, hyperplastic glands around dysplastic foci were associated with gastric foveolar metaplasia and papillary configuration in 13 cases, 11 of which showed a gradual increase in nuclear atypism in the transition from metaplastic to dysplastic glands. All of the metaplastic gastric glands showed diffuse and strong immunopositivity for gastric foveolar mucin (MUC5AC). Immunohistochemical profiles also supported the concept of a continuous spectrum in carcinogenesis from gastric foveolar hyperplasia through atypical hyperplasia or dysplasia and eventually to frank adenocarcinoma. The results of our study suggest, therefore, that dysplastic and/or carcinomatous change does occur in BGH, that they form the continuous morphologic spectrum, and that papillary foveolar metaplasia may be a precursor lesion in the process of carcinogenesis with a background of BGH.
Collapse
Affiliation(s)
- Takaki Sakurai
- Laboratory of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan.
| | | | | | | | | |
Collapse
|