En Bloc Endoscopic Resection of Large Pedunculated Brunner’s Gland Hamartoma: A Case Report

Brunner’s gland hamartoma (BGH) is an uncommon benign tumor arising from alkaline-based mucin-secreting glands of the duodenum. These lesions are typically discovered incidentally during upper gastrointestinal endoscopy or radiological diagnostics, even though they can eventually lead (in the case of increasing size) to obstructive or hemorrhagic symptoms. We report the case of a 67-year-old Caucasian man with two episodes of melena and epigastric pain during the last month. Esophagogastroduodenoscopy revealed a large pedunculated and eroded polyp inside the antrum with a 2-cm-long stalk arising from the anterior wall of the duodenal bulb. Endoscopic ultrasonography showed a submucosal lesion with homogeneous hyperechoic parietal thickening and some central gaps. The muscularis was undamaged. No lymphadenopathy was observed. We performed an en bloc endoscopic resection of the polyp. The size of the whole piece was approximately 6 × 3 × 2 cm, pseudocapsulated and tough in consistency. In the case presented, the en bloc endoscopic removal was successful despite the size of the tumor.

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Endoscopic resection of a giant symptomatic Brunner’s gland hamartoma of duodenal bulb

Journal of Advances in Internal Medicine ◽

10.3126/jaim.v8i2.28004 ◽

2019 ◽

Vol 8 (2) ◽

pp. 30-32

Author(s):

Umid Kumar Shrestha ◽

Gopi Aryal

Keyword(s):

Duodenal Bulb ◽

Complete Removal ◽

Endoscopic Polypectomy ◽

Upper Gastrointestinal Endoscopy ◽

Polypoidal Mass ◽

Brunner’S Gland ◽

Brunner's Gland ◽

Duodenal Lumen ◽

Brunner’S Gland Hamartoma ◽

Upper Gastrointestinal

Brunner's gland hamartoma is a very rare benign tumor arising from the Brunner’s gland of duodenum and is usually asymptomatic, but may present with the symptom of duodenal obstruction or upper gastrointestinal bleeding due to ulceration from the tumor, requiring endoscopic or surgical resection. In our study, we report the case of a 57 year-old male who presented with pain over epigastrium, recurrent vomiting, black stool and dizziness with a lowering of hemoglobin up to 7.5 gm/dl. The blood transfusion was done to raise the hemoglobin. The upper gastrointestinal endoscopy revealed a giant submucosal polypoidal mass with a thick short stalk in duodenal bulb causing almost complete obstruction of the lumen of duodenum and there was a superficial ulceration on the under-surface of the mass. The endoscopic ultrasound revealed a submucosal lesion arising from the echo layer three. The computed tomography of abdomen showed that the polypoidal mass was confined to the duodenal lumen with no significant lumphadenopathy and normal biliary and pancreas. The endoscopic polypectomy was attempted, but the lesion was too large to grab the polyp as a whole with the conventional snare. Hence, the repeated partial snare polypectomies were done, followed by submucosal dissection to ensure the complete removal of the mass. There were no complications after the procedure. The histopathology examination of the duodenal mass confirmed the diagnosis of Brunner’s gland hamartoma and showed the presence of Helicobacter pylori as well. The endoscopic treatment of giant Brunner’s gland hamartoma avoided the need of unnecessary more invasive surgical procedure.

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Endoscopic resection of a large Brunner's gland hamartoma

Gastroentérologie Clinique et Biologique ◽

10.1016/j.gcb.2007.12.011 ◽

2008 ◽

Vol 32 (1) ◽

pp. 11-14 ◽

Cited By ~ 4

Author(s):

R. Coriat ◽

M. Mozer-Bernardeau ◽

B. Terris ◽

A. Chryssostalis ◽

F. Prat ◽

...

Keyword(s):

Endoscopic Resection ◽

Brunner’S Gland ◽

Brunner's Gland ◽

Brunner’S Gland Hamartoma

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Giant Brunner’s Gland Hamartoma of the Duodenal Bulb Presenting with Upper Gastrointestinal Bleeding and Obstruction

Clinical Endoscopy ◽

10.5946/ce.2016.022 ◽

2016 ◽

Vol 49 (6) ◽

pp. 570-574 ◽

Cited By ~ 1

Author(s):

Ju Hyoung Lee ◽

Kyeong Min Jo ◽

Tae Oh Kim ◽

Jong Ha Park ◽

Seung Hyun Park ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Duodenal Bulb ◽

Brunner’S Gland ◽

Brunner's Gland ◽

Brunner’S Gland Hamartoma ◽

Upper Gastrointestinal

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Resección endoscópica de hamartoma gigante de glándulas de Brunner. Reporte de un caso

Acta gastroenterológica latinoamericana ◽

10.52787/gput6166 ◽

2021 ◽

Vol 51 (3) ◽

Author(s):

Karina Yonamine ◽

Cecilia Curvale ◽

Raul Matanó ◽

Alejandro Hensel ◽

María Fernanda Yankowyez

Keyword(s):

Histopathological Examination ◽

Duodenal Bulb ◽

Malignant Neoplasm ◽

Benign Neoplasm ◽

Duodenal Wall ◽

Large Size ◽

Brunner’S Gland ◽

Low Incidence ◽

Brunner's Gland ◽

Brunner’S Gland Hamartoma

Brunner's gland hamartoma or hyperplasia is a rare benign neoplasm of the small intestine, usually small, that is discovered incidentally on an upper digestive endoscopy or imaging tests. When it reaches a large size, it can cause digestive bleeding or intestinal obstruction. The pathogenesis is unknown. The endoscopic presentation can be nodular, polypoid or a diffuse glandular proliferation with thickening of the duodenal wall, and may be mistaken for a malignant neoplasm. Endoscopic resections of large Brunner's gland hamartomas in the duodenum is little reported in literature, due to its low incidence and diagnostic difficulty. The surgical approach is associated to greater morbidity compared to an endoscopic approach. The case of a 62-year-old patient is reported, who presented melena and symptomatic anemia, secondary to a giant polyp in the duodenal bulb. The polyp was successfully resected endoscopically without complications, which made it possible to avoid a more extensive surgical procedure. Histopathological examination of the whole specimen showed a Brunner's gland hamartoma. Conclusion: Brunner's gland hyperplasia or hamartoma is a benign neoplasm that rarely produces symptoms. Large lesions can become symptomatic and a high clinical-endoscopic suspicion and an evaluation of the extension are necessary before applying any therapeutic procedure, in order to avoid complex surgeries and favor a complete and safe endoscopic resection.

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Successful Endoscopic Resection of Large Pedunculated Brunner's Gland Hamartoma Causing Gastrointestinal Bleeding Arising from the Pylorus

Case Reports in Gastroenterology ◽

10.1159/000354138 ◽

2013 ◽

Vol 7 (2) ◽

pp. 304-307 ◽

Cited By ~ 6

Author(s):

Yunho Jung ◽

Il Kwun Chung ◽

Tae Hoon Lee ◽

Young Sin Cho ◽

Yeong Geol Jo ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Endoscopic Resection ◽

Brunner’S Gland ◽

Brunner's Gland ◽

Brunner’S Gland Hamartoma

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Large Brunner’s Gland Hyperplasia with Bleeding: A Case Report

Case Reports in Surgery ◽

10.1155/2021/8861308 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Yuki Okutomi ◽

Takaharu Kato ◽

Hidetoshi Aizawa ◽

Yuhei Endo ◽

Naoya Kasahara ◽

...

Keyword(s):

Duodenal Bulb ◽

Anterior Wall ◽

Severe Anemia ◽

Shortness Of Breath ◽

Fibrous Stroma ◽

Gastrointestinal Obstruction ◽

Resected Tumor ◽

History Of ◽

Brunner’S Gland ◽

Brunner's Gland

We report a rare case of a large Brunner’s gland hyperplasia (BGH) with severe anemia. A 33-year-old woman was transferred to our hospital with anemia and a duodenal mass. She had a 2-week history of melena and mild shortness of breath. Her hemoglobin level was 4.9 g/dl, and she required a blood transfusion. Abdominal computed tomography revealed a 7 cm tumor in the descending duodenum, and duodenoscopy revealed a polyp-like tumor with an ulcer at the duodenal bulb. We decided to perform surgery to prevent further bleeding. Intraoperatively, the tumor stalk was located at the anterior wall of the duodenal bulb; the ampulla was not involved, and we resected the tumor with the wall of the duodenal bulb. The resected tumor measured 7.0 × 4.0 × 2.3 cm , and pathologically, the tumor consisted of proliferated Brunner’s glands in a small amount of fibrous stroma. The histological diagnosis was BGH with no malignancy. Most cases of BGH are benign and asymptomatic; however, it is important to be aware that some patients have severe anemia, gastrointestinal obstruction, or malignant potential.

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Brunner’s gland hamartoma presenting as gastric outlet obstruction: unusual presentation and review of literature

Tropical Doctor ◽

10.1177/0049475519870980 ◽

2019 ◽

Vol 50 (1) ◽

pp. 68-70

Author(s):

Amit Gupta ◽

Depak Rajput ◽

Utkarsh Kumar ◽

Sweety Gupta ◽

Ashok Singh ◽

...

Keyword(s):

Gastric Outlet Obstruction ◽

Gastrointestinal Endoscopy ◽

Outlet Obstruction ◽

Gastrointestinal Haemorrhage ◽

Surgical Excision ◽

Upper Gastrointestinal Endoscopy ◽

Brunner’S Gland ◽

Brunner's Gland ◽

Brunner’S Gland Hamartoma ◽

Upper Gastrointestinal

Brunner’s gland hamartoma (or Brunneroma) is an uncommon tumour with an incidence of <0.01%, accounting for approximately 5–10% of benign duodenal tumours. Usually asymptomatic, it may manifest occasionally with duodenal obstruction or upper gastrointestinal haemorrhage and rarely with biliary fistulation, cholestatic jaundice and intussusception. It may be associated with uraemia and chronic pancreatitis. The diagnosis is usually confirmed by imaging studies and upper gastrointestinal endoscopy. Surgical excision or endoscopic resection is preferred for symptomatic large hamartomas. Here we report a case of 45-year-old man presenting with features of pancreatitis and gastric outlet obstruction due to a large Brunner’s gland hamartoma, on his endoscopic, radiologic, surgical and pathologic findings.

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