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. 2016:2016:6707235.
doi: 10.1155/2016/6707235. Epub 2016 Aug 8.

Endoscopic Resection of a Pedunculated Brunner's Gland Hamartoma of the Duodenum

Masaya Iwamuro  1 , Takehiro Tanaka  2 , Satoko Ando  3 , Tatsuhiro Gotoda  3 , Hiromitsu Kanzaki  3 , Seiji Kawano  3 , Yoshiro Kawahara  4 , Hiroyuki Okada  3
Affiliations

Endoscopic Resection of a Pedunculated Brunner's Gland Hamartoma of the Duodenum

Masaya Iwamuro et al. Case Rep Gastrointest Med. 2016.

Abstract

A 68-year-old Japanese woman presented with a solitary pedunculated polyp in the duodenum. Endoscopic ultrasonography showed multiple cystic structures in the polyp. The polyp was successfully resected by endoscopic snare polypectomy and pathologically diagnosed as Brunner's gland hamartoma. Because hamartomatous components were not identified in the stalk of the polyp, we speculate that the stalk developed from traction of the normal duodenal mucosa. When a solitary, pedunculated polyp with cystic structure within the submucosa is found in the duodenum, Brunner's gland hamartoma should be considered in the differential diagnosis, despite the rarity of the disease. This case underscores the usefulness of endoscopic ultrasonography for the diagnosis of duodenal subepithelial tumors.

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Figures

Figure 1
Figure 1
Barium follow-through examination images. A pedunculated polyp can be identified in the duodenum (arrows).
Figure 2
Figure 2
Endoscopy images. Esophagogastroduodenoscopy results showed a pedunculated polyp measuring approximately 20 mm ((a), (b)). The polyp was easily extended to the stomach by traction with biopsy forceps (c). Magnifying observation with narrowband imaging revealed that the surface of the polyp was entirely covered with intact duodenal mucosa (d). Endoscopic ultrasonography showed multiple cystic structures ((e), (f), arrows).
Figure 3
Figure 3
Endoscopic resection of the polyp. During the procedure, the stalk was strangulated with a detachable snare (a). The polyp was then resected by snare polypectomy (b). The cut surface was closed with two metal clips (c). The size of the resected specimen was 26 × 19 mm (d).
Figure 4
Figure 4
Images of the resected specimen. Macroscopically, multiple cystic structures can be observed in the head of the polyp, whereas no cyst is visible in the stalk.
Figure 5
Figure 5
Pathological images. Stromal cell proliferation and lobular arrangement of proliferated Brunner's glands separated by fibromuscular septa are visible in the head of the polyp ((a), ×4; (b), ×20). In the stalk, multiple blood vessels and adipose tissues can be seen ((c), ×4; (d), ×10). Brunner's glands are only partly visible in the stalk ((d), arrow). The cystic structure visible in the head of the polyp is lined with columnar cells ((e), ×4; (f), ×40). Based on the pathological features, a diagnosis of Brunner's gland hamartoma was reached.
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References

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