Case report of Brunner’s gland hyperplasia: A rare “mimic” of malignant pathology

IntroductionBrunner’s gland hyperplasia is a rare, benign lesion of the duodenum. The symptomology can range from asymptomatic (as an incidental finding on endoscopy) to gastrointestinal obstruction or haemorrhage.Case presentationWe report a case of a 60-year-old man presenting with post-prandial vomiting and weight loss. Inpatient evaluation led to the likely diagnosis of a duodenal malignancy for which the patient underwent a laparotomy and proximal duodenectomy.Clinical discussionBrunner’s gland hyperplasia is a rare, benign condition that can be overtreated due to the difficulty in obtaining an accurate pre-operative diagnosis. The literature has been reviewed to discuss the approach to diagnosis.ConclusionThis case highlights the potential for Brunner’s gland hyperplasia mimicking a malignancy.     

Local Leaders' Perspectives on Women Veterans’ Health Care: What Would Ideal Look Like?

Background

The Veterans Health Administration (VHA) faces challenges in providing comprehensive, gender-sensitive care for women. National policies have led to important advancements, but local leadership also plays a vital role in implementing changes and operationalizing national priorities. In this article, we explore the notions of ideal women veterans' health care articulated by women's health leaders at local VHA facilities and regional networks, with the goal of identifying elements that could inform practice and policy.

Renin as a risk factor in essential hypertension: More evidence

When patients with essential hypertension are classified into three major subgroups according to their plasma renin levels, they appear to exhibit different physiologic and epidemiologic characteristics. The present study extends previous observations which have suggested that low renin patients are relatively protected from development of heart attacks and strokes.Low renin patients despite the fact that they are older, exhibit lower blood urea levels than patients in the other two groups. These data are in keeping with the idea that low renin patients have relatively less renal vascular involvement.Young hypertensive blacks, known to be most prone to severe hypertension with vascular complications, practically always fall into the normal renin subgroup, whereas, in contrast, a vast majority of those blacks above the age of 50, with relatively milder hypertensive disease, exhibit low renin levels.These new findings which further associate vascular sequellae with the normal or high renin state provide more support for the concept that low renin patients have a relatively benign type of hypertensive disease.Nonhomogeneity of the low renin hypertensive population and differences in methodologic and physiologic approaches used to define such patients may provide the basis for conflicting observations from certain laboratories.     

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。     

Glycoconjugate histochemistry of bovine Brunner glands

The principal aims of this study have been to elucidate the nature of glycoconjugates produced by the two distinct parts of bovine Brunner glands, peripheral and central areas of lobules, and to investigate the presence of sialyl acid residues. Bovine duodenal tissues, embedded in paraffin wax, were investigated by means of both conventional histochemical methods (PAS, AB, HID) and biotinylated lectins (Con A, DBA, SBA, GS-I-B4, PNA, sWGA, GS-II, UEA-I, LPA, LFA). Conventional histochemical methods allowed us to accurately define two different areas: a central and a peripheral area. The central area, composed of secretory tubular tracts and the excretory duct, contained neutral glycoconjugates. The peripheral area was formed by both terminal alveolar and tubular secretory tracts and contained both neutral and acidic glycoconjugates, the latter partly carboxylated and partly sulfated. Lectin histochemistry confirmed differences highlighted by conventional histochemical methods and allowed us to characterise glycoprotein profiles of the preterminal and terminal tracts. The preterminal tracts and the excretory duct contained glycoconjugates with terminal D-Gal beta(1-3)GalNAc, alpha-D-Gal, alpha/beta-D-GalNAc, alpha/beta-D-GlcNAc, and internal beta(1-4) D-GlcNAc and alpha-Man residues. The terminal tracts were characterised by terminal alpha-L fucose, beta-D-GalNac, alpha/betaD-GlcNAc, alpha-D-Gal, alpha-D-GalNAc, and sialic acid residues. Internal beta(1-4) D-GlcNAc and alpha-Man residues were also identified. Finally, secretion of bovine Brunner glands is characterised by both O-linked and N-linked glycoproteins: cells located in the preterminal tracts and in the excretory duct produce mainly O-linked glycoproteins while cells located in the terminal tracts produce N-linked glycoproteins.     

Brunner gland cyst: report of three cases

Brunner gland cyst is a benign polypoid or nodular lesion of the duodenum that may not be familiar to gastroenterologists and pathologists because of its rarity. There have been only 9 cases documented in the world literature under various names. In this report, we describe the clinicopathologic features of three such cases to raise the awareness of its existence.     

Brunner腺瘤研究现状

Brunner腺瘤临床十分罕见,病因不清,临床表现缺乏特异性,超声内镜检查对该病的诊治有一定价值,外科手术或内镜下切除是主要的治疗方法。Brunner腺瘤切除术后,预后较好。     

十二指肠Brunner腺腺瘤的CT表现（附7例病例报道）

目的：探讨十二指肠Brunner腺腺瘤的CT影像学表现。方法回顾性分析7例经病理证实的十二指肠Brunner腺腺瘤CT表现。结果十二指肠Brunner腺腺瘤表现为密度均匀或不均匀的类圆形或长条形肿块,直径1．5～5．1 cm不等,平均4．1 cm,边缘清晰;CT平扫示肿瘤实体部分密度均与临近肠壁密度相似,增强扫描动脉期均呈中度不均匀强化,门静脉期均呈渐进性强化,密度仍欠均匀。结论十二指肠Brunner腺腺瘤的CT表现具有一定的特点,对其影像特征的认识可减少误诊率,但最终确诊仍有赖于病理诊断。     

A giant Brunner gland hamartoma successfully treated by endoscopic excision followed by transanal retrieval: A case report

Rationale:Brunner gland hamartoma (BGH) is a rare tumor of the duodenum. Although BGH is a benign tumor, larger lesion with gastrointestinal symptoms requires tumor removal. We report a giant BGH, successfully treated by endoscopic excision followed by transanal retrieval.Patient concerns:A 38-year-old woman complained of severe anemia, tarry stool, and vomiting.Diagnoses:Esophagogastroduodenoscopy (EGD) showed a pedunculated giant submucosal mass at the duodenal bulb.Interventions:We attempted to remove it because the lesion seemed to be responsible for patient''s anemia and vomiting. The lesion had clear but bulky stalk. We carefully cut the stalk using needle-knife and IT knife2. We tried to retrieve specimen, but the mass could not pass through the pyloric ring because of its size. Then we tried to obtain the specimen from anus. Polyethylene glycol solution was administered to accelerate rapid excretion.Outcomes:The mass was successfully removed and was histologically confirmed as a giant BGH, measuring 55 mm in size.Lessons:Reports about endoscopic resection of giant BGH are rare. Moreover, our case is the first report of transanal retrieval of resected specimen using polyethylene glycol solution. Endoscopic resection of BGH is less-invasive but can be more challenging if the mass is large. Our case provides useful option for endoscopic treatment of giant BGH.     

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