Inverted cystic tubulovillous adenoma involving Brunner’s glands of duodenum

Benign neoplasia of the duodenum are very rare. Moreover, duodenal tubulovillous adenomas are more uncommon lesions. The microscopic structure of tubulovillous adenoma has frond-like projection of mucosa with branching papillary structure and generally upward growth into the lumen. We describe a 72-year-old man who showed aduodenal tubulovillous adenoma with unusual inverted cystic growth pattern. Interestingly, this tubulovillous adenomatous lesion was interrupted by gastric metaplasia in the deep portion of the cyst and was closely surrounded by Brunner’s glands. Although histogenesis of gastric metaplasia of duodenum is not fully understood, Brunner’s glands has been suggested as a precursor for gastric metaplasia. Therefore, these findings argued that this adenoma arises from Brunner’s glands through gastric metaplasia. This is the first case of inverted cystic tubulovillous adenoma involving Brunner’s glands of duodenum with gastric metaplasia.     

Brunner＇s gland adenoma of duodenum： A case report and literature review

AIM: To analyze the clinicopathological features of Brunner‘s gland adenoma of the duodenum.METHODS: A rare case of Brunner‘s gland adenoma of the duodenum was described and related literature was reviewed.RESULTS: Brunner‘s gland adenoma of the duodenum appeared to be nodular hyperplasia of the normal Brunner‘s gland with an unusual admixture of normal tissues, including ducts, adipose tissue and lymphoid tissue. We suggested that it might be designated as a duodenal hamartoma rather than a true neoplasm.CONCLUSION: The most common location of the lesion is the posterior wall of the duodenum near the junction of its first and second portions. It can result in gastrointestinal hemorrhage and duodenal obstruction. Endoscopic polypectomy is a worthy treatment for benign Brunner‘s gland adenomas,as malignant changes in these tumors have never been proven.     

十二指肠球部巨大Brunner腺腺瘤1例

<正> 病例:患者男.63岁,因"阵发性上腹胀痛1年余"于2009年6月24日来我院消化科门诊就诊。患者1年前无明显诱因出现上腹部阵发性胀痛,无饥饿痛、夜间痛,无肩胛部放射痛,腹痛与进食无关,无呕血或黑便,自服抑酸剂和促胃肠动力药后无明显好转。发病来患者体质重无下降,排便无异常。查体:一般情况良好,浅表淋巴结未及肿大,血常规检查未见异常,粪便隐血试验(+)。B超检查示:肝胆胰未见异常。2009年7月2日行胃镜检查示:十二指肠球部     

Large Brunner＇s gland adenoma： Case report and literature review

Brunner's gland adenoma(BGA)is a very rare benigntumour of the duodenum,which is usually asymptomaticand discovered incidentally at endoscopy.Occasionally,this lesion may be large,causing upper gastrointestinalhaemorrhage or intestinal obstruction.The case had alarge Brunner's gland adenoma,presenting melena thatwas managed by endoscopic excision.     

内镜切除术治疗十二指肠球部巨大Brunner腺腺瘤1例

病例：患者男,56岁,因“黑便10d,头晕、乏力、面色苍白2d,于2008年1月17日入院。入院前无呕血、上腹痛、呕吐等症状,近2年反复上腹部饱胀不适。无肝炎和溃疡病史,无非甾体抗炎药、铁剂、铋剂和激素类药物服用史。     

十二指肠Brunner腺瘤内镜治疗

十二指肠Brunner腺瘤是一种少见的十二指肠良性肿瘤,由于其临床表现和常规检查缺乏特异性,常被误诊。近年来随着超声内镜检查应用和普及,使十二指肠Brunner腺瘤发现和诊断率得到提高。近4年来,我们在内镜下治疗了十二指肠Brunner腺瘤患者8例,现报道如下。     

胃镜下摘除十二指肠球部Brunner腺瘤2例报告

Brunner腺瘤（Brunner gland adenoma,BGA）并非真性肿瘤,系Brunner腺增生所致,国外文献多称之为布氏腺错构瘤（Hamartoma of Brunner’s glands）,临床十分罕见。自1876年由Salvioli首次报道以来,迄今为止国内外文献中报道不超过200例。由于其临床表现和常规检查缺乏特异性,常被误诊。近3年来,我们在内镜下治疗了2例十二指肠Brunner腺瘤．现报道如下：     

Cystic Brunner＇s gland hamartoma in the duodenum： A case report

Cystic Brunner's gland hamartoma in the duodenum is exceedingly rare, although microscopic examination may sometimes reveal a Brunner's gland hamartoma containing dilated ducts in the duodenum. We present a case of large cystic Brunner's gland hamartoma in the duodenum with a long stalk, which is described in light of multidetector-row computed tomography, magnetic resonance imaging, and a modified small bowel series, together with pathologic correlation and differential diagnosis.     

Carcinoma in situ arising in a tubulovillous adenoma of the distal common bile duct： A case report

Tubulovillous adenomas are common in the colon and rectum, but are rare in the common bile duct. Biliary adenomas may produce obstructive jaundice, which can be easily confused with a malignant neoplasm or stone. We report a case of a carcinoma in situ arising in a tubulovillous adenoma of the distal common bile duct causing obstructive jaundice. A 55-year-old male presented with a 10-d history of pruritus and progressive jaundice. Abdominal sonography and computed tomography showed a mass in the distal common bile duct. Endoscopic retrograde cholangiopancreatography showed luminal narrowing of the bile duct due to a polypoid mass. Positron emission tomography demonstrated no abnormal uptake. It was thought that this mass was a malignant tumor, thus a pylorus-preserving panceaticoduodenectomy was performed. The final pathology showed a tubulovillous adenoma with carcinoma in situ of the distal common bile duct. At follow-up 8 mo later, endoscopy showed multiple polyps in the rectum, colon and stomach. The polyps were removed by endoscopic mucosal resection and shown to be tubular adenomas with high grade dysplasia. Biliary adenomas require careful follow-up for early detection of recurrence and malignant transformation.     

巨大十二指肠Brunner腺瘤内镜切除一例并文献复习

Brunner腺瘤是一种罕见的十二指肠良性腺瘤,通常无症状。巨大Brunner腺瘤可引起上消化道出血或肠道阻塞症状。最近我院诊断1例引起幽门梗阻症状的巨大十二指肠息肉样增生,经内镜下切除后病理确诊为Brunner腺瘤,现报道如下,并作文献复习。患者男,19岁,因“反复上腹胀伴呕吐1年,加重1个月”入院,呕吐反复发作,或食后即吐,或呕吐宿食,曾出现黑便,予抑酸、止血等治疗,     

阑尾管状绒毛状腺瘤临床特征、内镜特点及文献复习

阑尾肿瘤临床上十分少见，占胃肠道肿瘤的0．4％。尤其是发生于阑尾的管状绒毛状腺瘤在临床上属少见病，具有癌变潜能由于本病症状不典型或无明显临床症状，特别是电子肠镜下特点总结较少，故常导致临床漏诊及误诊，为加深对本病的认识和了解，我们收集浙江中医药大学附属第一医院近年收治的阑尾管状绒毛状腺瘤患者2例，对其临床症状、病理基础和肠镜下表现进行总结分析，并进行文献复习。     

Brunner's gland adenoma with a focus of p53-positive atypical glands

A submucosal tumor was resected endoscopically from the duodenal bulb in a 43-year-old man complaining of epigastric discomfort. The tumor, measuring 22 × 20 × 19 mm, consisted mainly of Brunner's glands with no atypia. However, close histologic examination disclosed a focus of glands with cellular and structural atypia. The atypical glands showed staining by periodic acid-Schiff, alcian blue, and high iron-diamine methods. Mucin histochemistry was examined, and the atypical glands resembled the excretory ducts rather than the acinar cells of the tumor. Immunohistochemically, positivity for MIB-1 was high (38.0%), and p53-positive cells were detected sporadically in the atypical glands. These results indicated that the atypical glands probably represented a neoplastic lesion. Brunner's gland adenomas associated with foci of true neoplasm are very rare; only two cases, including one patient with microcarcinoid tumors, have been reported. Received: December 3, 1998 / Accepted: June 25, 1999     

Cystic Brunner's gland hamartoma in the duodenum: A case report

Cystic Brunner's gland hamartoma in the duodenum is exceedingly rare, although microscopic examination may sometimes reveal a Brunner's gland hamartoma containing dilated ducts in the duodenum. We present a case of large cystic Brunner's gland hamartoma in the duodenum with a long stalk, which is described in light of multidetector-row computed tomography, magnetic resonance imaging, and a modified small bowel series, together with pathologic correlation and differential diagnosis.     

Carcinoma of duodenum arising from Brunner's gland

Received: August 30, 2000 / Accepted: March 2, 2001     

Hemoclip-Assisted Polypectomy of Large Duodenal Brunner's Gland Hamartoma

Brunner's gland hamartoma, also known as Brunneroma or Brunner's gland adenoma, is a rare tumor of the duodenum and an uncommon cause of gastrointestinal bleeding. In symptomatic patients, treatment requires either surgical resection or endoscopic polypectomy. We report a case of upper gastrointestinal bleeding from a pedunculated Brunner's gland hamartoma in the duodenal bulb. A new technique using hemoclip-assisted polypectomy is described to remove a large pedunculated Brunner's gland hamartoma.     

Tubulovillous adenoma of anal canal： A case report

Tumors arising from the anal canal are usually of epithelial origin and are mostly squamous cell carcinoma or basal cell carcinoma. We present a case of benign anal adenomas arising from the anus, an extremely rare diagnosis. A 78-year-old white man presented with rectal bleeding of several months duration. Examination revealed a 4 cm friable mass attached to the anus by a stalk. At surgery, the mass was grasped with a Babcock forceps and was resected using electrocautery. Microscopic examination revealed a tubulovillus adenoma with no areas of high grade dysplasia or malignant transformation. The squamocolumnar junction was visible at the edges of the lesion confirming the anal origin of the tumor. We believe the tubulovillus adenoma arose from either an anal gland or its duct that opens into the anus. Although seen rarely, it is important to recognize and treat these tumors at an early stage because of their potential to transform into adenocarcinoma.     

Pedunculated Brunner's gland hamartoma of the duodenum causing upper gastrointestinal hemorrhage

A case of pedunculated Brunner's gland hamartoma (BGH) of the duodenum causing upper gastrointestinal (GI) hemorrhage is reported. The patient was a 47-year-old man who visited our hospital for further evaluation of tarry stools and shortness of breath.Endoscopic examination of the upper digestive tract revealed a large peduncular polyp with bleeding,about 30 mm in diameter, arising from the wall of the second portion of the duodenum. GI bleeding occurred from the base of the stalk of the polyp. Endoscopic polypectomy was performed. Histological examination of the specimen revealed that the main body of the polyp contained several lobules of mature Brunner'gland with areas of cystic dilatation. The surface epithelium consisted of normal duodenal mucosa with areas of focal ulceration. This polyp was diagnosed as a BGH. The symptom of tarry stools resolved after endoscopic resection. Our case shows that treatment is necessary for duodenal BGH if GI bleeding occurs.     

Effect of secretin and somatostatin on secretion of epidermal growth factor from brunner's glands in the rat

The effect of secretin and somatostatin on secretion of epidermal growth factor (EGF) from Brunner's glands was investigated in rats. Secretin increased volume secretion and the median output of EGF rose from 720 fmol/5 hr (total range 460–1320) in controls to 2065 fmol/5 hr (total range 1560–2730) at a dose of 50 pmol/kg/hr of secretin. Somatostatin inhibited Brunner's gland secretion, but the total output of EGF remained unchanged. Secretin-stimulated volume secretion and secretion of EGF was significantly reduced by simultaneous infusion of somatostatin. This study has shown that secretin stimulates secretion of EGF as well as volume secretion from Brunner's glands. Somatostatin prevents the effect of secretin on Brunner's glands, which suggests a role for somatostatin in control of Brunner's gland secretion.     

Successful endoscopic removal of a duodenal adenoma occurring in Brunner's gland hyperplasia

A case of duodenal neoplasm in the second portion of the duodenum is presented. Endoscopically, the lesion was characterized by a broad‐based, submucosal tumor‐like protrusion with a shallow central depression. The lesion was successfully removed by endoscopic mucosal resection. Histological examination of the resected specimen revealed the lesion to be composed of Brunner's gland hyperplasia in the submucosal layer and adenomatous glands in the mucosa. Our case suggests that neoplastic transformation possibly occurs in Brunner's gland hyperplasia.