Brunner's Gland Adenoma with High-Grade Dysplasia

Abstract

Brunner's gland adenoma is a rare, benign, small-bowel neoplasm. In a few reported cases, it can cause gastrointestinal hemorrhage and can be associated with cellular atypia. We report an 84-year-old woman with a 12-mm Brunner's gland adenoma in the second part of the duodenum that was successfully removed with a saline injection-lift technique using a hot snare, followed by placement of clips to prevent postpolypectomy bleeding. Pathological examination revealed Brunner's gland adenoma with high-grade dysplasia and oncocytic features with negative resection margins. The patient recovered uneventfully. Brunner's gland adenoma is traditionally considered a benign lesion, and few cases in the published literature have reported Brunner's gland adenoma with dysplasia or neoplasia. This suggests a dysplastic stage in the natural history of Brunner's gland adenoma and questions the malignant potential of such lesions.

Figure 1

(A and B) Esophagogastroduodenoscopy of the second part of the duodenum showing a sessile polyp with a central depression. (C) Snare polypectomy of lesion. (D) Site after successful polypectomy.

Figure 2

Histological images of Brunner’s gland hyperplasia in the duodenum. (A) Low-power view showing the adenoma between the asterisks * and the clear margins (arrows). (B) High-power view showing prominent mitoses (yellow arrow), increased apoptosis (blue arrow), and cytological atypia.