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Case Reports
. 2020 Aug 26;2020(8):rjaa191.
doi: 10.1093/jscr/rjaa191. eCollection 2020 Aug.

Brunner's glands hamartoma with pylorus obstruction: a case report and review of literature

Mohammed A Bakir  1 , Mohammed Y AlYousef  2 , Fahad I Alsohaibani  3 , Khaled O Alsaad  4
Affiliations
Case Reports

Brunner's glands hamartoma with pylorus obstruction: a case report and review of literature

Mohammed A Bakir et al. J Surg Case Rep. .

Abstract

Proliferative lesions of the Brunner's glands are uncommonly encountered lesions of the small intestine, originating from the deeply seated mucosal and submucosal Brunner's glands, mainly in the duodenum. The vast majorities of these lesions are benign and include Brunner's glands hyperplasia (adenomas/nodules) and hamartomas. The etiology and pathogenesis of these lesions are not fully understood, and the diagnosis can sometimes be challenging. We report a case of Brunner's gland hamartoma in a 57-year-old man who presented with chronic dyspepsia, hematemesis and weight loss. Endoscopic and radiological investigations show a submucosal polypoid lesion at the first part of the duodenum. Routine endoscopic biopsies demonstrated normal duodenal mucosa. The lesion considered endoscopically unresectable and was surgically resected. Frozen section examination and intraoperative consultation showed unremarkable duodenal mucosa and histologically bland Brunner's glands.

Keywords: Brunner's gland hamartoma; adenoma; duodenal polyps; frozen section; hyperplasia.

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Figures

Figure 1
Figure 1
Computed tomography of duodenal Brunner’s gland hamartoma. (a) Axial plane. (b) Coronal plane.
Figure 2
Figure 2
Endoscopic images. (a) Large duodenal submucosal lesion protruding through the pylorus to gastric antrum. (b) Narrow Band Imaging with normal tubulovillous mucosal patterns with regular vessels.
Figure 3
Figure 3
Endoscopic ultrasound, showing heterogeneous hypoechoic subepithelial lesion.
Figure 4
Figure 4
Histopathology of Brunner’s gland hamartoma. (a) The submucosal lesion consisted of lobules of proliferating bland Brunner’s glands, separated by fibromuscular septa; scattered lymphoid follicles were evident (Hematoxylin and Eosin × 100). (b) Irregularly-shaped ductal structures were present, mainly at the deep aspect of the lesion (Hematoxylin and Eosin × 400). (c) Focal papillary architecture was evident on the surface of the lesion (hematoxylin and eosin × 200).
See this image and copyright information in PMC

References

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