Brunner's gland hyperplasia: treatment of severe diffuse nodular hyperplasia mimicking a malignancy on pancreatic-duodenal area

Abstract

Brunner's gland hyperplasia is a benign tumor of the duodenum and it is rarely associated with clinical symptoms. We report on a 64-yr-old man with Brunner's gland hyperplasia who had undergone a duodenocephalo-pancreatectomy. The reason is that he presented upper gastrointestinal obstructive symptoms and the esophagogastroduodenoscopic finding revealed the lesion to be an infiltrating type mass on the second portion of the duodenum with luminal narrowing. An abdominal computed tomography showed a 2.5 cm-sized mass in the duodenal second portion with a suspicious pancreatic invasion and 7 mm-sized lymph node around the duodenum. Duodenocephalopancreatectomy was successfully performed. Histological examination revealed a Brunner's gland hyperplasia. The final diagnosis was the coexistence of Brunner's gland hyperplasia and pancreatic heterotopia with a pancreatic head invasion. The literature on Brunner's gland hyperplasia is reviewed.

Fig. 1

Endoscopic finding: the duodenal mass was an irregular and infiltrative type mass on the duodenal bulb area.

Fig. 2

Abdominal computed tomography: (A) obstruction finding due to circumference of the duodenal mass (B) lymph node enlargement circumference of the duodenal mass (C) pancreatic invasion with fat tissue loss between the duodenal mass and pancreatic head.

Fig. 3

Biopsy: (A) (×10) Brunner's gland hyperplasia, diffuse infiltrated type (B) (×100) Brunner's gland hyperplasia (C) (×400) pancreatic heterotopia in the serosa layer.