An ultrastructural study of the Brunner's cyst

Brunner's gland cyst: a clinicopathological study of 25 cases highlighting an underappreciated lesion

Brunner's gland cysts are rare, benign lesions of the duodenum usually seen as incidental, polypoid or cystic lesions of the duodenum. We present a series of 25 cases of Brunner's gland cyst, the largest case series to date. All the cases were identified during endoscopic assessment for unrelated causes. The mean age of the patients was 66.2 years and the sex ratio was approximately equal. Most were detected as a small (3-10 mm) polypoid lesion in the second part of the duodenum, away from the ampulla. Most of the cysts were unilocular and all were lined by undulating, cytologically bland cuboidal to columnar cells with clear cytoplasm and small, basal nuclei. No mitotic activity or proliferative activity was seen. No recurrence was noted, despite incomplete removal in many cases. We agree with the hypothesis that Brunner's gland cysts are likely to be caused by local obstruction to the draining duct of Brunner's glands.

Brunner's gland cyst in combination with gastrointestinal stromal tumor: A case report

Brunner's gland cysts are rare benign lesions that are mainly observed in the first and the second regions of the duodenum. Patients with Brunner's gland cyst demonstrate no specific symptoms. The present study reports the case of a patient with Brunner's gland cyst located in the duodenum in combination with a gastrointestinal stromal tumor (GIST) in the same region. To the best of our knowledge, the present study reports the first case of Brunner's gland cyst with GIST. A 58-year-old female patient was referred to Tianchang Hospital of Traditional Chinese Medicine (Tianchang, China) with a one-month history of upper abdominal discomfort, diarrhea and recurrent vomiting following the intake of food. Upper gastrointestinal endoscopy and a computed tomography scan revealed the presence of a round, cystic-like lesion with internal low density located within the duodenum. Pathological examination revealed that the cyst measured 0.3 cm in diameter and was consistent with a diagnosis of Brunner's gland cyst. Histopathology revealed that the cyst possessed characteristics of GIST. The patient underwent surgical exploration and tumor resection, and was discharged 2 weeks post-surgery. During the 12 month post-operative follow-up period, the outcome of the patient was good. This case study of Brunner's gland cyst combined with GIST enriches the present literature and promotes better understanding of the two diseases. Further investigation is required to explain the mechanism and association between the two rare diseases.

Clinicopathologic characteristics and mucin expression in Brunner's gland proliferating lesions

BACKGROUND

Brunner's gland proliferating lesions, termed Brunner's gland hamartoma, hyperplasia, or adenoma, is regarded as a benign condition. However, cancerous changes have been reported in Brunner's gland proliferating lesions.

AIMS

The purpose of this study was to define the characteristic features of Brunner's gland proliferating lesions and evaluate any observed cancerous changes.

METHODS

We analysed clinicopathologic features and mucin expression in 25 Brunner's gland proliferating lesions.

RESULTS

Brunner's gland proliferating lesions were categorized as Brunner's gland hamartoma or hyperplasia according to their tissue components. Brunner's gland hamartoma commonly occurred in the duodenal bulb and exhibited a polypoid appearance, while Brunner's gland hyperplasia was primarily observed in the second portion of duodenum as a submucosal mass and was accompanied by symptoms more frequently than Brunner's gland hamartoma. The Brunner's glands in Brunner's gland proliferating lesions exhibited various morphologic characteristics, from normal-appearing glands to sclerotic glandular foci with atypia. Changes in MUC5 expression observed in both sclerotic glandular foci and dilated Brunner's glands suggest that they might share a common mechanism and are associated with gastric foveolar metaplasia.

CONCLUSIONS

These findings indicate that most Brunner's gland proliferating lesions are either hamartoma or hyperplasia, and that true neoplastic Brunner's gland proliferating lesions are very rare. Thus, Brunner's gland adenomas or carcinomas arising in Brunner's gland proliferating lesions should be confirmed by ancillary tests, including immunostaining or molecular analysis, in addition to morphological criteria.

Subcellular localization of pepsinogen II in stomach and duodenum by the immunogold technique

We have determined the ultrastructural localization of pepsinogen II (PG II) in aldehyde-osmium fixed, resin-embedded ultrathin sections of human gastric fundic and pyloric gland mucosa and duodenum using the protein A immunogold technique and antiserum specific for PG II. Chief cells contained homogeneous, finely granular secretory granules that were uniformly PG II-positive. In contrast, mucous neck, pyloric gland, and Brunner's gland cells contained secretory granules consisting of an eccentrically placed dense core surrounded by a clear matrix; PG II immunoreactivity was concentrated over the dense core of these biphasic granules. Pyloric gland cells also contained monophasic secretory granules having the same electron density, texture, and PG II immunoreactivity as the nucleoids of biphasic granules and clear vesicular granules that were PG II-negative. Vesicular granules also were found in Brunner's gland cells. The Golgi region of pyloric gland cells contained small PG II-positive monophasic granules adjacent to small PG II-negative vesicular granules. This observation suggests that biphasic granules may form in the Golgi region of pyloric gland cells by fusion of PG II-containing monophasic granules and PG II-unreactive vesicular granules.