Carcinoma arising from brunners gland in the duodenum. Brunner s gland hyperplasia brunner s gland hamartoma redirects here. Brunner gland nodules may produce a mass lesion, but the histology is usually not adenomatous and can be readily distinguished from adenoma and. A welldefined histopathologic classification of brunners gland lesions is still lacking, and the terms hyperplasia, hamartoma, adenoma and. Indeed there appears to be a continuum between brunners gland hyperplasia, hamartoma and adenoma, with a potential for dysplastic changes. Curveilhier reported the first case of brunners gland adenoma in 1835 and salvioli reported a case in 1876. Brunners gland hyperplasias and hamartomas in association with.
The patient was managed conservatively during his hospital stay, and was doing well without any recurrence after nine months of followup. His histopathology revealed brunners gland hyperplasia. The glands are composed of neutral mucinsecreting cuboidal to columnar cells with basally located nuclei and are arranged in lobules containing thin fibrous septa. The age, gender, and histopathological findings in the biopsy samples of the. In general, overproduction results from hyperplasia, an increase in the number of cells in this case, hormonesecreting cells in a specific endocrine gland. It develops from the alkalinesecreting submucosal glands which protect the mucosa from the pylorus to the second portion of the duodenum. In the present case, a brunner s gland adenocarcinoma was indicated by positive mib1 and lysozyme staining, the absence of a surrounding normal brunner s gland, and negative staining for chromogranin a, p53, lipase and amylase. Radiographic features of the duodenal mucosa were analyzed in a series of 26 patients in whom the diagnosis of brunner gland hyperplasis bgh had been established by endoscopic biopsies. Brunners gland hyperplasia is a rare lesion which, since it was first described by salvioli in 1872, has been reported in only 200 cases in the literature. They are only found proximal to the sphincter of oddi. This website is intended for pathologists and laboratory personnel, who understand that medical information is imperfect and must be interpreted using reasonable medical judgment. On histology, the duodenal cysts invade into the muscularis propria. Brunner s gland adenoma of the duodenum appeared to be nodular hyperplasia of the normal brunner s gland with an unusual admixture of normal tissues, including ducts, adipose tissue and lymphoid. The modifier bilateral should be added when hyperplasia is present in both glands.
Brunners gland hyperplasia is clinically important because it can be mistaken for neoplastic lesions, although it is usually asymptomatic. This case report describes bgh arising at the ampulla of vater, causing abdominal. Brunner s gland adenoma bga of the duodenum appear to be nodular hyperplasia of the normal brunner s gland with an unusual admixture of normal tissues, including ducts, adipose tissue and lymphoid tissue. Surgical management of giant brunners gland hamartoma. This case suggests a dysplastic stage in the natural history of brunners gland hamartoma, and questions the. Pancreas sparing resection for giant hamartoma of brunners. Fatal gastrointestinal hemorrhage in a patient with brunners gland. An introduction to gastrointestinal pathology is in the gastrointestinal pathology article the clinical history is often. Brunners gland adenoma is a rare tumor of the duodenum and might also be an unusual cause of gastrointestinal bleeding or obstruction. Giant brunner s gland adenoma of the duodenal bulb.
The histologic features of brunners gland hyperplasia in sand rats are similar to that reported in humans. Structural units of the normal gastric mucosa antraltype figure by mit ocw. Conclusions primary duodenal tumors are extremely rare, accounting for less than 1% among all gl. Most brunners gland tumours within the duodenum, so called brunners gland adenomas or brunneriomas, are not true neoplasms but represent hyperplasias or hamartomas consisting of mature mucus. Jan 02, 2015 adrenal gland hyperplasia should be diagnosed and assigned a severity grade and site modifier i. Brunners gland hyperplasia and hamartoma are two representative lesions that are occasionally identified during esophagogastroduodenoscopic examination 1, 35.
The nomenclature regarding brunner s gland lesions in the literature is not well established because there is a substantial degree of interchangeability among the terms brunner s gland hyperplasia, brunner s gland hamartoma, and brunner s gland adenoma. It is accessible by egd esophagogastroduodenoscopy and frequently biopsied. The pathogenesis of brunner s gland hyperplasia remains unknown. Brunners gland hyperplasia is usually asymptomatic and an incidental finding during upper gastrointestinal endoscopy. Brunners gland hamartomas bgh are uncommon benign tumors of the duodenum forming mature brunners glands. The observed mucosal patterns could be classified into five categories. The nomenclature regarding brunners gland lesions in the literature is not well established because there is a substantial degree of interchangeability among the terms brunners gland hyperplasia, brunners gland hamartoma, and brunners gland adenoma. Brunners glands are mucus secreting acinar glands situated in the deep mucosa and submucosa of the duodenum which empty into the crypts of lieberkuhn 1. Brunners gland hamartoma, also known as brunners gland adenoma or brunneroma, comprises a small portion of these benign tumors. Patients may harbour the lesion for long periods with little symptoms and upon treatment have good outcomes. Bleeding brunner gland adenoma of duodenum simulating duodenal ulcer.
Radiology a barium study indicates that brunner s gland hyperplasia commonly appears as smooth, polypoid lesions of the duodenum and may show markedly thickened, irregular folds in the proximal duodenum. Small bowel small intestine brunner gland hamartoma. In two instances 4, 22, the pancreaticoduodenal mass was found to be diffuse nodular variant of brunners gland hyperplasia on histopathology. Brunners gland adenoma, duodenal polyp, nodular hyperplasia of brunners gland. This nodularity should be distinguished from the genuine single polyps that can be encountered in the duodenal bulb referred to as. From our data it appears in the sand rat that age and gastric ulceration are associated with brunners gland hyperplasia. Given the diagnostic uncertainty, laparotomy was undertaken with frozen sections. Clinicopathological characteristics of duodenal epithelial. Immunohistochemical examination is essential for determining the origin of carcinomas arising from brunner s gland.
A case report is presented of a brunners gland hamartoma, whose histology revealed a focus of well marked epithelial dysplasia. At endoscopy, hyperplasia of brunner glands appears as nodular duodenitis. Generally, it is a single pedunculated polyp, rarely larger than 5 cm. It may be an incidental finding during an investigation but can also present acutely with haemorrhage or obstruction, requiring endoscopic or surgical resection. Brunner gland hyperplasia results from disproportionate overgrowth of brunner glands in the duodenum as a result of hyperacidity. The third type is the single nodule of adenomatous hyperplasia varying in size up to several centimeters. Pathology of brunners gland adenoma dr sampurna roy md. Brunners gland hyperplasia is a rare elusive duodenal pathology, symptomatically mimicking alarming duodenal lesions and mostly diagnosed on histopathology of specimen. Pancreas sparing resection for giant hamartoma of brunner. Several features of these lesions favor their designation as hamartomas, including the lack of encapsulation.
Pdf the terms brunners gland adenoma and hamartoma are 2 pathological expressions of. Hyperplasia begins at the pylorus and extends distally within the first 23rds of the duodenum. Chronic inflammation gland atrophy intestinal metaplasia pylori metaplasia with involvement of the corpus patchy andor focal involvement identified as the precancerous lesion in 95% of early gastric adenocarcinomas in japan. Helicobacter pylori gastritis typical histopathology is characterized by. Clearly, from the benign nature of brunners gland hamartoma in all the previous case reports, these dysplastic changes appear to be a rare phenomenon. Except for its association with duodenal ulcers, brunners gland hyperplasia has no clinical significance and mostly asymptomatic. When a large polyp is noted at duodenum, it is important for clinicians to have brunners gland hamartoma as a differential diagnosis, even with the rarity of the disease. Polyp size increases in a timedependent manner, however, the growth. Bgh was undiagnosed before surgery, due to its particular submucosal growth simulating an expanding process starting from the duodenum, and secondly due to unsuccessful biopsies performed during endoscopic procedure.
We report here an unusual case of a giant bgh that was not amenable to endoscopic or surgical local resection thus requiring a pancreaticoduodenectomy for extirpation. It can also be caused by neoplasia, the growth of a tumour in an endocrine gland. Histopathology demonstrated brunner s gland hyperplasia in all resected polyps. Brunners gland adenoma is a rare tumor of the duodenum and might. Brunners gland hyperplasia in the duodenum is a rare, benign, hamartomatous, proliferative disorder of the duodenum and accounts for about 10% of neoplasias of the duodenal bulb 1, 2. Discussion brunner s gland hyperplasia is a rare cause of biliary obstruction and pancreatitis and the literature is limited to a few case reports 3, 4. Case report malignant potential in a brunners gland hamartoma. Adrenal gland hyperplasia should be diagnosed and assigned a severity grade and site modifier i. The afip uses the term brunner s gland hamartoma for lesions 5 mm. Brunners gland hyperplasia bgh is a diagnostic challenge where in the pathophysiology and natural history.
Although most endocrine tumours are benign, the resulting hypersecretion of hormone read more. Discussion brunners glands are submucosal mucin secreting glands localized predominantly in the duodenal bulb and proximal duodenum, decreasing progressively in size and number in the. Case report malignant potential in a brunners gland. Adenocarcinoma in situ arising from brunners gland. Nodular proliferation of normal brunner glands, ducts, stroma also called brunner gland hyperplasia or adenoma usually in mid duodenum associated with erosions and duodenitis may cause melena or obstruction probably not neoplastic. This regular feature presents special issues in oncologic pathology. Brunner s gland hamartomas bgh are uncommon benign tumors of the duodenum forming mature brunner s glands. Postoperative recovery was uneventful and ng feeds discontinued with resumption of oral feeding.
Pdf the pathological expressions of brunners gland hyperplasia. The distinction between brunners gland hyperplasia and hamartoma is arbitrary. Brunner gland hyperplasia radiology reference article. Brunner s gland hyperplasia is a rare lesion which, since it was first described by salvioli in 1872, has been reported in only 200 cases in the literature. At low power, hyperplastic lobules of proliferating brunner glands filling the submucosa, and partially. A region of tumor duct and mucous duct hyperplasia was found in the lamina propria. In the past, the terms brunner gland hyperplasia, brunner gland hamartoma, and brunner gland adenoma have been used interchangeably causing some confusion in the pathologic classi. Curveilhier reported the first case of brunner s gland adenoma in 1835 and salvioli reported a case in 1876. Where the focal growth of hyperplastic cells is greater than 1 cm in diameter, the hyperplastic region is referred to as brunner gland adenoma. Brunners gland hyperplasia and hamartoma the nomenclature regarding brunners gland lesions in the literature is not well established because there is a substantial degree of interchangeability among the terms brunners gland hyperplasia, brunners gland hamartoma, and brunners gland adenoma. Polyps of the small intestine diagnostic histopathology. Brunner s gland hyperplasia is clinically important because it can be mistaken for neoplastic lesions, although it is usually asymptomatic.
Here we report a rare case of hemorrhagic shock caused by intestinal bleeding from brunners gland hyperplasia. This article summarizes our experience with pathologically proven cases of brunners hyperplasia and hamartoma accessioned into the radiologic pathology. Biliary obstruction and pancreatitis caused by brunner gland hyperplasia of the ampulla of vater. Brunners gland acini were also seen amidst the splayed muscularis mucosa. The pathogenesis of brunner gland hamartoma of the duodenum is unknown. Radiology a barium study indicates that brunners gland hyperplasia commonly appears as smooth, polypoid lesions of the duodenum and may show markedly thickened, irregular folds in the proximal duodenum. They can show a cystic appearance because of the dilatation of the glandular acini or ducts. A 70 year old male presented to our emergency department with melena. The second type is the circumscribed nodular hyperplasia in which isolated nodules of brunners glands are located in the suprapapillary portion of the duodenum, often accompanied by atrophy of the intervening glands. Rarely one or few hyperplastic brunners glands may form a mass lesion large enough to cause obstructive symptoms, epigastric pain, or upper gi bleeding. Brunners gland adenoma, also known as brunneroma or polypoid hamartoma is a rare, benign, proliferative lesion arising from the brunners gland of the duodenum accounting for 10.
Brunners gland hyperplasia in the sand rat psammomys. Benign brunner gland adenoma without dysplasia a 41yearold white man with no significant medical history presented to our emergency department with worsening intermittent palpitations and. A diagnosis of brunners gland hyperplasia with active duodenitis was made. Complete excision of the pyloric mass confirmed brunners gland hyperplasia bgh, and a heinekemikulicz pyloroplasty was performed. Related pathology brunner gland hyperplasia brunner gland adenoma. Background brunners glands are exocrine glands located in proximal duodenum. Pdf the pathological expressions of brunners gland. Jan 14, 2014 in the past, a 60yearold male case was reported that brunners gland hyperplasia forming a 5. Brunner gland hyperplasia results from disproportionate overgrowth of brunner glands in the duodenum as a result of hyperacidity hyperplasia begins at the pylorus and extends distally within the first 23 rds of the duodenum. Brunners gland adenoma of the duodenum appeared to be nodular hyperplasia of the normal brunners gland with an unusual admixture of normal tissues, including ducts, adipose tissue and lymphoid.
Brunners glands are predominantly located in the duodenal submucosa, although they may focally transgress the muscularis mucosae and extend into the lamina propria. Chronic active antral gastritis, with or without chronic active superficial gastritis in the corpus lymphoplasmacytic inflammation in the lamina propria neutrophils in the lamina propria and gastric pits lymphoid aggregates and follicles characteristic bacilli, primarily in the foveolar mucus. Brunners gland hamartoma bgh is a rare benign tumour formed from a proliferation of brunners glands, typically forming a polypoidal growth in the proximal duodenum. In 2001, she underwent open rouxeny gastrojejunostomy for ongoing biliary reflux, however, she continued to have issues with pain and malnutrition and became tpn dependent. This variety may be more difficult to differentiate from pancreaticoduodenal malignancy than the adenomatous hyperplastic type which usually presents as a welldefined polyp. Brunners gland hyperplasia at the ampulla of vater janes sej, zaitoun am1, catton ja, aithal gp2, beckingham ij abstractabstract brunners gland hyperplasia bgh is a diagnostic challenge where in the pathophysiology and natural history remain poorly understood. Brunners gland hamartoma is a rare tumor, predominantly found in the fifth to sixth decades of life. Complete excision of the pyloric mass confirmed brunner s gland hyperplasia bgh, and a heinekemikulicz pyloroplasty was performed. Histologically, brunners gland hyperplasia may manifest as solitary or multiple small nodules composed of proliferating glands with maintenance of a lobular architecture and fibrous septa separating the hyperplastic lobules. It has been reported that brunners gland hyperplasia and hamartoma account for approximately five per cent of all duodenal masses 2, 6. This case suggests a dysplastic stage in the natural history of brunners gland hamartoma, and questions. Adenocarcinoma in situ arising from brunners gland treated. Asymptomatic cases are found incidentally, but cases with a large polyp tend to have gastrointestinal bleeding andor obstructive symptoms.
Hyperplasia of brunner glands with a lesion greater than 1 cm was initially described as a brunner gland adenoma. Brunners gland hamartomas are rare tumours of the duodenum. Brunners gland hamartoma bgh, characterized by benign proliferation of the. These lesions have previously been described as being benign, with no malignant potential. Brunner gland hyperplasia is commonly encountered in association with peptic duodenitis, and therefore mostly limited to the duodenal bulb. Histological analysis showed hyperplasia of brunner s glands correspondent to a brunner s gland hamartoma. Tumors differentiating into brunners glands have been reported in. Brunners gland, hyperplasia, hamartoma, gastrointestinal. Adrenal gland hyperplasia nonneoplastic lesion atlas. In this case series, we examined 2 brunner gland tumors. Histological analysis showed hyperplasia of brunners glands correspondent to a brunners gland hamartoma. Brunner glands are compound tubular submucosal glands found in the duodenum.
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