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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.
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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
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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.
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Large Brunner's Gland Hyperplasia with Bleeding: A Case Report. Case Rep Surg 2021; 2021:8861308. [PMID: 34194867 PMCID: PMC8214502 DOI: 10.1155/2021/8861308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 05/21/2021] [Accepted: 06/01/2021] [Indexed: 12/03/2022] Open
Abstract
We report a rare case of a large Brunner's gland hyperplasia (BGH) with severe anemia. A 33-year-old woman was transferred to our hospital with anemia and a duodenal mass. She had a 2-week history of melena and mild shortness of breath. Her hemoglobin level was 4.9 g/dl, and she required a blood transfusion. Abdominal computed tomography revealed a 7 cm tumor in the descending duodenum, and duodenoscopy revealed a polyp-like tumor with an ulcer at the duodenal bulb. We decided to perform surgery to prevent further bleeding. Intraoperatively, the tumor stalk was located at the anterior wall of the duodenal bulb; the ampulla was not involved, and we resected the tumor with the wall of the duodenal bulb. The resected tumor measured 7.0 × 4.0 × 2.3 cm, and pathologically, the tumor consisted of proliferated Brunner's glands in a small amount of fibrous stroma. The histological diagnosis was BGH with no malignancy. Most cases of BGH are benign and asymptomatic; however, it is important to be aware that some patients have severe anemia, gastrointestinal obstruction, or malignant potential.
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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: 4.0] [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.
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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.
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Zhou SR, Ullah S, Liu YY, Liu BR. Brunner's gland adenoma: Lessons learned for 48 cases. Dig Liver Dis 2021; 53:134-136. [PMID: 33168417 DOI: 10.1016/j.dld.2020.10.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Si-Ran Zhou
- Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Saif Ullah
- Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yue-Yuan Liu
- Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bing-Rong Liu
- Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.; State key laboratory of esophageal cancer prevention and treatment, Zhengzhou University, Zhengzhou, China.
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Brunner's gland adenoma is a rare cause of upper gastrointestinal bleeding: A case report and literature review. Arab J Gastroenterol 2020; 21:122-124. [PMID: 32327365 DOI: 10.1016/j.ajg.2020.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/02/2019] [Accepted: 04/08/2020] [Indexed: 11/22/2022]
Abstract
Brunner's gland adenoma is a rare benign tumour that arises from Brunner's glands in the duodenum. Lesions are usually incidentally discovered during oesophagogastroduodenoscopy. However, in some cases, they may present clinically with vague abdominal symptoms or bleeding. We present the case of a 54-year-old male who complained of progressive fatigue and intermittent melena for 3 months. Clinical examination findings were unremarkable. Routine blood tests showed microcytic hypochromic anaemia. Oesophagogastroduodenoscopy showed normal oesophageal and gastric mucosa as well as a pedunculated polyp on the anterior wall of the duodenal bulb. Endoscopic ultrasound (EUS) revealed a duodenal hyperechoic mass arising from the submucosal layer of the anterior wall of the duodenal bulb with central cystic degeneration. Both endoscopic- and EUS-guided biopsies were non-diagnostic. Endoscopic mucosal resection was performed after the patient provided consent. Histopathological examination revealed hyperplastic mucosal lobules containing Brunner's glands and smooth muscle cells; malignant cells or Helicobacter pylori infection were not evident. Brunner's gland adenoma is a rare lesion of the duodenum and should be considered in the differential diagnosis of upper gastrointestinal bleeding. EUS is helpful in the diagnosis and detection of the layer of origin. However, the final diagnosis is usually made after lesion removal.
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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: 1.0] [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.
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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
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Barat M, Dohan A, Dautry R, Barral M, Boudiaf M, Hoeffel C, Soyer P. Mass-forming lesions of the duodenum: A pictorial review. Diagn Interv Imaging 2017; 98:663-675. [PMID: 28185840 DOI: 10.1016/j.diii.2017.01.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 02/07/2023]
Abstract
Recent advances in imaging have resulted in marked changes in the investigation of the duodenum, which still remains primarily evaluated with videoendoscopy. However, improvements in computed tomography (CT) and magnetic resonance (MR) imaging have made detection and characterization of duodenal mass-forming abnormalities easier. The goal of this pictorial review was to illustrate the most common conditions of the duodenum that present as mass-forming lesions with a specific emphasis on CT and MR imaging. MR imaging used in conjunction with duodenal distension appears as a second line imaging modality for the characterization of duodenal mass-forming lesions. CT remains the first line imaging modality for the detection and characterization of a wide range of duodenal mass-forming lesions.
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Affiliation(s)
- M Barat
- Department of Radiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - A Dohan
- Department of Radiology, McGill University Health Centre, Montreal General and Royal Victoria Hospitals, Montreal, Canada.
| | - R Dautry
- Department of Radiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - M Barral
- Department of Radiology, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - M Boudiaf
- Pôle santé du plateau, 3/5, avenue de Villacoublay, 92360 Meudon-La-Forêt, France.
| | - C Hoeffel
- Department of Radiology, hôpital Robert-Debré, 11, boulevard Pasteur, 51092 Reims, France.
| | - P Soyer
- Medicine department, Université Paris-Diderot, Sorbonne Paris Cité, 10, avenue de Verdun, 75010 Paris, France.
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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: 0.7] [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.
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