Duodenal gangliocytic paraganglioma: A rare cause for gastrointestinal polyp

Duodenal gangliocytic paragangliomas are rare neoplasms often arising in the duodenum in close proximity to the ampulla of Vater. These neoplasms are considered to have a benign behavior with lymph node metastases being a rare phenomenon and distant metastases even more so. Although a standardized treatment has not been determined, a margin-free tumor resection seems to be the best treatment modality. We report herein the case of a 36-year-old female who presented with abdominal pain and was found to have a polyp in the second part of duodenum which was excised endoscopically. Histopathology and immunohistochemistry revealed characteristic features of this rare tumor.

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 of Brunner's Gland Adenoma Presenting as Large Polyp with Stalk

Sporadic duodenal polyps are uncommon, being found at 5% of patient referred for upper endoscopy. They are often discovered incidentally and are usually asymptomatic. Endoscopic features and histologic results from endoscopically biopsied specimen cannot exclude malignancy. Recently, we experienced a Brunner's gland adenoma of duodenum mimicking malignant neoplasm. A 52-year-old female visited for evalution of a duodenal mass. A 3 cm sized polypoid mass located at the mesenteric border of 2nd portion of duodenum was found on endoscopic examination. Histologic results based on tissue taken from endoscopic biopsy showed gastric foveolar hyperplasia. Endoscopic polypectomy was performed to exclude malignancy and histological finding was consistent with Brunner's gland adenoma.

A Case of Isolated Light Chain Deposition Disease in the Duodenum

Light chain deposition disease (LCDD) is a rare disorder associated with a clonal proliferation of plasma cells, which synthesize abnormal monoclonal immunoglobulin light chains. LCDD is characterized by systemic deposition of light chains in various organs, with the kidneys being most commonly affected. There have been few reports of isolated LCDD. We report a rare case of LCDD limited to a duodenal polyp. A 63-yr-old man visited our hospital for health screening without symptoms in 2009. On gastrofiberscopy, a duodenal polyp was observed. The biopsy showed diffuse infiltration by atypical plasma cells, which were positive for kappa-type light chains by immunohistochemistry. While the patient refused further management, we could find no evidence of recurrence until 2 yr after the initial diagnosis. It has been reported that isolated LCDD has relatively good prognosis compared to systemic LCDD. However, treatment for this disease has not been established yet.

A Case of a Huge Duodenal Brunner's Gland Hyperplasia / 대한소화기내시경학회지

So called Brunner's gland hyperplasia is characterized by a nodular proliferation of histologically normal Brunner's gland, accompanied by ducts and scattered stromal element. The clinical presentation vary from vague epigastric disomfort to obstruction and gastrointestinal bleeding. We experienced a case of huge Brunner's gland hyperplasia presented as a huge duodenal polyp. A 28-year-old woman was refered to our hospital because of suspicious ampulla of Vater cancer or duodenal cancer in abdominal CT scan. The patient complained of dizziness and intermittent melena. The side view duodenoscopic examination revealed a huge pedunculated mass originated from the posterior wall of the duodenal bulb. The head of the polyp was placed on the ampulla of Vater with several erosions suggesting recent bleeding. Resection of duodenal polyp was performed by laparoscopic duodenotomy and Brunner's gland hyperplasia was revealed on pathologic examination.

Clinical Study on Duodenal Polyps Prevalence Submitted to Upper Gaatrointestinal Endoscopy / 대한소화기내시경학회지

Retrospective studies of duodenal polyps have shown a prevalence of 0.3-4.6% in patients referred to upper gastrointestinal endoscopy, and histologic classification have been inconsistent. A prospective consecutive study was carried out in 3,871 patients referred to diagnostic endoscopy, Sixteen patients had polyps in the first part of duodenum, for a prevalence 0.41%(0.28-0.53%, 95% confidence interval). Fourteen polyps were either inflammatory(thirteen polyps) or ectopic gastric mucosa(one polyp). Two hyperplasitc polyps were founded. All polyps were benign and sessile, and most of polyps(75%) were solitary.