Brunner's Gland Hamartoma
Article Outline
- Answer to the Clinical Challenges and Images in GI Question: Image 1 (page 789): Brunner's Gland Hamartoma
- References
- Copyright
Question: A 54-year-old man was referred from the local hospital because of the finding of 1 ampullary tumor via esophagogastroduodenoscopy. He presented a 1-week history of progressively worsening epigastric pain. He denied having any previous episodes of similar abdominal pain, fever, bloody stools, or a history of familial polyposis. Physical examination revealed that the man had pale conjunctivae and mucous membranes. No petechiae, ecchymoses, mucocutaneous pigmentation, hepatosplenomegaly, or lymphadenopathy were detected. Stool samples contained occult blood. Laboratory tests showed iron deficiency anemia, with a hemoglobin level of 9.9 g/dL. Esophagogastroduodenoscopy revealed an elongated polypoid lesion with erosion and hemorrhage at the tip, which extending from the postbulbar area and beyond the major papilla (Figure A). Upper gastrointestinal barium study with small bowel follow-through (Figure B) and abdominal computed tomography (Figure C) showed an elongated mass with an irregular border in the proximal duodenum. Endoscopic biopsy was interpreted as hyperplasia. A 5-cm tumor was removed by duodenotomy through a midline incision (Figure D). What is the diagnosis?
Look on page 1187 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.
Answer to the Clinical Challenges and Images in GI Question: Image 1 (page 789): Brunner's Gland Hamartoma
Histologic studies showed smooth muscle bundles among the benign duodenal glands with focal cystic changes (Figure E). The diagnosis is Brunner's gland hamartoma (also called Brunner's gland adenoma or Brunneroma), which was first described in 1876, accounts for approximately 5% of all duodenal tumors and tends to present in middle age with no gender predominance. Although many of them are asymptomatic, the most common presentations, in symptomatic patients, are occult or massive gastrointestinal hemorrhage and obstructive symptoms.1 These benign tumors are sometimes confused with a malignancy of the duodenal area.2 Endoscopically, Brunner's gland hamartomas have a smooth surface and tend to be well-circumscribed, solitary polyps that can be pedunculated or sessile.1, 2, 3 The tumors are most often located in the first portion of the duodenum, and have a broad range of sizes from 0.5 to 12 cm.1, 2, 3 A punch biopsy is often inadequate for diagnosis. Only a deep endoscopic or a surgical biopsy provides adequate tissue because the Brunner's gland proliferations may be covered by normal mucosa.2 These lesions can be managed by either surgical or endoscopic excision.1, 2 It depends on the size, shape, and location of the tumor owing to a risk of bleeding from hypervascularities.2, 3 Generally, Brunner's gland hamartomas are benign and have a good prognosis.2 This patient remained symptom-free without tumor recurrence and anemia 1 year after surgery.
References
- Brunner's gland hamartomas: clinical presentation and pathological features of 27 cases. Am J Gastroenterol. 1995;90:290–294
- Gastric outlet obstruction caused by Brunner's gland hyperplasia: case report and review of literature. Gastrointest Endosc. 2006;64:464–467
- Proboscis-like Brunner's gland hyperplasia. Am J Surg. 2008;196:e33–e34
Conflicts of interest The authors disclose no conflicts.
For submission instructions, please see the Gastroenterology web site (www.gastrojournal.org).
PII: S0016-5085(09)00306-0
doi:10.1053/j.gastro.2009.02.056
© 2009 AGA Institute. Published by Elsevier Inc. All rights reserved.
