Brunner’s gland hyperplasia associated with lipomatous pseudohypertrophy of the pancreas presenting with gastrointestinal bleeding: A case report

Figure 1 Computed tomography (CT) and magnetic resonance imaging (MRI). A: Plain CT: density of the pancreatic parenchyma was uniformly decreased to the same level as that of the surrounding fatty tissue (attenuation value = 90.64 HU); B: Contrast-enhanced CT: Pancreatic parenchyma was absent, completely replaced by fat; C and D: MRI of the pancreas. In- and out-phase MRI respectively show a typical global (C) hyperintensity; and (D) fat suppression.

Figure 2 Contrast-enhanced computed tomography (CECT) and magnetic resonance imaging (MRI). A: CECT showing fatty tissue infiltration into duodenal wall (orange arrows); B: MRI also showed fatty tissue infiltration into duodenal wall (orange arrows); C: CECT scan showed hypoechoic saccular dilatations in segment IV of the liver; D: T2-weighted MRI showed segmental biliary ectasia (arrow).

Figure 3 Endoscopic appearance of the submucosal tumor arising from the duodenum (arrows). A: Irregular surface with shallow ulcers; B–D: A thick stalk below the head portion of the tumor; E and F: Surface ulcers with bleeding.

Figure 4 Histological findings of duodenal and pancreatic biopsy specimens. A and B: The duodenal biopsy showed lobulated proliferation of submucosal Brunner’ glands comprising benign-looking acini lined by mucous cells with basal nuclei without atypia, which was consistent with Brunner’s gland hyperplasia. C and D: Percutaneous pancreatic biopsies revealed adipose tissue replacing the pancreatic parenchyma. Some pancreatic acini were identified with a scattered distribution. Hematoxylin and eosin stain (A–D). Original magnification: (A, C, D) × 40, (B) × 100.