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Shmais M, Mousawi A, Mourad F, Sharara AI. Brunner's gland hamartomas: Not always benign. Arab J Gastroenterol 2024; 25:70-73. [PMID: 38296695 DOI: 10.1016/j.ajg.2023.12.003] [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: 06/24/2023] [Revised: 12/14/2023] [Accepted: 12/23/2023] [Indexed: 02/02/2024]
Abstract
Brunner's gland hamartoma (BGH) is a rare, benign tumor of the duodenum. It is mostly asymptomatic and usually found incidentally on routine esophagogastroduodenoscopy (EGD). However, some BGHs present with major complications including anemia, bleeding, obstruction, or dysplasia, requiring management and resection of these lesions. Herein, we present two cases of large BGHs of the duodenum, one presenting as severe gastrointestinal bleeding and the other, noted on EGD for iron deficiency anemia, found to have high grade dysplasia. This literature review discusses the rare serious complications of BGH, including iron deficiency anemia, overt gastrointestinal bleeding, and malignant potential.
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Affiliation(s)
- Manar Shmais
- Division of Gastroenterology and Hepatology, Saint Louis University Hospital, MO, USA.
| | - Ahmad Mousawi
- Division of Gastroenterology and Hepatology, American University of Beirut, Beirut, Lebanon.
| | - Fadi Mourad
- Division of Gastroenterology and Hepatology, American University of Beirut, Beirut, Lebanon.
| | - Ala I Sharara
- Division of Gastroenterology and Hepatology, American University of Beirut, Beirut, Lebanon.
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McCafferty J, Tokhi A, Krishnamoorthy S, Pande G. Case report of Brunner's gland hyperplasia: A rare "mimic" of malignant pathology. Int J Surg Case Rep 2021; 81:105827. [PMID: 33887840 PMCID: PMC8041716 DOI: 10.1016/j.ijscr.2021.105827] [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: 03/05/2021] [Revised: 03/19/2021] [Accepted: 03/19/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Brunner's gland hyperplasia is a rare, benign lesion of the duodenum. The symptomology can range from asymptomatic (as an incidental finding on endoscopy) to gastrointestinal obstruction or haemorrhage. CASE PRESENTATION We report a case of a 60-year-old man presenting with post-prandial vomiting and weight loss. Inpatient evaluation led to the likely diagnosis of a duodenal malignancy for which the patient underwent a laparotomy and proximal duodenectomy. CLINICAL DISCUSSION Brunner's gland hyperplasia is a rare, benign condition that can be overtreated due to the difficulty in obtaining an accurate pre-operative diagnosis. The literature has been reviewed to discuss the approach to diagnosis. CONCLUSION This case highlights the potential for Brunner's gland hyperplasia mimicking a malignancy.
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Affiliation(s)
| | - Ashraf Tokhi
- Royal Melbourne Hospital, Melbourne, Australia; Launceston General Hospital, Launceston, Australia
| | | | - Girish Pande
- Launceston General Hospital, Launceston, Australia
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Urso EDL, Crimì F, Rivella G, Celotto F, Zucchetta P, Albertoni L, Pucciarelli S, Bao QR. Robotic Resection of Giant Duodenal Hamartoma After 18Fluorodeoxyglucose Positron Emission Tomography Magnetic Resonance Imaging ( 18FDG PET-MRI). Am Surg 2021:3134821995071. [PMID: 33605778 DOI: 10.1177/0003134821995071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Brunner's gland hamartoma is a rare duodenal lesion. Resection for benign neoplasms of the duodenum should be considered in case of malignant potential or in case of symptomatic lesions. An accurate preoperative staging is mandatory in order to allow minimally invasive surgical approach, and to avoid under- or overtreatment. Endoscopic ultrasonography (EUS), Computed tomography (CT) scan, Magnetic Resonance Imaging (MRI) and PET/CT are techniques widely used for gastrointestinal tumor staging. We report a case of a 41-year-old female presenting a giant lesion of the second portion of the duodenum. Pathological examination of multiple forceps biopsies was inconclusive for histological characterization of the lesion. After a clinical staging including Esophagusgastroduodenoscopy, EUS, and CT scan, a Hybrid 18FDG PET/MRI was performed to assess the malignant potential of the lesion and the relation between polyp base and Vater's papilla. After multidisciplinary meeting, the patient underwent robotic transduodenal excision. The post-operative course was uneventful, and the patient was discharged on post-operative day 5. Final pathologic report consists in a histologically of Brunner's Glands Hamartoma. This is the first report on the role of 18FDG PET/MRI in staging and planning treatment of bulky low malignant duodenal lesion. An accurate staging with 18FDG PET/MRI could be very useful in the planning the management of duodenal lesion with uncertain malignant potential in order to avoid under- and overtreatment.
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Affiliation(s)
- Emanuele Damiano Luca Urso
- Clinica Chirurgica I, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), 9308University Hospital of Padova, Padova, Italy
| | - Filippo Crimì
- Institute of Radiology, Department of Medicine-DIMED, 9308University Hospital of Padova, Padova, Italy
| | - Giorgio Rivella
- Clinica Chirurgica I, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), 9308University Hospital of Padova, Padova, Italy
| | - Francesco Celotto
- Clinica Chirurgica I, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), 9308University Hospital of Padova, Padova, Italy
| | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine-DIMED, 9308University Hospital of Padova, Padova, Italy
| | - Laura Albertoni
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, 9308University Hospital of Padova, Padova, Italy
| | - Salvatore Pucciarelli
- Clinica Chirurgica I, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), 9308University Hospital of Padova, Padova, Italy
| | - Quoc Riccardo Bao
- Clinica Chirurgica I, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), 9308University Hospital of Padova, Padova, Italy
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Bakir MA, AlYousef MY, Alsohaibani FI, Alsaad KO. Brunner's glands hamartoma with pylorus obstruction: a case report and review of literature. J Surg Case Rep 2020; 2020:rjaa191. [PMID: 32874536 PMCID: PMC7449553 DOI: 10.1093/jscr/rjaa191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 03/12/2020] [Accepted: 07/08/2020] [Indexed: 12/16/2022] Open
Abstract
Proliferative lesions of the Brunner’s glands are uncommonly encountered lesions of the small intestine, originating from the deeply seated mucosal and submucosal Brunner’s glands, mainly in the duodenum. The vast majorities of these lesions are benign and include Brunner’s glands hyperplasia (adenomas/nodules) and hamartomas. The etiology and pathogenesis of these lesions are not fully understood, and the diagnosis can sometimes be challenging. We report a case of Brunner’s gland hamartoma in a 57-year-old man who presented with chronic dyspepsia, hematemesis and weight loss. Endoscopic and radiological investigations show a submucosal polypoid lesion at the first part of the duodenum. Routine endoscopic biopsies demonstrated normal duodenal mucosa. The lesion considered endoscopically unresectable and was surgically resected. Frozen section examination and intraoperative consultation showed unremarkable duodenal mucosa and histologically bland Brunner’s glands.
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Affiliation(s)
| | | | - Fahad I Alsohaibani
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Khaled O Alsaad
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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