Brunners gland cyst: rare differential diagnosis of dyspeptic symptoms / Cisto da glândula de Brunner: diagnóstico diferencial raro de sintomas dispépticos

abstract A 60-year-old woman was under investigation of dyspeptic symptoms. The upper gastrointestinal endoscopy showed a cystic subepithelial lesion in the second portion of the duodenum, measuring 8 mm in its longest diameter. The biopsy showed dilated Brunner's gland lobular ducts with scattered stromal elements, what characterized a Brunner's gland cyst. Brunner's gland cyst should be included in the differential diagnosis of gastrointestinal bleeding, dyspepsia, gastroesophageal reflux disease (GERD), malabsorption syndrome, anemia, among others. The correct nomenclature is important to facilitate research for articles specifically related to each duodenal cystic lesions and better understanding of these diseases, as some may have malignant potential.

resumen Paciente femenina, de 60 años de edad, tenía quejas dispépticas. La endoscopía digestiva reveló lesión subepitelial ubicada en la segunda porción del duodeno con aspecto quístico (signo de la tienda de campaña), de 8 mm en su mayor diámetro. Se realizó biopsia de la lesión. El análisis histopatológico mostró dilatación de los ductos lobulares de las glándulas de Brunner, acompañada por elementos estromales dispersos, identificando un quiste de las glándulas duodenales. Es un diagnóstico diferencial de sangrado intestinal, dispepsia, enfermedad por reflujo gastroesofágico (ERGE), malabsorción y anemia. La nomenclatura es importante tanto para buscar artículos específicos de cada lesión quística en el duodeno como para mejor caracterizar esas lesiones, puesto que algunas pueden tener potencial maligno.

resumo Paciente do sexo feminino, 60 anos, com queixas dispépticas. A endoscopia digestiva revelou lesão subepitelial localizada na segunda porção do duodeno com aspecto cístico (sinal da tenda positivo), de 8 mm no seu maior diâmetro. Biópsia da lesão foi realizada. A análise histopatológica mostrou dilatação dos ductos lobulares das glândulas de Brunner, acompanhada por elementos estromais dispersos, caracterizando um cisto da glândula de Brunner. É um diagnóstico diferencial de sangramento intestinal, dispepsia, doença do refluxo gastroesofágico (DRGE), má absorção e anemia. A nomenclatura é importante tanto para a pesquisa de artigos específicos de cada lesão cística no duodeno quanto para melhor caracterização dessas lesões, uma vez que algumas podem apresentar potencial maligno.

Hemorragia digestiva en paciente con hiperplasia de glándulas de Brunner / Digestive tract hemorrhaging in a patient with Brunner's gland hyperplasia

Resumen Objetivo: analizar las características epidemiológicas, bases etiopatogénicas y presentación clínica, así como el diagnóstico y el tratamiento de la hiperplasia de glándulas de Brunner (HGB). Métodos: describir un caso de HGB diagnosticado de forma incidental durante una endoscopia electiva y realizar una revisión de la literatura disponible hasta el momento. Resultados: esta neoformación consiste en una proliferación glandular localizada preferentemente en el duodeno proximal. Su diagnóstico, normalmente realizado mediante biopsia endoscópica, puede asociarse con complicaciones que, aunque infrecuentes, no deben ser subestimadas. Conclusiones: las neoplasias duodenales representan un porcentaje pequeño dentro del total de las que afectan al tracto gastrointestinal. Debido a que el diagnóstico de estas lesiones suele realizarse de forma casual durante una endoscopia programada, el tratamiento deberá basarse en la sintomatología, así como el tamaño de las mismas, de acuerdo con los estándares de tratamiento de cada centro.

Abstract Objective: This study analyzes the epidemiological characteristics, etiological and pathogenic bases, clinical presentation, diagnosis and treatment of Brunner's gland hyperplasia. Methods: We describe a case of Brunner's gland hyperplasia that was diagnosed incidentally during elective endoscopy and review the available literature. Results: This neoplasm consists of glandular proliferation preferentially located in the proximal duodenum. Its diagnosis, normally made by endoscopic biopsy, can be associated with complications that, although infrequent, should not be underestimated. Conclusions: Duodenal neoplasms are a small percentage of those that affect the gastrointestinal tract. Because diagnosis is usually made by chance during a scheduled endoscopy, treatment should be based on the symptoms and size of the lesion according to the treatment standards of each medical center.

Brunneroma: reporte de un caso / Brunneroma: a case report

RESUMEN Fundamento: las glándulas de Brunner son estructuras túbulo-acinares ubicadas en la submucosa del duodeno. Su crecimiento excesivo por lo regular no da síntomas o estos son mínimos, lo cual es conocido como adenoma de glándulas de Brunner, hamartoma o brunneroma. Su localización más frecuente es en la primera porción del duodeno y muy raro por debajo de la ampolla de Váter. Objetivo: presentar el caso clínico de un paciente con el diagnóstico de Brunneroma. Caso Clínico: paciente femenina, blanca de 72 años de edad con antecedentes de padecer de úlcera duodenal hace 20 años que ingresa con dolor difuso en abdomen superior acompañado de deposiciones abundantes como borra de café, sudoraciones profusas y pérdida ligera de peso en el último mes. Conclusiones: el Brunneroma es una lesión benigna poco frecuente del duodeno; puede descubrirse de forma accidental y en algunas ocasiones pueden causar hemorragia digestiva.

ABSTRACT Background: The Brunner's glands are tubular structures located in the submucosa of the duodenum. Their excessive growth does not usually give symptoms or at least they are minimum. This is known as Brunner's gland adenoma, Hamartoma or Brunneroma. Its most frequent localization is in the first portion of the duodenum, but it is extremely strange below the ampulla of Vater. Objective: to present the clinical case of a patient with the diagnosis of Brunneroma. Clinical case: white-skinned, 72 years-old, female patient with antecedents of a 20-years duodenal ulcer who is hospitalize with diffuse pain in superior abdomen accompanied by abundant depositions like coffee powder, profuse sweating and slight loss of weight in the last month. Conclusions: Brunneroma is a not very frequent benign lesion of the duodenum; it can be discovered accidentally and in some occasions it may cause digestive hemorrhage.

Duodenal Adenocarcinoma of Brunner Gland Origin: A Case Report

We report a case of adenocarcinoma originating from the duodenal Brunner glands in a 47-year-old female patient. The lesion was 0.8 cm in extent and located at the posterior wall of the first part of the duodenum. Histologically, the tumor showed transition from non-neoplastic Brunner glands through dysplastic epithelium into adenocarcinoma. The carcinoma cells were strongly positive for MUC6 protein, which is an epithelial marker for the Brunner glands. Tumor protein p53 was overexpressed in the carcinoma cells, but not in the non-neoplastic or dysplastic epithelium. Dystrophic calcification was predominant. This is the first case report of duodenal adenocarcinoma of Brunner gland origin in Korea.

Large Brunner's gland hamartoma with annular stricture causing gastric outlet obstruction

No abstract available.

Adenocarcinoma Arising from Brunner's Gland Hyperplasia

Brunner's gland hyperplasia, also known as Brunner's gland adenoma or hamartoma, is often encountered as a proliferative lesion arising from the Brunner's glands of the duodenum. This lesion has previously been described as being benign, with no malignant potential. We report a case of Brunner's gland hyperplasia that was incidentally discovered on endoscopy for evaluation of gastrointestinal bleeding. The histopathological findings of this lesion revealed a marked dysplastic and malignant changes from the normal Brunner's gland structure. Our case demonstrates the possibility of malignant potential in the natural history of Brunner's gland hyperplasia, even though its incidence is very rare.

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

Brunner’s gland hamartomas are small benign lesions that are most commonly found in the bulb of the duodenum. They are very uncommon, and most are found incidentally during upper gastrointestinal series or esophagogastroduodenoscopy. The lesions tend to be asymptomatic, but patients may present with symptoms of duodenal obstruction or hemorrhage secondary to ulceration. Histologically, a Brunner's gland hamartoma consists of the components of Brunner's gland cells, as well as glandular, adipose and muscle cells. In this study, we report the case of a 30-year-old man who presented with upper gastrointestinal bleeding and obstructive symptoms due to a giant Brunner's gland hamartoma in the duodenal bulb. The hamartoma was successfully removed by endoscopic resection. No significant complications were observed. Microscopically, the lesion was found to be entirely composed of variable Brunner's glands and adipocytes.

Hiperplasia de las glándulas de Brunner: A propósito de 2 casos / Brunners gland hiperplasia: Report of two cases

La hiperplasia de las glándulas de Brunner constituye una lesión benigna infrecuente localizada en la primera o segunda porción duodenal. El espectro de la misma incluye la hiperplasia nodular circunscrita, la difusa y los adenomas de las glándulas de Brunner. Reportamos dos casos, uno con un adenoma de las glándulas de Brunner como un pólipo duodenal y el otro como una hiperplasia nodular difusa del bulbo duodenal.

Brunner’s gland hyperplasia is an infrequent benign injury located on the first or second portion of the duodenum. The disease spectrum includes diffuse nodular hyperplasia, circumscribed nodular hyperplasia, and Brunner’s gland adenoma. We report two cases, one with an adenoma of Brunner’s glands as a duodenal polyp and the other as a diffuse nodular hyperplasia of the duodenal bulb.

A Case-control Study on Relationship between Helicobacter pylori Infection and Duodenal Brunner ’s Gland Hyperplasia / 胃肠病学

Background:The incidence of duodenal Brunner’s gland hyperplasia is low and the etiology and pathogenesis has not yet been clarified. Aims:To investigate the relationship between duodenal Brunner’s gland hyperplasia and Helicobacter pylori( Hp ) infection. Methods:A total of 96 patients with duodenal Brunner ’s gland hyperplasia diagnosed by pathological examination from October 2005 to December 2013 at People’s Hospital of Xinjiang Uygur Autonomous Region were enrolled in this study,and 270 cases without duodenal Brunner’s gland hyperplasia were served as controls. Hp infection was detected by 14 C-urea breath test( 14 C-UBT). The relationship between duodenal Brunner’s gland hyperplasia and Hp infection was analyzed. Results:In the duodenal Brunner ’s gland hyperplasia group,75 patients were Hp positive,the proportion of Hp infection was 3. 57( 75/21 ). In the control group,110 cases were Hp positive,the proportion of Hp infection was 1. 45(160/110). The difference between the two groups was statistically significant(χ2 =10. 97,P=0. 001). Hp infection was a risk factor of the genesis of duodenal Brunner’s gland hyperplasia( OR=2. 46, 95% CI:1. 44-4. 19). Conclusions:Hp infection may be related with the genesis of duodenal Brunner’s gland hyperplasia.

Hemorragia digestiva alta secundária a hamartoma de glândulasde Brunner: relato de caso e revisão da literatura / Upper gastrintestinal bleeding due to Brunner?s gland hamartoma: case reportand literature review

Objetivos: Relatar o caso de um paciente com diagnóstico de hamartoma de glândulas de Brunner durante investigação de hematêmese e melena.Descrição do caso: Paciente masculino, 52 anos, apresentou hematêmese e melena, sendo hospitalizado e evoluindo com instabilidade hemodinâmica e parada cardiorrespiratória. Após estabilização clínica na unidade de terapia intensiva, foi submetido a endoscopia digestiva alta, sendo identificada lesão polipoide duodenal com cerca de 3 cm. A lesão foi ressecada e o exame anatomopatológico evidenciou hamartoma de glândulas de Brunner.Conclusões: Apesar do hamartoma de glândulas de Brunner ser uma lesão benigna e rara, de crescimento indolente e comumente assintomática, pode provocar quadros graves como o descrito neste relato, devendo ser sempre lembrado como diagnóstico diferencial em casos de hemorragia digestiva alta.

Aims: To present the case report of a patient with Brunner?s gland hamartoma identified after investigation for hematemesis and melena.Case description: A 52 years old male patient presented with hematemesis and melena, being hospitalized and evolving with hemodynamic instability and cardiac arrest. After clinical stability in the intensive care unit, an upper gastrointestinal endoscopy was performed, and a 3 cm duodenal polypoid lesion with active bleeding was identified. The lesion was removed and the histopathological examination revealed a Brunner?s gland hamartoma.Conclusions: Despite hamartoma of Brunner?s glands being a benign and rare disease, with indolent growth and often asymptomatic, it can cause a severe clinical picture as described in this report, and therefore it should always be considered as a differential diagnosis in cases of upper gastrointestinal bleeding.

Distribution of nesfatin-1/NUCB2 in the digestive system of humans and rodents / 中华消化杂志

Objective To investigate the regional distribution and morphological features of nesfatin-1/NUCB2 in digestive system of the humans, Sprague-Dawley (SD) rats and the institute of cancer research (ICR) mice, so as to lay the foundation for further study of its functions in the digestive system. Methods The specimens were obtained from SD rats and ICR mice as well as 20 patients with digestive disease, who were admitted to the First hospital affiliated to Nanjing Medical University and receired surgercal treatment. The specimens from patients with malignant tumors were obtained 5 cm apart from cancerous tissues and from patients with benign tumors were obtained near the focus. The resected tissues included pancreas, stomach, duodenum, esophagus, liver, small intestine or colon. The distribution of nesfatin-1/NUCB2 was examined with immunohistochemical (IHC) staining and its protein level in each organ was measured using Western blotting. Results The immuinohistocemical study revealed the similar distribution pattern of nesfatin-1/NUCB2 in the digestive system of the patients, SD rats and ICR mice. Nesfatin-1/NUCB2 was found to localize in the center of the pancreatic islets, the lower 1/3 to 1/2 of the gastric mucosal glands, as well as the submucosa of the duodenum. Western blotting examination showed the expression of NUCB2 in all tissues from patients, SD rats and ICR mice, whereas the protein level of the nesfatin-1/NUCB2 was higher in pancreas (0.84±0.03, 0. 84±0.05 and 0. 84±0.04, respectively), stomach (0.86±0.06,0.81±0.02 and 0. 78±0.02, respectively) or duodenum (0.79±0.09,0. 79±0.04 and 0.78±0.05)than that in esophagus (0.43±0.04,0.44 ± 0.02 and 0.47 ± 0.06, respectively), liver (0.42±0.01,0.44±0.04 and 0.43 ± 0.01, objectively), small intestine (0.32±0.04,0. 32 ± 0. 04 and 0.34 ±0.04, respectively) or colon (0. 29±0.01,0.32±0.03 and 0. 28±0.03, respectively)(all P values=0. 000). Conclusion Nesfatin-1/NUCB2 is widely expressed in the pancreatic islets, gastric mucosal glands and duodenum of the patients, SD rats and ICR mice, which indicates that nesfatin-1/NUCB2 may be involved in the regulation of food intake, carbohydrate metabolism and gastrointestinal motility.

Brunnera's Gland Hyperplasia: Treatment of Severe Diffuse Nodular Hyperplasia Mimicking a Malignancy on Pancreatic-Duodenal Area

Brunnera's gland hyperplasia is a benign tumor of the duodenum and it is rarely associated with clinical symptoms. We report on a 64-yr-old man with Brunnera's gland hyperplasia who had undergone a duodenocephalo-pancreatectomy. The reason is that he presented upper gastrointestinal obstructive symptoms and the esophagogastroduodenoscopic finding revealed the lesion to be an infiltrating type mass on the second portion of the duodenum with luminal narrowing. An abdominal computed tomography showed a 2.5 cm-sized mass in the duodenal second portion with a suspicious pancreatic invasion and 7 mm-sized lymph node around the duodenum. Duodenocephalopancreatectomy was successfully performed. Histological examination revealed a Brunnera's gland hyperplasia. The final diagnosis was the coexistence of Brunnera's gland hyperplasia and pancreatic heterotopia with a pancreatic head invasion. The literature on Brunnera's gland hyperplasia is reviewed.

A Case of Multiple Cystic Brunner's Gland Hyperplasia / 대한소화기내시경학회지

Hyperplasia of Brunner's glands is considered an uncommon finding; its wide range of morphological variation has led to confusing identifying terminology which includes: hyperplasia, adenoma, and hamartoma. Some investigators have suggested that hyperplasia of Brunner's glands is hamartomatous in nature, whereas others have favored a causative relationship that results from gastric acid hypersecretion. Although most commonly an incidental finding, that appears as multiple small submucosal sessile nodules, usually located in the duodenal bulb, it can lead to clinically significant symptoms including gastrointestinal bleeding, abdominal pain, and intestinal obstruction. Here, we report a case of hyperplasia of multiple cystic Brunner's glands on the duodenal bulb in a patient with acute pancreatitis; they were discovered incidentally on abdominal CT and duodenoscopy. This is the first report of hyperplasia of Brunner's glands with these morphological characteristics.

A Case of Brunner's Gland Hamartoma Presenting as Obscure Gastrointestinal Hemorrhage / 대한소화기학회지

Brunner's gland hamartomas are rare tumors of duodenum, they are often discovered incidentally during esophagogastroduodenoscopy or upper gastrointestinal series. These tumors arise mainly in the duodenal bulb and can present with gastrointestinal hemorrhage and intestinal obstruction. Most of Brunner's gland hamartomas are located within the range of the standard esophagogastroduodenoscope. However, they are rarely located below the third portion of duodenum. As well known, the small intestine, including the 4th portion of duodenum, jejunum, and ileum, is relatively inaccessible with routine endoscopy. Thus, the diagnosis of Brunner's gland hamartoma in these area can be delayed up to several months after onset of symptoms. We report a case of Brunner's gland hamartoma which was located in the fourth portion of the duodenum and presented as obscure gastrointestinal hemorrhage. Radiologic, surgical, and pathologic appearances are presented.