Brunner’s gland adenoma – a rare cause of gastrointestinal bleeding

Česká verzia

Authors: M. Kliment
Authors place of work: Gastroenterologie und Hepatologie, Klinik für Innere Medizin, Vivantes Klinikum Spandau, Berlin, Německo
Published in the journal: Gastroent Hepatol 2018; 72(3): 225-230
Category:
doi: https://doi.org/10.14735/amgh2018228

Summary

Brunner’s gland adenomas are rare benign tumors of the duodenum, which are often diagnosed incidentally during esophagogastroduodenoscopy or upper gastrointestinal series. The lesions are most commonly asymptomatic, but a minority of patients may present with symptoms of duodenal obstruction or hemorrhage secondary to ulceration. Histologically, a Brunner’s gland adenoma consists of components of Brunner’s gland cells, as well as glandular, adipose and muscle cells. We report a case of a 53-year-old woman with a Brunner’s gland adenoma with a size of 3.5 cm, causing an upper gastrointestinal bleeding. Endosonography revealed a highly vascularized duodenal tumor arising from the submucosa. After histological examination of an endosonographically guided fine needle aspiration biopsy revealed a Brunner’s gland adenoma, the adenoma was successfully removed using a polypectomy snare and an endoloop. We also present a literature review, including other therapy options.

Key words:
Brunner’s gland – duodenal polyp – gastrointestinal bleeding – endoscopic polypectomy

The author declares he has no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted: 19. 4. 2018

Accepted: 12. 5. 2018

Zdroje

1. Van der Walle P, Dillemans B, Vandelanotte M et al. The laparoscopic resection of a benign stromal tumour of the duodenum. Acta Chir Belg 1997; 97 (3): 127–129.

2. Ohba R, Otaka M, Jin M et al. Large Brunner‘s gland hyperplasia treated with modified endoscopic submucosal dissection. Dig Dis Sci 2007; 52 (1): 170–172. doi: 10.1007/s10620-006-9607-1.

3. Stewart ZA, Hruban RH, Fishman EF et al. Surgical management of giant Brunner‘s gland hamartoma: case report and literature review. World J Surg Oncol 2009; 7: 68. doi: 10.1186/1477-7819-7-68.

4. Jung Y, Chung IK, Lee TH et al. Successful endoscopic resection of large pedunculated Brunner‘s gland hamartoma causing gastrointestinal bleeding arising from pylorus. Case Rep Gastroenterol 2013; 7 (2): 304–307. doi: 10.1159/000354138.

5. Sakurai T, Sakashita H, Honjo G et al. Gastric foveolar metaplasia with dysplastic changes in Brunner‘s gland hyperplasia: possible precursor lesions of Brunner gland adenocarcinoma. Am J Surg Pathol 2005; 29 (11): 1442–1448.

6. Cruveilhier J. Anatomy of the human body. New York: Harper and Brothers 1844.

7. Peison B, Benisch B. Brunner‘s gland adenoma of the duodenal bulb. Am J Gastroenterol 1982; 77 (4): 276–278.

8. Walden DT, Marcon NE. Endoscopic injection and polypectomy for bleeding Brunner‘s gland hamartoma: case report and expanded literature review. Gastrointest Endosc 1998; 47 (5): 403–407.

9. Peetz ME, Moseley HS. Brunner‘s glands hyperplasia. Am J Surg 1989; 55 (7): 474–477.

10. Stolte M, Schwabe H, Prestele H. Relationship between diseases of the pancreas and hyperplasia of Brunner‘s glands. Virchows Arch A Pathol Anat Histol 1981; 394 (1–2): 75–87.

11. Kurella RR, Ancha HR, Hussain S et al. Evolution of Bruner‘s gland hamartoma associated with Helicobacter pylori infection. South Med J 2008; 101 (6): 648–650. doi: 10.1097/SMJ.0b013e318172435a.

12. Gao YP, Zhu JS, Zheng WJ. Brunner‘s gland adenoma of duodenum: a case report and literature review. World J Gastroenterol 2004; 10 (17): 2616–2617.

13. Scholz HG. Recurrent acute pancreatitis, a complication of brunneromas. Leber Magen Darm 1976; 6 (5): 300–302.

14. Kirshnamurthy P, Junaid O, Moezzi J et al. Gastric outlet obstruction caused by Brunner‘s gland hyperplasia: case report and review of literature. Gastrointest Endosc 2006; 64 (3): 464–467. doi: 10.1016/j.gie.2006.02.026.

15. Hizawa K, Iwai K, Esaki M et al. Endosonographic features of Brunner‘s gland hamartomas which were subsequently resected endoscopically. Endosocopy 2002; 34 (12): 956–958. doi: 10.1055/s-2002-35849.

16. Sorleto M, Timer-Stranghöner A, Wuttig H et al. Brunner‘s gland adenoma – a rare cause of gastrointestinal bleeding: case report and systematic review. Case Rep Gastroenterol 2017; 11 (1): 1–8. doi: 10.1159/000454711.

17. Park JH, Park CH, Park JH et al. The safety and usefulness of endoscopic polypectomy for treatment of Brunner‘s gland adenomas. Korean J Gastroenterol 2004; 43 (5): 299–303.

18. Appel MF, Bentlif PS. Endoscopic removal of bleeding Brunner gland adenoma. Arch Surg 1976; 111 (3): 301–302.

19. Zanetti G, Casadei G. Brunner‘s gland hamartoma with incipient ductal malignancy. Report of a case. Tumori 1981; 67 (1): 75– 78.

20. Fujimaki E, Nakamura S, Sugai T et al. Brunner‘s gland adenoma with a focus of p53-positive atypical glands. J Gastroenterol 2000; 35 (2): 155–158.

21. Akino K, Kondo Y, Ueno A et al. Carcinoma of duodenum arising from Brunner‘s gland. J Gastroenterol 2002; 37 (4): 293–296.