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Ukwade D, Hussain S, Ali S, Boulay B. Brunner's Gland Hamartoma: Masquerading as a Duodenal Mass. Clin Case Rep 2025; 13:e70335. [PMID: 40134962 PMCID: PMC11932883 DOI: 10.1002/ccr3.70335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 12/30/2024] [Accepted: 03/02/2025] [Indexed: 03/27/2025] Open
Abstract
Brunner's gland hamartoma is a benign mass of the duodenum often asymptomatic in presentation and typically identified endoscopically. Treatment is dependent on how the mass manifests. If asymptomatic, then no treatment is necessary. If there is concern for malignant transformation or obstruction, then treatment is endoscopic or surgical resection.
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Affiliation(s)
- Dirin Ukwade
- University of Illinois ChicagoChicagoIllinoisUSA
| | | | - Saaed Ali
- University of Illinois ChicagoChicagoIllinoisUSA
| | - Brian Boulay
- Division of GastroenterologyUniversity of Illinois ChicagoChicagoIllinoisUSA
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2
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Sato S, Kawazoe T, Tanaka Y, Ota M, Oki E, Yoshizumi T. Duodenal Brunner's gland hamartoma resected using laparoscopic and endoscopic cooperative surgery: A case report. Int J Surg Case Rep 2024; 125:110617. [PMID: 39566430 PMCID: PMC11617905 DOI: 10.1016/j.ijscr.2024.110617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Revised: 11/11/2024] [Accepted: 11/13/2024] [Indexed: 11/22/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Brunner's gland hamartoma is a rare benign duodenal tumor. Resection is recommended for large or symptomatic lesions, but conventional pancreaticoduodenectomy and other procedures can be overly invasive for the lesion. We report a case of Brunner's gland hamartoma resected using laparoscopic and endoscopic cooperative surgery (LECS). CASE PRESENTATION A 51-year-old woman was referred to our hospital with an asymptomatic duodenal tumor that had increased in size. A submucosal tumor was found on the anterior wall of the duodenal bulb during a detailed examination, and surgery was performed because the tumor was large (2 cm). In order to optimally resect the tumor, duodenal LECS (D-LECS) was selected. The resection line was determined while checking the base of the lesion with an intraoperative endoscope, and after the lesion was resected, the mucosal defect was closed using laparoscopic manipulation. Histopathological evaluation revealed Brunner's gland hyperplasia and mixed smooth muscle bundles, and the lesion was diagnosed as a Brunner's gland hamartoma. The surgery was completed without any problems, and the patient made a full recovery after the surgery with no complications such as stenosis, and no recurrence was observed. CLINICAL DISCUSSION With D-LECS, the lesion can be resected without excess or deficiency, and the incision can be sutured with minimal invasiveness. D-LECS is an effective method as a treatment option for Brunner's gland hamartoma. CONCLUSION We herein report a case of Brunner's gland hamartoma treated safely with a minimally invasive surgical technique: D-LECS.
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Affiliation(s)
- Shota Sato
- Department of Surgery and Science, Kyushu University, Fukuoka, Japan
| | - Tetsuro Kawazoe
- Department of Surgery and Science, Kyushu University, Fukuoka, Japan.
| | - Yasushi Tanaka
- Department of Surgery and Science, Kyushu University, Fukuoka, Japan.
| | - Mitsuhiko Ota
- Department of Surgery and Science, Kyushu University, Fukuoka, Japan.
| | - Eiji Oki
- Department of Surgery and Science, Kyushu University, Fukuoka, Japan.
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3
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Matsuyama S, Fukuda A, Agatsuma N, Hoki M, Utsumi T, Seno H. A case of duodenal adenocarcinoma with a gastric phenotype demonstrating a rapidly progressive course. Intern Med 2024:4004-24. [PMID: 39523003 DOI: 10.2169/internalmedicine.4004-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2024] Open
Abstract
We herein report a rare case of duodenal adenocarcinoma with a rapidly progressive course. Esophagogastroduodenoscopy revealed Brunner's gland hyperplasia in the bulbs of the duodenum three years prior to this presentation. Two years earlier, gastric foveolar metaplasia had been observed in the bulbs. One year earlier, the lesion had increased slightly in size. At this time, the lesion had markedly increased in size, and the duodenum was circumferentially stenotic due to the mass. Pathologically, he was diagnosed with duodenal adenocarcinoma with a gastric-dominant immunophenotype and he died two months later. Although extremely rare, we should keep in mind that duodenal tumors with a gastric phenotype may sometimes progress rapidly within a short period of time.
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Affiliation(s)
- Sho Matsuyama
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Japan
| | - Akihisa Fukuda
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Japan
| | - Nobukazu Agatsuma
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Japan
| | - Masahito Hoki
- Department of Diagnostic Pathology, Kyoto University Hospital, Japan
| | - Takahiro Utsumi
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Japan
| | - Hiroshi Seno
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Japan
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4
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De Pastena M, Zingaretti CC, Paiella S, Guerriero M, De Santis N, Luchini C, Bassi C, Malleo G, Salvia R. Impact of extra-ampullary duodenal adenocarcinoma subtypes on surgical and oncological outcomes following pancreaticoduodenectomy. Updates Surg 2024; 76:87-95. [PMID: 38093152 DOI: 10.1007/s13304-023-01688-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/25/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND There is little information about the relevance of extra-ampullary duodenal adenocarcinoma (EDA) subtypes. The aim of this study was to evaluate the impact of EDA subtypes on surgical and oncological outcomes following pancreatoduodenectomy (PD). METHODS Consecutive patients undergoing PD for EDA from 2000 to 2019 were analyzed. Results were stratified by pathologic subtype (intestinal versus non-intestinal). Uni-and multivariable analyses were performed using standard statistical methods. RESULTS The study population consisted of 70 patients, of whom 49 (70%) had an intestinal phenotype. EDA with intestinal phenotype was more frequently proximal to the Ampulla of Vater, while non-intestinal EDA was more frequently found distally (76% vs. 33%, p = 0.002). Patients with intestinal EDA were less likely to experience severe morbidity, with decreased reoperation and unplanned Intensive Care Unit admission rates relative to non-intestinal subtypes (2% vs. 29% p = 0.002, and 2% vs. 19%, p = 0.007, respectively). The median follow-up post-pancreatectomy was 73 months. Intestinal EDA was associated with improved overall and disease-free survival, with 3-year and 5-year survival rates of 71% vs. 29% and 53% vs. 24%, respectively. (p = 0.019 and p = 0.025). CONCLUSION Intestinal-type EDA, which more often arises from supra-ampullary duodenum, was associated with better postoperative outcomes and improved survival.
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Affiliation(s)
- Matteo De Pastena
- Unit of Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, P.Le Scuro 10, 37134, Verona, Italy
| | - Caterina Costanza Zingaretti
- Unit of Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, P.Le Scuro 10, 37134, Verona, Italy
| | - Salvatore Paiella
- Unit of Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, P.Le Scuro 10, 37134, Verona, Italy
| | - Massimo Guerriero
- Clinical Research Unit, 18621IRCCS Sacro Cuore-Don Calabria, Negrar, Italy
| | | | - Claudio Luchini
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Verona, Italy
- ARC-Net Research Center for Applied Research on Cancer, University of Verona, Verona, Italy
| | - Claudio Bassi
- Unit of Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, P.Le Scuro 10, 37134, Verona, Italy
| | - Giuseppe Malleo
- Unit of Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, P.Le Scuro 10, 37134, Verona, Italy
| | - Roberto Salvia
- Unit of Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, P.Le Scuro 10, 37134, Verona, Italy.
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5
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Chong A, Lewin J, Goh IY, Liu C. Brunner's gland adenoma: a robotic approach. BMJ Case Rep 2023; 16:e254566. [PMID: 37907319 PMCID: PMC10619083 DOI: 10.1136/bcr-2023-254566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
This report describes an unusual case of a symptomatic Brunner's gland adenoma arising in a man in his 40s that underwent robotic transduodenal resection. Initial investigations revealed a polypoidal, submucosal lesion that was found in the first part of the duodenum. Microscopically, there was neither dysplasia nor evidence of adenocarcinoma, suggesting differentials of gastrointestinal stroma tumour and duodenal adenoma. Given the size of the lesion, he underwent a surgical resection. Symptomatic Brunner's gland adenoma is uncommon and should be considered as a differential diagnosis in patients presenting with obstructive symptoms.
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Affiliation(s)
- Alyssa Chong
- General Surgery, Mater Hospital Brisbane, Brisbane, Queensland, Australia
| | - Joel Lewin
- General Surgery, Mater Hospital Brisbane, Brisbane, Queensland, Australia
| | - Ian Y Goh
- General Surgery, Mater Hospital Brisbane, Brisbane, Queensland, Australia
| | - Cheng Liu
- Anatomical Pathology, Mater Hospital Brisbane, Brisbane, Queensland, Australia
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6
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Hong P, Ghanim M, Haseeb A, Ding X, Abegunde AT. Recurrence of Brunner Gland Adenocarcinoma After Duodenectomy and Gastrojejunostomy. ACG Case Rep J 2023; 10:e01060. [PMID: 37305801 PMCID: PMC10249712 DOI: 10.14309/crj.0000000000001060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/24/2023] [Indexed: 06/13/2023] Open
Abstract
Malignant neoplasms arising from the Brunner gland are exceedingly rare. A 62-year-old man with a history of surgical resection of Brunner gland adenocarcinoma presented with upper extremity cellulitis. Hospital course was complicated by atrial fibrillation and hematochezia. Bidirectional endoscopy was negative; however, small bowel enteroscopy revealed recurrence of Brunner gland adenocarcinoma 6 years after surgical resection. To our knowledge, this is the first reported case of recurrent Brunner gland adenocarcinoma after curative resection.
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Affiliation(s)
- Paul Hong
- Department of Internal Medicine, Loyola University Medical Center, Maywood, IL
| | - Marcel Ghanim
- Division of Gastroenterology and Nutrition, Loyola University Medical Center, Maywood, IL
| | - Abdul Haseeb
- Division of Gastroenterology and Nutrition, Loyola University Medical Center, Maywood, IL
| | - Xianzhong Ding
- Department of Pathology, Loyola University Medical Center, Maywood, IL
| | - Ayokunle T. Abegunde
- Division of Gastroenterology and Nutrition, Loyola University Medical Center, Maywood, IL
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7
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Ortega M, Sparks J, Lichy J, Nava VE. KRAS G12D mutation in Brunner gland adenoma. BMJ Case Rep 2023; 16:e252160. [PMID: 36707100 PMCID: PMC9884920 DOI: 10.1136/bcr-2022-252160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/28/2023] Open
Abstract
Brunner gland lesions (BGLs) encompass benign proliferations of the homonymous glands and have been designated as hyperplasia, adenoma (BGA), hamartoma or nodule. In general terms, lesions larger than 0.5 cm are considered true neoplasia with unknown malignant potential and unclear pathogenesis. Genetic alterations have seldom been reported in BGL, and include SMAD4/DPC4 and LRIG1, but not KRAS (Kirsten rat sarcoma viral oncogene homologue) to the best of our knowledge.We present the case of a man in his 60s, evaluated for iron deficiency anaemia harbouring a 1.5 cm BGA found by duodenoscopy. Immunohistochemistry failed to reveal microsatellite instability, and next-generation sequencing revealed a KRAS G12D point mutation.
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Affiliation(s)
- Mahatma Ortega
- Pathology, George Washington University School of Public Health and Health Services, Washington, District of Columbia, USA
| | - Jessica Sparks
- University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Jack Lichy
- Department of Pathology, George Washington University, Washington, District of Columbia, USA
| | - Victor E Nava
- Department of Pathology, George Washington University, Washington, District of Columbia, USA
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8
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Gurzu S, Burlacu D, Jung I. Nonpolypous Hamartomas of the Gastrointestinal Tract: An Updated Review on Classification, Denominations, and Clinical Management. JOURNAL OF ONCOLOGY 2022; 2022:6983460. [PMID: 35586207 PMCID: PMC9110201 DOI: 10.1155/2022/6983460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/22/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To perform the first systematic report about histological subtypes of nonpolypous hamartomas of the gastrointestinal (GI) tract, from esophagus to anal canal. DESIGN From over 19,000 studies about hamartomas, most of them published as case series or case presentations, we have selected the most representative ones for the GI tract, excluding polyposis syndromes. To have a whole picture of these hamartomas, all of the data were combined with the personal experience of the authors who are GI pathologists. RESULTS The examined articles showed predominance of vascular and combined vascular and mesenchymal hamartomas. Arteriovenous hamartomas or Brunner gland hamartomas are mainly diagnosed in the small intestine, with preponderance for duodenum. Other malformations such cavernous hamartomas are more specific for the colorectal segments, whereas chondromatous hamartomas or those derived from the neural ectoderm were mostly reported in the esophagus. As newly recognized entities were admitted in the last years, misdiagnosis is frequent, and the best therapeutic approach is far to be known. CONCLUSION Even rare, hamartomas of the GI tract need to be differentiated from tumors and familial polyposis syndromes. Knowing their proper denominations and possible complications is valuable for gastroenterologists, pathologists, and surgeons, to be aware in the differential diagnosis.
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Affiliation(s)
- Simona Gurzu
- Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
- Research Center of Oncopathology and Transdisciplinary Research (CCOMT), George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
- Department of Pathology, Clinical County Emergency Hospital, Targu Mures, Romania
| | - Diana Burlacu
- Department of Pathology, Clinical County Emergency Hospital, Targu Mures, Romania
| | - Ioan Jung
- Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
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9
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Carbone R, Rovedatti L, Lenti MV, Furlan D, Errichiello E, Gana S, Luinetti O, Arpa G, Alvisi C, De Grazia F, Valente EM, Sessa F, Paulli M, Vanoli A, Di Sabatino A. Histologic heterogeneity and syndromic associations of non-ampullary duodenal polyps and superficial mucosal lesions. Dig Liver Dis 2021; 53:1647-1654. [PMID: 33814312 DOI: 10.1016/j.dld.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Duodenal polyps and superficial mucosal lesions (DP/SMLs) are poorly characterised. AIMS To describe a series of endoscopically-diagnosed extra-ampullary DPs/SMLs. METHODS This is a retrospective study conducted in a tertiary referral Endoscopy Unit, including patients who had DPs or SMLs that were biopsied or removed in 2010-2019. Age, gender, history of familial polyposis syndromes, DP/SML characteristics were recorded. Histopathological, immunohistochemical and molecular analyses were performed. RESULTS 399 non-ampullary DP/SMLs from 345 patients (60.6% males; median age 67 years) were identified. Gastric foveolar metaplasia represented the most frequent histotype (193 cases, 48.4%), followed by duodenal adenomas (DAs; 77 cases, 19.3%). Most DAs (median size 6 mm) were sessile (Paris Is; 48%), intestinal-type (96.1%) with low-grade dysplasia (93.5%). Among syndromic DAs (23%), 15 lesions occurred in familial adenomatous polyposis 1, two were in MUTYH-associated polyposis and one was in Peutz-Jeghers syndrome (foveolar-type, p53-positive, low-grade dysplasia). Only one (3.3%) tubular, low-grade DA showed mismatch repair deficiency (combined loss of MLH1 and PMS2, heterogeneous MSH6 expression), and it was associated with a MLH1 gene germline mutation (Lynch syndrome). CONCLUSION DPs/SMLs are heterogeneous lesions, most of which showing foveolar metaplasia, followed by low-grade, intestinal-type, non-syndromic DAs. MMR-d testing may identify cases associated with Lynch syndrome.
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Affiliation(s)
- Riccardo Carbone
- Unit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Italy
| | - Laura Rovedatti
- Endoscopy Unit, First Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Marco Vincenzo Lenti
- First Department of Internal Medicine, University of Pavia, IRCCS San Matteo Hospital Foundation, Viale Golgi 19, 27100, Italy.
| | - Daniela Furlan
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Edoardo Errichiello
- General Biology and Medical Genetics Unit, Department of Molecular Medicine, University of Pavia, Italy; IRCCS Mondino Foundation, Pavia, Italy
| | | | - Ombretta Luinetti
- Anatomic Pathology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Giovanni Arpa
- Unit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia, Italy
| | - Costanza Alvisi
- Endoscopic Unit, Department of Surgery, ASST Pavia, Pavia, Italy
| | - Federico De Grazia
- Endoscopy Unit, First Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Enza Maria Valente
- General Biology and Medical Genetics Unit, Department of Molecular Medicine, University of Pavia, Italy; IRCCS Mondino Foundation, Pavia, Italy
| | - Fausto Sessa
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Marco Paulli
- Unit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia, Italy; Anatomic Pathology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Alessandro Vanoli
- Unit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia, Italy; Anatomic Pathology Unit, IRCCS San Matteo Hospital Foundation, Pavia, Italy
| | - Antonio Di Sabatino
- First Department of Internal Medicine, University of Pavia, IRCCS San Matteo Hospital Foundation, Viale Golgi 19, 27100, Italy
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10
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An Unusual Gastric Polyp: Brunneroma. ACG Case Rep J 2021; 8:e00681. [PMID: 34815979 PMCID: PMC8604019 DOI: 10.14309/crj.0000000000000681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/29/2021] [Indexed: 11/19/2022] Open
Abstract
Brunneromas or polypoid hamartomas are benign lesions arising from Brunner glands. They are usually benign lesions with low potential for malignancy. They are usually located in the duodenum and manifest with different unspecific symptoms, such as abdominal pain, nausea, or bloating. Other more serious manifestations are also reported in the literature that are related to the size of the lesion. Usually, they are treated with endoscopic resection, with some lesions requiring surgical intervention. We present a case of a gastric antral polypoid lesion that was consistent with Brunneroma on histology.
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11
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Ishizu K, Hashimoto T, Naka T, Yatabe Y, Kojima M, Kuwata T, Nonaka S, Oda I, Esaki M, Kudo M, Gotohda N, Yoshida T, Yoshikawa T, Sekine S. APC mutations are common in adenomas but infrequent in adenocarcinomas of the non-ampullary duodenum. J Gastroenterol 2021; 56:988-998. [PMID: 34514550 DOI: 10.1007/s00535-021-01823-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/05/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Recent studies highlighted the clinicopathological heterogeneity of non-ampullary duodenal adenomas and adenocarcinomas, but the detailed process of the malignant transformation remains unclear. METHODS We analyzed 144 adenomas and 54 adenocarcinomas of the non-ampullary duodenum for immunohistochemical phenotypes, genetic alterations, and mismatch repair (MMR) status to probe their histogenetic relationship. RESULTS The median ages of patients with adenoma and adenocarcinoma were the same (66 years). Adenomas were histologically classified as intestinal-type adenoma (n = 124), pyloric gland adenoma (PGA, n = 10), gastric-type adenoma, not otherwise specified (n = 9), and foveolar-type adenoma (n = 1). Protein-truncating APC mutations were highly frequent in adenomas (85%), with the highest prevalence in intestinal-type adenomas (89%), but rare in adenocarcinomas (9%; P = 2.1 × 10-23). Close associations between phenotypic marker expression and genetic alterations were observed in adenomas, but not in adenocarcinomas, excluding the common association between GNAS mutations and MUC5AC expression. MMR deficiency was more frequent in adenocarcinomas (20%) than in adenomas (1%; P = 2.6 × 10-6). One MMR-deficient adenoma and three MMR-deficient adenocarcinomas occurred in patients with Lynch syndrome. Additionally, three other patients with an MMR-deficient adenocarcinoma fulfilled the revised Bethesda criteria. CONCLUSION The discrepant APC mutation frequency between adenomas and adenocarcinomas suggests that APC-mutated adenomas, which constitute the large majority of non-ampullary duodenal adenomas, are less prone to malignant transformation. Non-ampullary duodenal adenocarcinomas frequently exhibit MMR deficiency and should be subject to MMR testing to determine appropriate clinical management, including the identification of patients with Lynch syndrome.
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Affiliation(s)
- Kenichi Ishizu
- Division of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Department of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Taiki Hashimoto
- Division of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Tomoaki Naka
- Division of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yasushi Yatabe
- Division of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Division of Molecular Pathology, National Cancer Center Research Institute, Tokyo, Japan
| | - Motohiro Kojima
- Division of Pathology, Research Center for Innovative Oncology, National Cancer Center, Chiba, Japan
| | - Takeshi Kuwata
- Division of Pathology, Research Center for Innovative Oncology, National Cancer Center, Chiba, Japan
| | - Satoru Nonaka
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Ichiro Oda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Minoru Esaki
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Masashi Kudo
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Naoto Gotohda
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Teruhiko Yoshida
- Division of Genetics, National Cancer Center Research Institute, Tokyo, Japan
| | - Takaki Yoshikawa
- Department of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Shigeki Sekine
- Division of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. .,Division of Molecular Pathology, National Cancer Center Research Institute, Tokyo, Japan.
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12
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Giant duodenal polyp. Acta Gastroenterol Belg 2021; 84:523-524. [PMID: 34599583 DOI: 10.51821/84.2.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A 52 year-old man was referred with a history of anemia and fatigue. There was no melena and he was not taking any medication Blood analysis revealed microcytic anemia, with a hemoglobin of 9,7 g/dl (NR 13-18 ), MCV of 65,8 fl (NR 80-100) and serum ferritine was below 5 ng/ml (NR 30-400) with normal coagulation.There was no inflammation, no renal insufficiency and liver function tests were normal. Vitamine B12 and folic acid were normal. He underwent endoscopic work-up. Colonoscopy was normal. Gastroscopy revealed a large pedunculated polyp (5x2 cm) localized in the duodenal bulb and it was eroded on the top (Figure 1A and B). Multiple biopsies were taken showing no abnomarlity. There was no Helicobacter pylori nor metaplasia.
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13
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Zhu M, Li H, Wu Y, An Y, Wang Y, Ye C, Zhang D, Ma R, Wang X, Shao X, Guo X, Qi X. Brunner's Gland Hamartoma of the Duodenum: A Literature Review. Adv Ther 2021; 38:2779-2794. [PMID: 33914269 PMCID: PMC8189944 DOI: 10.1007/s12325-021-01750-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/15/2021] [Indexed: 02/07/2023]
Abstract
Brunner's gland hamartoma is a benign tumor of the duodenum, but has malignant potential with a very low risk of progression into adenocarcinoma. It is uncommon with a frequency of less than 1.0% among the primary tumors of the small intestine. In addition, its clinical manifestations are nonspecific, etiology remains unclear, and treatment strategy needs to be further refined. This literature review mainly discusses the epidemiology, clinical features, possible etiology and pathogenesis, diagnostic methods, malignant potential, treatment, and prognosis of Brunner's gland hamartoma.
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Affiliation(s)
- Menghua Zhu
- Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China
- Postgraduate College, Jinzhou Medical University, Jinzhou, People's Republic of China
| | - Hongyu Li
- Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China
| | - Yanyan Wu
- Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China
- Postgraduate College, Jinzhou Medical University, Jinzhou, People's Republic of China
| | - Yang An
- Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China
- Postgraduate College, Shenyang Pharmaceutical University, Shenyang, People's Republic of China
| | - Yuye Wang
- Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China
- Postgraduate College, Jinzhou Medical University, Jinzhou, People's Republic of China
| | - Chun Ye
- Department of General Surgery, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China
| | - Dan Zhang
- Department of General Surgery, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China
| | - Rui Ma
- Department of General Surgery, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China
| | - Xuehan Wang
- Department of Pathology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China
| | - Xiaodong Shao
- Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China.
| | - Xiaozhong Guo
- Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China.
| | - Xingshun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China.
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Vanoli A, Grillo F, Furlan D, Arpa G, Grami O, Guerini C, Riboni R, Mastracci L, Di Sabatino A. Small Bowel Epithelial Precursor Lesions: A Focus on Molecular Alterations. Int J Mol Sci 2021; 22:4388. [PMID: 33922305 PMCID: PMC8122855 DOI: 10.3390/ijms22094388] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 12/15/2022] Open
Abstract
The wider use of gastrointestinal endoscopic procedures has led to an increased detection of small intestinal preneoplastic and neoplastic epithelial lesions, most of which are identified in the duodenum and ampullary region. Like their malignant counterparts, small intestinal glandular precursor lesions, which include adenomas and hamartomas, may arise sporadically or be associated with hereditary tumor syndromes, such as familial adenomatous polyposis, MUTYH-associated polyposis, Lynch syndrome, Peutz-Jeghers syndrome, juvenile polyposis syndrome, and Cowden syndrome. In addition, dysplastic, preinvasive lesions have been observed adjacent to small bowel adenocarcinomas complicating immune-related disorders, such as celiac or Crohn's disease. Adenomatous lesions may exhibit an intestinal-type, gastric-type, or, very rarely, serrated differentiation, related to different molecular pathogenetic mechanisms. Finally, in the background of multiple endocrine neoplasia 1 syndrome, precursor neuroendocrine growths have been described. In this review we offer a comprehensive description on the histo-molecular features of the main histotypes of small bowel epithelial precursors lesions, including: (i) sporadic adenomas (intestinal-type and gastric-type; non-ampullary and ampullary); (ii) syndromic adenomas; (iii) small bowel dysplasia in celiac and Crohn's disease; (iv) serrated lesions; (v) hamartomatous lesions; and (vi) neuroendocrine precursor lesions.
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Affiliation(s)
- Alessandro Vanoli
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Lombardy, Italy; (G.A.); (O.G.); (C.G.); (R.R.)
| | - Federica Grillo
- Pathology Unit, Department of Surgical and Diagnostic Sciences, University of Genoa and Ospedale Policlinico San Martino University Hospital, 16132 Genoa, Liguria, Italy; (F.G.); (L.M.)
| | - Daniela Furlan
- Pathology Unit, Department of Medicine and Surgery, University of Insubria, 21100 Varese, Lombardy, Italy;
| | - Giovanni Arpa
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Lombardy, Italy; (G.A.); (O.G.); (C.G.); (R.R.)
| | - Oneda Grami
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Lombardy, Italy; (G.A.); (O.G.); (C.G.); (R.R.)
| | - Camilla Guerini
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Lombardy, Italy; (G.A.); (O.G.); (C.G.); (R.R.)
| | - Roberta Riboni
- Anatomic Pathology Unit, Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Lombardy, Italy; (G.A.); (O.G.); (C.G.); (R.R.)
| | - Luca Mastracci
- Pathology Unit, Department of Surgical and Diagnostic Sciences, University of Genoa and Ospedale Policlinico San Martino University Hospital, 16132 Genoa, Liguria, Italy; (F.G.); (L.M.)
| | - Antonio Di Sabatino
- Department of Internal Medicine, University of Pavia and Fondazione IRCCS San Matteo Hospital, 27100 Pavia, Lombardy, Italy;
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15
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Bhatti S, Alghamdi M, Omer E. Brunner's Gland Hyperplasia: A Massive Duodenal Lesion. Cureus 2020; 12:e7542. [PMID: 32377490 PMCID: PMC7198079 DOI: 10.7759/cureus.7542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/03/2020] [Indexed: 11/17/2022] Open
Abstract
A 57-year-old male with a history of gastroesophageal reflux disease and esophageal strictures presented with melena and abdominal pain. He underwent an esophagogastroduodenoscopy, which revealed a 5-cm duodenal bulb mass causing partial obstruction of the gastric outlet. Endoscopic ultrasound showed a 5-cm, hypoechoic lesion, arising from the mucosal layer, with a large blood vessel feeding the lesion. Biopsy revealed benign Brunner's gland hyperplasia. The large mass was causing symptomatic obstruction of the pylorus and iron deficiency anemia, and had risk for malignant transformation. Due to its size it was not amenable to endoscopic removal. Subsequently, he underwent exploratory laparotomy with pyloroplasty, duodenotomy and partial duodenal resection. Surgical pathology showed Brunner's gland hyperplasia and was negative for malignancy.
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Affiliation(s)
- Sundus Bhatti
- Internal Medicine, University of Louisville School of Medicine, Louisville, USA
| | - Mohammed Alghamdi
- Pathology, University of Louisville School of Medicine, Louisville, USA
| | - Endashaw Omer
- Gastroenterology, University of Louisville, Louisville, USA
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16
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Benign and non-neoplastic tumours of the duodenum. GASTROENTEROLOGY REVIEW 2019; 14:233-241. [PMID: 31988669 PMCID: PMC6983766 DOI: 10.5114/pg.2019.90250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 03/03/2019] [Indexed: 12/18/2022]
Abstract
This review study describes the problem of duodenal tumours, which are rare but important in gastrological practice. The most common location of small intestinal tumours is the duodenum, and this observation is probably partly due to the greater diagnostic availability for most proximal segments of the small intestine. Among tumours the following should be mentioned – benign: adenomas, lipomas, haemangiomas, and leiomyomas; and malignant: malignant tumours of epithelial origin, primary gastrointestinal stromal tumours, neuroendocrine tumours and carcinoids, lymphomas, sarcomas, teratomas, and secondary metastases. Early duodenal tumour recognition, especially with histological assessment, plays a crucial diagnostic role with future therapeutic implications. In recent years the prevalence of benign duodenal tumours has been rising due to a higher level of clinicians’ doubts and the convenience of gastrointestinal endoscopy; hence, knowledge of this problem is important in routine clinical practice. The method of duodenal tumour treatment should be selected on an individual basis.
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17
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Yoshida M, Shimoda T, Abe M, Kakushima N, Kawata N, Takizawa K, Ono H, Sugino T. Clinicopathological characteristics of non-ampullary duodenal tumors and their phenotypic classification. Pathol Int 2019; 69:398-406. [PMID: 31328367 DOI: 10.1111/pin.12829] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/22/2019] [Indexed: 12/14/2022]
Abstract
The tumorigenesis of non-ampullary duodenal epithelial tumors (NADETs) might be different between the oral and anal sides of Vater's papilla. We conducted an immunohistological review to elucidate the clinicopathological features according to the tumor location and phenotypic classification. A review of an institutional database identified 121 patients with 125 superficial NADETs. NADETs were histologically evaluated and classified into the intestinal or gastric type based on immunohistochemical analysis. Clinicopathological factors were compared based on the tumor location and phenotype. Logistic regression analysis was performed to identify independent predictors for gastric-type NADETs. According to location analysis, the mucin phenotype was significantly different (oral side, intestinal-type 64.8%, gastric-type 35.3%; anal side, intestinal-type 87.3%, gastric-type 12.7%; P < 0.01). Although the incidence of adenoma was significantly predominant in the intestinal type (75.3%), most gastric-type NADETs were cancerous (64.3%). Notably, most gastric-type NADETs were adenocarcinomas even when the tumor size was ≤0 mm. In multivariate analysis, tumor location on the oral side (odds ratio [OR], 4.42), villous structure (OR, 6.44), and low tumor gland density (OR, 9.49) were independent predictors of gastric-type tumors. Gastric-type NADETs significantly differ from intestinal-type NADETs in terms of tumor location, morphology, and biology.
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Affiliation(s)
- Masao Yoshida
- Division of Pathology, Shizuoka Cancer Center, Shizuoka, Japan.,Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Masato Abe
- Division of Pathology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Naomi Kakushima
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Noboru Kawata
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kohei Takizawa
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takashi Sugino
- Division of Pathology, Shizuoka Cancer Center, Shizuoka, Japan
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18
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Satoh T, Matsubayashi H, Takizawa K, Ishiwatari H, Kakushima N, Fujie S, Yoshida M, Kawata N, Sasaki K, Terashima M, Ono H. Giant Brunner's Gland Hyperplasia of the Duodenum Diagnosed by Endoscopic Ultrasonography-guided Fine Needle Biopsy and Treated by Laparoscopic Endoscopic Cooperative Surgery. Intern Med 2019; 58:2009-2013. [PMID: 30918195 PMCID: PMC6702001 DOI: 10.2169/internalmedicine.2477-18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
A 57-year-old female was referred to our department for treatment of a duodenal submucosal tumor (SMT), which had been growing over the last five years. Computed tomography demonstrated a marginally enhanced mass, measuring 36 mm in diameter, containing internal multiple hypovascular areas. Endoscopic ultrasonography-guided fine needle biopsy was performed using a 20-gauge core trap needle, and the specimens showed benign Brunner's glands. She underwent laparoscopic endoscopic cooperative surgery and the SMT was completely removed without any adverse events. Histology of the resected tumor showed Brunner's gland hyperplasia (BGH). BGH is generally a benign lesion. However, an accurate diagnosis is required to avoid overtreatment when it mimics malignancy.
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Affiliation(s)
| | | | | | | | | | - Shinya Fujie
- Division of Endoscopy, Shizuoka Cancer Center, Japan
| | - Masao Yoshida
- Division of Endoscopy, Shizuoka Cancer Center, Japan
| | - Noboru Kawata
- Division of Endoscopy, Shizuoka Cancer Center, Japan
| | - Keiko Sasaki
- Division of Pathology, Shizuoka Cancer Center, Japan
| | | | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Japan
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19
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Cui R, Zhou L, Yan X, Jin Z, Zhang H. Clinicopathological features of duodenal bulb biopsies and their relationship with upper gastrointestinal diseases. Ann Diagn Pathol 2019; 40:40-44. [DOI: 10.1016/j.anndiagpath.2019.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 02/08/2019] [Indexed: 02/07/2023]
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20
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Brunner's Gland Hyperplasias and Hamartomas in Association with Helicobacter pylori. Can J Gastroenterol Hepatol 2019; 2019:6340565. [PMID: 31187029 PMCID: PMC6521441 DOI: 10.1155/2019/6340565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/25/2019] [Accepted: 04/14/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The proliferative lesions of the Brunner's glands (BGs) are hyperplasia and hamartomas, and they are usually asymptomatic and very rarely diagnosed. The aetiology of these lesions is not yet clear. The aim of this study is to evaluate the clinical presentations of patients with BG hyperplasia and hamartomas and to assess the pathological features of these lesions in association with Helicobacter pylori (H. pylori). METHODS Our retrospective study included patients who underwent upper gastrointestinal system endoscopy between 2010 and 2015. The hospital records of 18 patients diagnosed with hyperplasia or hamartoma of BG were reviewed for the clinical and pathological findings. Data from patients with BG lesion were compared with 37 patients who had nonspecific duodenitis as the control group. RESULTS Female/male ratio in our study sample was 1/1. The age range was between 16 and 85 years with a mean age of 48.61. BG hyperplasia and hamartomas were found in 72.22 and 27.78% of the patients, respectively. The rate of H. pylori in gastric mucosa was 43.2% in the control group and 66.7% in the BG lesion group. In the BG lesion group, the rate of H. pylori was higher. H. pylori was identified in 60% of BG hamartomas and in 69.2% of hyperplastic BGs. CONCLUSION Our study demonstrated that H. pylori may play an important role in the development of BG hyperplasia and hamartomas in association with chronic gastritis and duodenitis. This is probably due to chronic irritation.
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21
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Uchiyama T, Hatakeyama K, Nakagawa K, Kushima R, Ohbayashi C. Gastric-type adenocarcinoma of the duodenum arising from Brunner glands. Pathol Int 2019; 69:177-179. [PMID: 30694586 DOI: 10.1111/pin.12759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 12/06/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Tomoko Uchiyama
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Kinta Hatakeyama
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Kenji Nakagawa
- Department of Surgery, Nara Medical University, Kashihara, Japan
| | - Ryoji Kushima
- Division of Diagnostic Pathology, Department of Clinical Laboratory Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Chiho Ohbayashi
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
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22
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Brunner's Gland Adenoma with High-Grade Dysplasia. ACG Case Rep J 2018; 5:e81. [PMID: 30568969 PMCID: PMC6277137 DOI: 10.14309/crj.2018.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/06/2018] [Indexed: 11/17/2022] Open
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.
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23
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Abstract
CONTEXT.— Duodenal epithelial polyps are reported in 1.5% to 3% of individuals referred for upper endoscopy. Most duodenal epithelial polyps are asymptomatic and nonneoplastic; however, a small subset is neoplastic and may progress to adenocarcinoma. Recent advances in immunohistochemical and molecular techniques have helped further characterize these polyps, shedding light on their origin, classification, and risk of progression to adenocarcinoma. OBJECTIVE.— To provide a comprehensive clinicopathologic review of nonneoplastic and neoplastic duodenal epithelial polyps, with particular emphasis on recent developments in classification schemes and risk stratification based upon immunohistochemical and molecular profiles. DATA SOURCES.— This review is based on peer-reviewed literature and the authors' experiences. CONCLUSIONS.— In this review we provide an update on the clinicopathologic, immunohistochemical, and molecular features of duodenal epithelial polyps and discuss the surveillance recommendations and treatment options available. Particular attention should be placed on recognizing duodenal adenomas with intestinal, gastric, and serrated phenotype, as they have an increased risk of malignant transformation if not completely excised.
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Affiliation(s)
- Katrina Collins
- From the Department of Pathology & Laboratory Medicine, Hartford Hospital, Hartford, Connecticut
| | - Saverio Ligato
- From the Department of Pathology & Laboratory Medicine, Hartford Hospital, Hartford, Connecticut
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24
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Matsuo Y, Yamamoto H, Sato Y, Oikawa R, Maehata T, Fujino T, Yahagi N, Yasuda H, Takagi M, Itoh F. GNAS-mutated carcinoma arising from gastric foveolar metaplasia in the duodenum after 9 years of observation. Clin J Gastroenterol 2018; 11:391-395. [DOI: 10.1007/s12328-018-0856-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/28/2018] [Indexed: 11/29/2022]
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25
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26
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Brunnerʼs Gland Adenoma with High-Grade Dysplasia. ACG Case Rep J 2018. [DOI: 10.14309/02075970-201805110-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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27
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Mitsuishi T, Hamatani S, Hirooka S, Fukasawa N, Aizawa D, Hara Y, Dobashi A, Goda K, Fukuda T, Saruta M, Urashima M, Ikegami M. Clinicopathological characteristics of duodenal epithelial neoplasms: Focus on tumors with a gastric mucin phenotype (pyloric gland-type tumors). PLoS One 2017; 12:e0174985. [PMID: 28376132 PMCID: PMC5380350 DOI: 10.1371/journal.pone.0174985] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/18/2017] [Indexed: 12/16/2022] Open
Abstract
Objective Epithelial tumors less commonly occur in the duodenum than in the stomach or large intestine. The clinicopathological characteristics of duodenal epithelial tumors remain a matter of debate. We therefore studied resected specimens to investigate the clinicopathological characteristics of duodenal epithelial tumors. Materials and methods Among duodenal epithelial tumors resected endoscopically or surgically in our hospital, we studied the clinicopathological characteristics of 110 adenomas or intramucosal carcinomas. The grade of atypia of all tumors was classified into 3 groups according to the World Health Organization (WHO) 2010 classification. The tumors were immunohistochemically evaluated to determine the frequency of differentiation toward fundic glands. Results As for patient characteristics, there were 76 men (75.2%) and 25 women (24.8%), with a median age of 65 years (range, 34 to 84). The tumors most commonly arose in the first to second part of the duodenum. Many lesions were flat, and the median tumor diameter was 8.0 mm. The lesions were classified into 2 types according to mucin phenotype: intestinal-type tumors (98 lesions, 89.1%) and gastric-type tumors (12 lesions, 10.9%). Intestinal-type tumors were subdivided into 2 groups: tubular-type tumors (91 lesions, 82.7%) and tubulovillous-type tumors (7 lesions, 6.4%). Gastric-type tumors were classified into 2 types: foveolar type (3 lesions, 2.7%) and pyloric gland-type (PG) tumors (9 lesions, 8.2%). The grade of atypia was significantly higher in gastric-type tumors (p<0.01). PG tumors were gastric-type tumors characterized by pyloric glands and findings suggesting differentiation toward fundic glands. Conclusions About 10% of the duodenal tumors had a gastric-type mucin phenotype. Gastric-type tumors showed high-grade atypia. In particular, PG tumors showed similarities to PG tumors of the stomach, such as differentiation toward fundic glands.
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Affiliation(s)
- Takehiro Mitsuishi
- Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
- * E-mail:
| | - Shigeharu Hamatani
- Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Shinichi Hirooka
- Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Nei Fukasawa
- Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Daisuke Aizawa
- Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Yuko Hara
- Department of Endoscopy, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Akira Dobashi
- Department of Endoscopy, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Kenichi Goda
- Department of Endoscopy, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Takahiro Fukuda
- Division of Neuropathology, Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Masayuki Saruta
- Division of Gastroenterology and Hepatology, Department of Internal medicine, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Mitsuyoshi Urashima
- Division of Molecular Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Masahiro Ikegami
- Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
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Giant Brunner's Gland Hamartoma as a Cause of Iron Deficiency Anemia. ACG Case Rep J 2017; 4:e37. [PMID: 28331876 PMCID: PMC5356200 DOI: 10.14309/crj.2017.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 12/06/2016] [Indexed: 11/17/2022] Open
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30
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A Giant Brunneroma Causing Gastrointestinal Bleeding and Severe Anemia Requiring Transfusion and Surgery. Case Rep Surg 2017; 2017:6940649. [PMID: 28299229 PMCID: PMC5337360 DOI: 10.1155/2017/6940649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 01/26/2017] [Accepted: 01/29/2017] [Indexed: 12/29/2022] Open
Abstract
Brunner's gland hamartoma, also called hyperplasia, adenoma, and Brunneroma, is an extremely rare benign proliferative lesion of Brunner's glands in the duodenum. While being mostly small and asymptomatic, they can result in gastrointestinal bleeding and obstruction. We report the case of a 54-year-old man presenting with melena and severe anemia requiring blood transfusion. CT scans showed a large mass of 8 cm in diameter, presumably arising in the duodenum. Endoscopic biopsies were not conclusive. As we were unable to determine the nature of the mass preoperatively and due to the severe symptoms, its size, and the uncertain malignant potential, a classic Whipple procedure was performed. The resected specimen showed extensive proliferation of Brunner's glands without signs of malignancy.
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31
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Sorleto M, Timmer-Stranghöner A, Wuttig H, Engelhard O, Gartung C. Brunner's Gland Adenoma - A Rare Cause of Gastrointestinal Bleeding: Case Report and Systematic Review. Case Rep Gastroenterol 2017; 11:1-8. [PMID: 28203131 PMCID: PMC5301130 DOI: 10.1159/000454711] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 11/22/2016] [Indexed: 11/19/2022] Open
Abstract
Brunner's gland adenoma is an extremely rare benign small bowel neoplasm, often discovered incidentally during upper gastrointestinal endoscopy or radiological diagnostics. In few cases, it tends to cause gastrointestinal hemorrhage or intestinal obstruction. We report here our experience with a 47-year-old woman with a Brunner's gland adenoma of more than 6 cm in size, located in the first part of the duodenum and causing gastrointestinal bleeding. Initially, we performed a partial endoscopic resection using endoloop and snare alternatively to prevent severe bleeding. A rest endoscopic polypectomy with the submucosal dissection technique was planned. However, on request of the patient, an elective surgical duodenotomy with submucosal resection of the remaining small duodenal tumor was performed. To better define the patient's characteristics and treatment options of such lesions, we performed a systematic review of the available literature in PubMed. Recently, an endoscopic removal is being increasingly practiced and is considered as a safe treatment modality of such lesions.
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Affiliation(s)
- Michele Sorleto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital Johannes-Wesling-Klinikum Minden, Minden, Germany
| | - Annette Timmer-Stranghöner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital Johannes-Wesling-Klinikum Minden, Minden, Germany
| | - Helge Wuttig
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital Johannes-Wesling-Klinikum Minden, Minden, Germany
| | - Oliver Engelhard
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital Johannes-Wesling-Klinikum Minden, Minden, Germany
| | - Carsten Gartung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital Johannes-Wesling-Klinikum Minden, Minden, Germany
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Santy L, Fierens J, Dedrye L. Laparoscopic treatment of a Brunner's gland hamartoma: a case report. Acta Chir Belg 2016; 116:197-200. [PMID: 27426650 DOI: 10.1080/00015458.2016.1139836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background Brunner's gland hyperplasia is a rare benign tumour and occurs most frequently in the upper part of the duodenum, mostly in the fifth or the sixth decade. Pathogenesis is still unknown. Symptoms are mostly absent, but larger lesions can cause gastric outlet obstruction or bleeding. Biopsies are necessary for differential diagnosis and to rule out cancerous changes. Mostly a resection is required. Methods A case report of a symptomatic Brunneroma is described with a review of the literature. Results: A 72-year-old female presented with melena due to a post-pyloric Brunneroma. After medical work-up a full laparoscopic resection was performed, with an uneventful recovery. Conclusion Brunner's gland hyperplasia is a benign lesion, although malignant transformation has been described. Small pedunculated Brunneromas can be resected endoscopically, but larger lesions need surgical treatment. A full laparoscopic treatment is possible and safe.
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Abstract
Brunner gland hyperplasia, a rare duodenal tumor, usually presents with benign features. A 68-year-old man with a history of anemia presented with a polypoid duodenal mass that was detected by CT and esophagogastroduodenoscopy. This mass showed high F-FDG avidity on PET/CT and was histopathologically confirmed as Brunner gland hyperplasia. We suggest that Brunner gland hyperplasia should be considered in the differential diagnosis of F-FDG-avid duodenal tumors.
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Abstract
Extra-ampullary duodenal adenocarcinomas are rare, and when studied, frequently have been grouped with jejunoileal adenocarcinomas. Nevertheless, anecdotal experiences suggest that these neoplasms may present 2 or more distinct phenotypes. To better characterize these neoplasms, we performed a retrospective review of 38 cases with a special focus on the morphologic and immunophenotypic characteristics and their clinicopathologic significance. Our cohort of extra-ampullary duodenal adenocarcinomas was classified on the basis of the morphologic features into gastric type (n=19, 50%), intestinal type (n=14, 37%), pancreaticobiliary type (n=2, 5%), and others (n=3, 8%). Most gastric-type adenocarcinomas (n=18, 95%) developed in the proximal duodenum, whereas the other types were located equally in the proximal and distal duodenum. Intestinal-type dysplasia was present at the periphery of 8 (57%) intestinal-type adenocarcinomas, and 8 (42%) gastric-type adenocarcinoma were associated with gastric-type dysplasia. Gastric foveolar metaplasia (n=12) and Brunner gland hyperplasia (n=10) were exclusively recognized adjacent to gastric-type adenocarcinomas. Notably, intestinal-type histology and the absence of lymph node metastasis were significantly associated with favorable disease-free survival in univariate and multivariate analyses. In summary, this study demonstrated that 2 major subsets of extra-ampullary duodenal adenocarcinoma, intestinal type and gastric type, are associated with distinct histopathologic features and clinical behavior.
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Akaki M, Taniguchi S, Hatakeyama K, Kushima R, Kataoka H. Duodenal mucosal damage is associated with proliferative activity of Brunner's gland hamartoma: a case report. BMC Gastroenterol 2014; 14:14. [PMID: 24422755 PMCID: PMC3898372 DOI: 10.1186/1471-230x-14-14] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 01/10/2014] [Indexed: 12/16/2022] Open
Abstract
Background Brunner’s gland hamartoma is a rare tumor, predominantly found in the fifth to sixth decades of life. Generally, it is a single pedunculated polyp, rarely larger than 5 cm. Asymptomatic cases are found incidentally, but cases with a large polyp tend to have gastrointestinal bleeding and/or obstructive symptoms. Polyp size increases in a time-dependent manner, however, the growth mechanism is unknown. We report a Japanese male case in his mid-twenties with an over 6 cm sized polyp. Case presentation A 26-year-old man presented black stools and anemia. Endoscopic examination revealed a large pedunculated polyp at gastroduodenal junction. The polyp, subsequently resected by distal gastrectomy, was lobulated with random surface erosions and sized 6.4 × 3 cm. Histological examination revealed that the polyp arose from duodenal mucosa and was composed of hyperplastic Brunner’s glands in lobules separated by fibromuscular septa, associated with lymphocytic infiltrate and lymphoid follicles. No evidence of malignancy was found. Thus, the lesion was diagnosed as Brunner’s gland hamartoma. Further immunohistochemical studies indicated that gastric foveolar metaplasia is associated with surface epithelium covering upper two thirds of the polyp, showing immunohistochemical positivity for mucin 5 AC (MUC5AC). Below the metaplastic surface epithelium, Brunner’s glands had high proliferative activity (MIB-1 labeling index: 7.9%). The similar staining pattern was observed at surface erosive sites (MIB-1 labeling index in Brunner’s glands: 9%). On the other hand, surface epithelium in the lower side of the polyp still preserved intestinal nature, containing CDX2-positive nuclei and MUC2-positive goblet cells. Brunner’s glands below the surface epithelium with intestinal characteristics showed low proliferative activity (MIB-1 labeling index: 0.77%). Conclusion Proliferative activity of Brunner’s glands was high at the sites with surface erosion and also below the epithelium showing gastric foveolar metaplasia. As gastric foveolar metaplasia occurs along with a mucosal repair process in the duodenum, mucosal damages underlay the hamartomatous proliferation of Brunner’s glands and eventually resulted in a formation of large polypoid mass in this case.
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Affiliation(s)
- Mayumi Akaki
- Clinical Laboratory, University of Miyazaki Hospital, 5200 Kihara, Kiyotake, Miyazaki, Miyazaki, 889-1692, Japan.
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Lenz L, Felipe-Silva A, Nakao F, Miyajima N, Della Libera E, Chaves DM, Sugai BM, Rohr MRDS. Pyloric Brunner's gland hamartoma with atypical hyperplasia. AUTOPSY AND CASE REPORTS 2013; 3:49-51. [PMID: 28584807 PMCID: PMC5453661 DOI: 10.4322/acr.2013.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 12/03/2013] [Indexed: 11/23/2022] Open
Abstract
Brunner's gland hamartoma (BGH) is an extremely rare benign digestive tumor, generally located in the duodenal bulb. We report the case of a 51-year-old asymptomatic man with a large pedunculated BGH arising from the pylorus. It was successfully removed en bloc by endoscopic resection.
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Affiliation(s)
- Luciano Lenz
- Fleury Medicina e Saúde, São Paulo/SP - Brazil.,Department of Endoscopy - Universidade Federal de São Paulo, São Paulo/SP - Brazil
| | - Aloísio Felipe-Silva
- Fleury Medicina e Saúde, São Paulo/SP - Brazil.,Anatomic Pathology Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Frank Nakao
- Fleury Medicina e Saúde, São Paulo/SP - Brazil.,Department of Endoscopy - Universidade Federal de São Paulo, São Paulo/SP - Brazil
| | - Nelson Miyajima
- Fleury Medicina e Saúde, São Paulo/SP - Brazil.,Gastrointestinal Endoscopy Service - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Ermelindo Della Libera
- Fleury Medicina e Saúde, São Paulo/SP - Brazil.,Department of Endoscopy - Universidade Federal de São Paulo, São Paulo/SP - Brazil
| | - Dalton Marques Chaves
- Fleury Medicina e Saúde, São Paulo/SP - Brazil.,Gastrointestinal Endoscopy Service - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | | | - Maria Rachel da Silveira Rohr
- Fleury Medicina e Saúde, São Paulo/SP - Brazil.,Department of Endoscopy - Universidade Federal de São Paulo, São Paulo/SP - Brazil
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Clinicopathologic characteristics and mucin expression in Brunner's gland proliferating lesions. Dig Dis Sci 2013; 58:194-201. [PMID: 22836185 DOI: 10.1007/s10620-012-2320-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 07/07/2012] [Indexed: 01/15/2023]
Abstract
BACKGROUND Brunner's gland proliferating lesions, termed Brunner's gland hamartoma, hyperplasia, or adenoma, is regarded as a benign condition. However, cancerous changes have been reported in Brunner's gland proliferating lesions. AIMS The purpose of this study was to define the characteristic features of Brunner's gland proliferating lesions and evaluate any observed cancerous changes. METHODS We analysed clinicopathologic features and mucin expression in 25 Brunner's gland proliferating lesions. RESULTS Brunner's gland proliferating lesions were categorized as Brunner's gland hamartoma or hyperplasia according to their tissue components. Brunner's gland hamartoma commonly occurred in the duodenal bulb and exhibited a polypoid appearance, while Brunner's gland hyperplasia was primarily observed in the second portion of duodenum as a submucosal mass and was accompanied by symptoms more frequently than Brunner's gland hamartoma. The Brunner's glands in Brunner's gland proliferating lesions exhibited various morphologic characteristics, from normal-appearing glands to sclerotic glandular foci with atypia. Changes in MUC5 expression observed in both sclerotic glandular foci and dilated Brunner's glands suggest that they might share a common mechanism and are associated with gastric foveolar metaplasia. CONCLUSIONS These findings indicate that most Brunner's gland proliferating lesions are either hamartoma or hyperplasia, and that true neoplastic Brunner's gland proliferating lesions are very rare. Thus, Brunner's gland adenomas or carcinomas arising in Brunner's gland proliferating lesions should be confirmed by ancillary tests, including immunostaining or molecular analysis, in addition to morphological criteria.
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Chatelain D. [« Non-intestinal » oesophageal and gastric dysplasia: terminology, diagnostic criteria]. Ann Pathol 2012; 32:S53-7. [PMID: 23127941 DOI: 10.1016/j.annpat.2012.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 08/30/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Denis Chatelain
- Service d'anatomie et cytologie pathologiques, CHU, place Victor-Pauchet, 80054 Amiens cedex 1, France.
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Abstract
Brunner’s glands are submucosal glands located in the proximal duodenum. Hyperplasia of the Brunner’s gland has been reported rarely in humans and animals. We examined sections of the Brunner’s gland from 63 sand rats submitted for necropsy over 2 years. Of the 63 animals necropsied, 45 (71%) had evidence of hyperplasia defined as nodular expansion, dilated ducts, or intraductal papillary proliferation. The hyperplasia was graded as mild in 22 (49%) of the cases, moderate in 15 (33%), and marked in 8 (18%). We found an association with both increased age and evidence of gastric ulceration and hyperplasia of the Brunner’s gland. In sand rats with marked hyperplasia, 8 of 8 (100%) had evidence of gastric ulceration, compared to 13 of 18 (72%) in animals with no hyperplasia. Animals with marked hyperplasia were, on average, 8.4 months older than animals with no hyperplasia. There was no association with gender. The lesion in sand rats is histologically similar to that in humans.
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Affiliation(s)
- T. J. Steinbach
- Experimental Pathology Laboratories Inc., Sterling, Virginia
| | - J. D. Kane
- Veterinary Services Program, Walter Reed Institute of Research, Silver Spring, Maryland
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Khor TS, Brown I, Kattampallil J, Yusoff I, Kumarasinghe MP. Duodenal adenocarcinoma arising from a pyloric gland adenoma with a brief review of the literature. BMJ Case Rep 2010; 2010:2010/dec21_1/bcr1020103385. [PMID: 22802482 DOI: 10.1136/bcr.10.2010.3385] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Pyloric gland-type adenoma of the duodenum with documented malignant progression is rare. A case is presented of an 87-year-old man with bloating and nausea, who on investigation was found to have a polyp on the anteroinferior wall of the duodenal cap. Histologic examination of the polyp showed features of a pyloric gland adenoma (PGA) demonstrating the full spectrum of progression from low- to high-grade dysplasia and finally invasive adenocarcinoma. The carcinoma showed gastric-type differentiation highlighted by its mucin immunohistochemistry profile and was of advanced stage with lymph node metastasis. The literature on PGAs and the little documentations on progression to carcinoma in duodenal PGAs are reviewed.
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Affiliation(s)
- T S Khor
- Department of Histopathology, PathWest, Fremantle Hospital, Fremantle, Australia.
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Image of the month. Adenocarcinoma derived from Brunner's gland. Clin Gastroenterol Hepatol 2010; 8:A26. [PMID: 19501675 DOI: 10.1016/j.cgh.2009.05.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Revised: 05/21/2009] [Accepted: 05/23/2009] [Indexed: 02/07/2023]
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Ohta Y, Saitoh K, Akai T, Uesato M, Ochiai T, Matsubara H. Early primary duodenal carcinoma arising from Brunner's glands synchronously occurring with sigmoid colon carcinoma: report of a case. Surg Today 2008; 38:756-760. [PMID: 18668323 DOI: 10.1007/s00595-007-3707-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2007] [Accepted: 12/04/2007] [Indexed: 11/25/2022]
Abstract
We herein report a case of early primary duodenal carcinoma arising from Brunner's glands synchronously occurring with sigmoid colon carcinoma. A 65-year-old man with a 5-year history of diabetes mellitus and benign prostatic hypertrophy was admitted to our hospital to undergo a resection of sigmoid colon carcinoma in December 2000. Upper gastrointestinal endoscopy, which was performed as routine preoperative screening, revealed an elevated submucosal-tumor-like lesion with a shallow central depression in the anterior wall of the duodenal bulb. A partial duodenectomy with a partial gastrectomy including No. 5 and No. 6 lymph node dissection and a sigmoidectomy were thus performed. The patient's postoperative course was uneventful. The histopathology of the resected duodenal specimen revealed the tumor to be an adenocarcinoma arising from Brunner's glands. The patient has remained disease-free and has shown no relapse for 6 years postoperatively. Because duodenal carcinoma arising from Brunner's glands is very rare, we report our case with a review of 25 similar documented cases.
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Affiliation(s)
- Yoshihito Ohta
- Department of Frontier Surgery (M9), Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
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Koizumi M, Sata N, Yoshizawa K, Kurihara K, Yasuda Y. Carcinoma Arising from Brunner's Gland in the Duodenum after 17 Years of Observation - A Case Report and Literature Review. Case Rep Gastroenterol 2007; 1:103-9. [PMID: 21487554 PMCID: PMC3073796 DOI: 10.1159/000108944] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A 60-year-old man presented with melena and hematemesis in 1984. Esophagogastroduodenoscopy (EGD) detected a small protruding lesion in the duodenal bulb, which was diagnosed as Brunner's adenoma. No significant change was detected in subsequent annual EGD and biopsies for 10 years, after which the patient was not observed for 7 years. The patient presented with melena again in 2001. The lesion had changed shape to become a 10 mm sessile tumor with a central depression, and following a biopsy was diagnosed as an adenocarcinoma. The patient underwent partial resection of the duodenum. Histopathological assessment showed acidophilic cells with swollen nuclei, and clear cells forming a tubular or papillary tubule in the mucosal lamina propria and submucosal layer. The tumor cells stained positive for lysozyme, indicating that they arose from Brunner's gland. The patient showed no sign of recurrence and was disease-free for more than 34 months after surgery. The patient died of pneumonia. This is an extremely rare case of primary duodenal carcinoma arising from Brunner's gland in a patient observed for 17 years.
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Affiliation(s)
- Masaru Koizumi
- Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
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44
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Kim JH, Choi JW, Seo YS, Lee BJ, Yeon JE, Kim JS, Byun KS, Bak YT, Kim I, Park JJ. Inverted cystic tubulovillous adenoma involving Brunner’s glands of duodenum. World J Gastroenterol 2007; 13:3262-4. [PMID: 17589910 PMCID: PMC4436617 DOI: 10.3748/wjg.v13.i23.3262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Benign neoplasia of the duodenum are very rare. Moreover, duodenal tubulovillous adenomas are more uncommon lesions. The microscopic structure of tubulovillous adenoma has frond-like projection of mucosa with branching papillary structure and generally upward growth into the lumen. We describe a 72-year-old man who showed aduodenal tubulovillous adenoma with unusual inverted cystic growth pattern. Interestingly, this tubulovillous adenomatous lesion was interrupted by gastric metaplasia in the deep portion of the cyst and was closely surrounded by Brunner’s glands. Although histogenesis of gastric metaplasia of duodenum is not fully understood, Brunner’s glands has been suggested as a precursor for gastric metaplasia. Therefore, these findings argued that this adenoma arises from Brunner’s glands through gastric metaplasia. This is the first case of inverted cystic tubulovillous adenoma involving Brunner’s glands of duodenum with gastric metaplasia.
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Affiliation(s)
- Ji Hoon Kim
- Department of Internal Medicine, Guro Hospital, Korea University College of Medicine, 97, Guro-Dong Gil, Guro-Dong, Guro-Ku, Seoul, 152-703, South Korea
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Abstract
BACKGROUND In cases of known aetiology, gastric duodenal metaplasia (GMD) is a reversible lesion. In cases of unknown aetiology, the fate of GMD remains elusive. GMD was recently found in a duodenal adenoma. AIM To audit the frequency of GMD occurring in a cohort of duodenal adenomas. METHODS Filed H&E-stained sections from 306 consecutive duodenal adenomas were investigated for the presence of GMD. RESULTS 68% of the adenomas (n = 208) were from patients with familial adenomatous polyposis (FAP), and the remaining 32% (n = 98) were sporadic. GMD was found in 31.7% (66/208) of the duodenal FAP adenomas and in 59.2% (58/98) of the duodenal sporadic adenomas (p<0.05). The causes for this difference are elusive. CONCLUSIONS As for other metaplasias of the gastrointestinal tract (intestinal metaplasia of the oesophagus and of the stomach, and metaplastic-hyperplastic polyposis of the colon, known to antedate neoplastic transformation), a subset of GMDs of unknown cause might be present in the duodenal mucosa before adenomatous changes ensue. That subset of GMD might have neoplastic proclivity similar to the metaplastic epithelium in other organs of the gastrointestinal tract. The known carcinogenic effect of high concentrations of bile acids and pancreatic juices bathing the duodenal mucosa carrying an irreversible subset of GDM might set aflame the adenomatous neoplastic transformation in these patients.
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Affiliation(s)
- C A Rubio
- Gastrointestinal and Liver Pathology Research Laboratory, Department of Pathology Karolinska Institute and University Hospital, Stockholm, Sweden.
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46
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Abstract
BACKGROUND In cases of known aetiology, gastric duodenal metaplasia (GMD) is a reversible lesion. In cases of unknown aetiology, the fate of GMD remains elusive. GMD was recently found in a duodenal adenoma. AIM To audit the frequency of GMD occurring in a cohort of duodenal adenomas. METHODS Filed H&E-stained sections from 306 consecutive duodenal adenomas were investigated for the presence of GMD. RESULTS 68% of the adenomas (n = 208) were from patients with familial adenomatous polyposis (FAP), and the remaining 32% (n = 98) were sporadic. GMD was found in 31.7% (66/208) of the duodenal FAP adenomas and in 59.2% (58/98) of the duodenal sporadic adenomas (p<0.05). The causes for this difference are elusive. CONCLUSIONS As for other metaplasias of the gastrointestinal tract (intestinal metaplasia of the oesophagus and of the stomach, and metaplastic-hyperplastic polyposis of the colon, known to antedate neoplastic transformation), a subset of GMDs of unknown cause might be present in the duodenal mucosa before adenomatous changes ensue. That subset of GMD might have neoplastic proclivity similar to the metaplastic epithelium in other organs of the gastrointestinal tract. The known carcinogenic effect of high concentrations of bile acids and pancreatic juices bathing the duodenal mucosa carrying an irreversible subset of GDM might set aflame the adenomatous neoplastic transformation in these patients.
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Affiliation(s)
- C A Rubio
- Gastrointestinal and Liver Pathology Research Laboratory, Department of Pathology Karolinska Institute and University Hospital, Stockholm, Sweden.
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