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Case Reports
. 2021 Oct 24;2(1):e65.
doi: 10.1002/deo2.65. eCollection 2022 Apr.

Giant Brunner's gland hamartoma diagnosed via endoscopic mucosal resection: A case report

Sakiko Naito  1 , Masakatsu Fukuzawa  1 , Shunsuke Nakamura  1 , Shin Kono  1 , Jun Matsubayashi  2 , Takao Itoi  1
Affiliations
Case Reports

Giant Brunner's gland hamartoma diagnosed via endoscopic mucosal resection: A case report

Sakiko Naito et al. DEN Open. .

Abstract

We report the case of a patient with a giant Brunner's gland hamartoma that was pathologically diagnosed by endoscopic mucosal resection. A 69-year-old woman presented with intermittent abdominal pain, and imaging revealed a smooth saccular submucosal tumor, 40 mm in diameter, on the anterior wall of the duodenal bulb. Brunner's gland and smooth muscle tissue were observed on endoscopic ultrasound-guided fine-needle aspiration biopsy, which resulted in the preoperative diagnosis of a duplication cyst. However, subsequent endoscopic mucosal resection established a final histopathological diagnosis of Brunner's gland hamartoma.

Keywords: Brunner's gland hamartoma; duplication cyst; endoscopic mucosal resection; intestinal neoplasms; intussusception.

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Conflict of interest statement

The authors declare no conflict of interest. The author T.I. is an EIC of DEN Open.

Figures

FIGURE 1
FIGURE 1
Endoscopic images and pathological findings of the lesion in the duodenal bulb: (a) A 25‐mm‐large duodenal submucosal tumor (SMT) was observed on the interior of the duodenum at the time of initial examination. (b) Follow‐up endoscopy findings after 2 years revealed an increase to 40 mm. (c) A hypoechoic lesion with non‐uniform hyperechoic components internally was detected by endoscopic ultrasound. (d) Histopathological examination revealed Brunner's glands and a smooth muscle tissue in the preoperative biopsy specimen
FIGURE 2
FIGURE 2
Abdominal computed tomography findings computed tomography demonstrated (red arrows) a 40‐mm pedunculated mass with internal nonuniformity in the descending part of the duodenum. (a) coronal image and (b) axial image
FIGURE 3
FIGURE 3
Endoscopic mucosal resection (EMR) images: (a) Duodenal submucosal tumor (SMT) on the anterior wall of the duodenal bulb and (b) EMR was performed to remove the duodenal SMT. Glycerol was injected locally to lift the basal mucosa and the lesion was resected using a snare. (c) Duodenal surface after resection of the tumor and (d) endoscopic clipping was successful
FIGURE 4
FIGURE 4
Pathological findings of the resected specimen (a) Specimen was 40 mm in diameter. The mucosal surface was smooth with glandular characteristics. (b) Macroscopic appearance of the cut surface of the resected specimen. (c) Histopathological examination of the resected tumor on a loupe view demonstrated a well‐defined pedunculated polypoid lesion with cystic structures. (d) Histopathological examination of the tumor on high‐power magnification revealed that there was a dense proliferation of Brunner's glands with no nuclear and structural atypia and irregular intercalation of smooth muscle bundles
See this image and copyright information in PMC

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