Giant Brunner's gland hamartoma diagnosed via endoscopic mucosal resection: A case report

Abstract

We report the case of a patient with a giant Brunner's gland hamartoma that was pathologically diagnosed by endoscopic mucosal resection. A 69‐year‐old woman presented with intermittent abdominal pain, and imaging revealed a smooth saccular submucosal tumor, 40 mm in diameter, on the anterior wall of the duodenal bulb. Brunner's gland and smooth muscle tissue were observed on endoscopic ultrasound‐guided fine‐needle aspiration biopsy, which resulted in the preoperative diagnosis of a duplication cyst. However, subsequent endoscopic mucosal resection established a final histopathological diagnosis of Brunner's gland hamartoma.

Gel immersion endoscopic mucosal resection for pedunculated Brunner’s gland hyperplasia in the duodenal bulb near the pylorus

“…Endoscopic resection is indicated when there is bleeding, obstructive symptoms, or the lesion is large and malignancy cannot be ruled out 1 . Conventional endoscopic mucosal resection (EMR) for the resection of Brunner’s gland hyperplasia has been reported 2 3 . However, conventional EMR of large Burner’s gland hyperplasia in the duodenal bulb is often difficult because the space is narrowed by local injection, reducing visibility and maneuverability.…”

Nonpolypous Hamartomas of the Gastrointestinal Tract: An Updated Review on Classification, Denominations, and Clinical Management

“…It is about nodular or pedunculated uncommon submucosal masses of the duodenum diagnosed in adults [ 10 , 60 , 61 ]. About 70% of the cases involved the pylorus and duodenal bulb [ 64 ]. Only one pediatric pyloric localization was reported in literature [ 62 , 63 ].…”

“…According to the Armed Forces Institute of Pathology, solitary or multiple masses below 5 mm in size, composed by excessive Brunner glands separated by fibrous septa, is indicated to be called “hyperplasia” [ 61 , 64 ]. The term “hamartoma” is reserved to nonencapsulated solitary and larger than 5 mm, even giant masses, composed by sheets of Brunner glands along with acini and ducts, some being dilated, mesenchymal (smooth muscle bundles and adipose tissue), and lymphoid tissue, which are infrequently admixed with heterotopic pancreas [ 10 , 61 , 63 ].…”

“…The main complications are intussusception and ileus. Although it was long-time known that malignization is not a complication of Brunner gland hyperplasia/hamartoma, recent data showed dysplasia in 2.1% and associated Brunner glands adenocarcinoma in 0.3% of cases [ 60 , 64 , 65 ].…”

“…The Brunner gland hyperplasia needs to be differentiated by polyposis syndromes, pancreatic heterotopia, pyloric/duodenal duplication cysts, nodular lymphoid hyperplasia or duodenitis, and tumors such as neuroendocrine neoplasm, lipoma, and leiomyoma [ 60 , 62 , 64 ].…”