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Case Reports
. 2019 Aug 23;19(1):151.
doi: 10.1186/s12876-019-1074-1.

A giant Brunner's gland hamartoma being treated as a pedunculated polyp: a case report

Lizhi Yi  1 , Zhengyu Cheng  2 , Huarong Qiu  2 , Jianjun Yang  3 , Tao Wang  4 , Ke Liu  2
Affiliations
Case Reports

A giant Brunner's gland hamartoma being treated as a pedunculated polyp: a case report

Lizhi Yi et al. BMC Gastroenterol. .

Abstract

Background: With the development and application of endoscopic technology, most pedunculated polyps can be absolutely resected with a complete specimen by hot snare polypectomy (HSP). Brunner's gland hamartoma (BGH) is a rare benign small bowel tumor. The majority of BGH measuring about 2 cm in diameter, rarely larger than 5 cm. Most patients are asymptomatic, some may present with gastrointestinal hemorrhage or intestinal obstruction. Symptomatic larger lesions leading to bleeding or obstruction should be excised either endoscopically or surgically. Whether it is safe and effective that removing a BGH measuring about 7 cm by HSP is not known.

Case presentation: Here, we reported a rare case of a proximal duodenum pedunculated mass measuring about 7 cm which was responsible for the patient's severe anemia. we treated it as a pedunculated polyp. After being pretreated the stalk with an endoloop which was placed around the base of the mass to prevent post-polypectomy bleeding (PPB), the pedunculated BGH was removed by HSP completely. The stalk of the mass was negative. We achieved a curative resection.

Conclusion: It is a safe and effective for our patient to treat the pedunculated BGH measuring about 7 cm as a pedunculated polyp and remove it by HSP. And future prospective studies in larger cohorts are needed to confirm it.

Keywords: Brunner’s gland hamartoma; Case report; Endoscopy; Hot snare polypectomy; Severe anemia.

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Conflict of interest statement

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Figures

Fig. 1
Fig. 1
(a) Contrast-enhanced sagittal and (b) axial computed tomography scan shows a large polypoid mass in the duodenal bulb (arrows)
Fig. 2
Fig. 2
Esophagogastroduodenoscopy shows a tortuous pedunculated mass occupying the lumen of the duodenal bulb. (a) The long and thick pedicle of the tumor. (b) The tumor is coiled around the duodenal bulb
Fig. 3
Fig. 3
(a) The appearance after polypectomy (b) The complete endoscopic resection specimen showed a large duodenal lesion measuring 7 × 3 × 1.6 cm3
Fig. 4
Fig. 4
Microscopic pictures. (a) Light microscopy showed hyperplastic lobules of proliferating Brunner’s glands separated by fibrous. H&E staining, scale bar: 1 mm. (b) Brunner’s gland hyperplasia composed of variable size of Brunner’s glands can be observed. H&E staining, scale bar: 100 μm
See this image and copyright information in PMC

References

    1. Ferlitsch M, Moss A, Hassan C, et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2017;49:270–297. doi: 10.1055/s-0043-102569. - DOI - PubMed
    1. Tan YM, Wong WK. Giant brunneroma as an unusual cause of upper gastrointestinal hemorrhage: report of a case. Surg Today. 2002;32:910–912. doi: 10.1007/s005950200179. - DOI - PubMed
    1. Frenkel NC, Laclé MM, Borel Rinkes IH, Molenaar IQ, Hagendoorn J. A Giant Brunneroma causing gastrointestinal bleeding and severe Anemia requiring transfusion and surgery. Case Rep Surg. 2017;2017:6940649. - PMC - PubMed
    1. Jung Y, Chung IK, Lee TH, et al. Successful endoscopic resection of large pedunculated Brunner's gland hamartoma causing gastrointestinal bleeding arising from the pylorus. Case Rep Gastroenterol. 2013;7(2):304–307. doi: 10.1159/000354138. - DOI - PMC - PubMed
    1. Kitagawa Y, Osumi H, Kawachi H, et al. Giant duodenal Brunner’s gland hamartoma successfully treated via endoscopic mucosal resection. Arab J Gastroenterol. 2018;19:125–129. doi: 10.1016/j.ajg.2018.08.004. - DOI - PubMed

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