© Georg Thieme Verlag KG Stuttgart · New York
A true Brunner’s gland adenoma
07 February 2007 (online)
Brunner’s gland adenoma is an extremely rare neoplasm, which may be confused with Brunner’s gland hyperplasia or hamartoma. The present report describes a case of “true” Brunner’s gland adenoma resected by surgery.
An 82-year-old man with a duodenal polyp was admitted to hospital for surgical treatment of newly diagnosed gastric cancer. Gastroduodenoscopy revealed a 12-mm subpedunculated polypoid lesion, covered with smooth, reddish mucosa, in the duodenal bulb (Figure ). Distal gastrectomy was carried out for the gastric cancer and for the duodenal polypoid lesion.
Figure 1 The duodenal polypoid lesion at chromoendoscopy.
Histologically, the duodenal polypoid lesion was found to consist of Brunner-like glands with moderate nuclear atypia. Nonneoplastic Brunner’s gland hyperplasia was seen at the basal side of the polypoid lesion (Figure ). Figure [2 ] b shows the transition from the hyperplastic area to the adenomatous area. Immunohistochemically, the adenomatous Brunner-like glands were positive for MUC6, showing that they originated from Brunner’s glands. The surface of the polypoid lesion was covered with gastric foveolar-like glands.
Figure 2 a, b The histological appearance of the polypoid lesion, showing the transition from the Brunner’s gland hyperplastic area to the adenomatous area. a Hematoxylin-eosin, original magnification × 30. b Hematoxylin-eosin, original magnification × 50.
Brunner’s gland adenoma is extremely rare, representing only 10.6 % of benign duodenal tumors , which are themselves rare at 0.008 % of all surgical and autopsy specimens. Matsumoto et al. reported a case of a large Brunner’s gland adenoma removed by endoscopic polypectomy . Fujimaki et al. reported a case of duodenal polypoid lesion consisting mainly of hyperplastic Brunner’s glands, but with a focus of atypical glands consisting of cells with nuclear atypia . There have been reports of neoplasia occurring in Brunner’s gland hyperplasia . The present case shows a transition from a hyperplastic area in the Brunner’s glands to an adenomatous area, showing that a “true” Brunner’s gland adenoma can exist and suggesting its etiology.
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K. Suda, M. D.
Dept. of Internal Medicine
Fukuoka City Hospital