Endoscopy 2007; 39: E37-E38
DOI: 10.1055/s-2006-945023
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

A true Brunner’s gland adenoma

K. Suda1 , S. Hamada1 , M. Takahashi1 , Y. Kumashiro2 , T. Yao2 , K. Sugimachi3 , D. Korenaga3 , K. Takenaka3
  • 1Dept. of Internal Medicine, Fukuoka City Hospital, Fukuoka, Japan
  • 2Dept. of Anatomic Pathology, Kyushu University, Fukuoka, Japan
  • 3Dept. of General Surgery, Fukuoka City Hospital, Fukuoka, Japan
Further Information

K. Suda, M. D.

Dept. of Internal Medicine

Fukuoka City Hospital

Yoshizuka-honmachi 13-1

Fukuoka 812-0046

Japan

Fax: +81-92-632-0900

Email: md199055@yahoo.co.jp

Publication History

Publication Date:
07 February 2007 (online)

Table of Contents

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 [1]). Distal gastrectomy was carried out for the gastric cancer and for the duodenal polypoid lesion.

Zoom Image

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 [2]). 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.

Zoom Image

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.

Zoom Image

Brunner’s gland adenoma is extremely rare, representing only 10.6 % of benign duodenal tumors [1], 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 [2]. 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 [3]. There have been reports of neoplasia occurring in Brunner’s gland hyperplasia [4]. 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.

Endoscopy_UCTN_Code_CCL_1AB_2AZ_3AB

#

References

K. Suda, M. D.

Dept. of Internal Medicine

Fukuoka City Hospital

Yoshizuka-honmachi 13-1

Fukuoka 812-0046

Japan

Fax: +81-92-632-0900

Email: md199055@yahoo.co.jp

#

References

K. Suda, M. D.

Dept. of Internal Medicine

Fukuoka City Hospital

Yoshizuka-honmachi 13-1

Fukuoka 812-0046

Japan

Fax: +81-92-632-0900

Email: md199055@yahoo.co.jp

Zoom Image

Figure 1 The duodenal polypoid lesion at chromoendoscopy.

Zoom Image

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.

Zoom Image