A Case Of Huge Brunner's Gland Adenoma With Acute Bleeding Treated By Endoscopic Resection

Pyung Kang Park; Woo-Cho Chung; Kyoung Yong Lee; Sung Hak Lee; Jae Jung Jang; Seungchul Suh

doi:10.7180/kmj.2015.30.2.171

Journal List > Kosin Med J > v.30(2) > 1057050

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Park, Chung, Lee, Lee, Jang, and Suh: A Case Of Huge Brunner's Gland Adenoma With Acute Bleeding Treated By Endoscopic Resection

Case Report

Kosin Medical Journal 2015;30(2):171-174.

Published online: 20 January 2015

DOI: https://doi.org/10.7180/kmj.2015.30.2.171

A Case Of Huge Brunner's Gland Adenoma With Acute Bleeding Treated By Endoscopic Resection

Pyung Kang Park¹, Woo-Cho Chung¹, Kyoung Yong Lee¹, Sung Hak Lee¹, Jae Jung Jang², Seungchul Suh^1,

¹Department of Internal Medicine, Anyang-si, Gyeonggi-do, Korea.

²Department of Pathology, Anyang SAM hospital, Anyang-si, Gyeonggi-do, Korea.

Corresponding Author: Seungchul Suh, M.D. Department of Internal medicine, Anyang SAM hospital, 9, Samdeok-ro, Manan-gu, Anyang-si, Gyeonggi-do 14030, Korea Tel: +82-31-467-9110, Fax:+82-31-467-9198, E-mail: orient4@naver.com

Received 5 November 201430 January 2015 Accepted 24 February 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Brunner's gland adenoma is a rare benign small bowel neoplasm and it represents 10% of small bowel benign tumor. Most of adenoma manifest as polypoidal, multiple and size does not exceed 1 cm and mostly asymptomatic, but the lesion larger than 1 ㎝ is solitary and can cause bleeding, obstruction, intussusception and there are some reports of showing malignant transformation. Until the present, there are two cases of over 8㎝ huge Brunner's gland adenoma in Korea and each of their chief complaint was abdominal discomfort and melena, but there is no case report of over 8 ㎝ Brunner's gland adenoma accompanied with acute bleeding as seen in this case. We diagnosed an 8 ㎝ sized, huge duodenal Brunner's gland adenoma which accompanied with acute bleeding and treated it by endoscopic resection using an IT-knife, successfully.

Keywords: adenoma, bleeding, Brunner's gland, endoscopy

References

1. Rocco A, Borriello P, Compare D, De Colibus P, Pica L, Iacono A, et al. Large Brunner's gland adenoma: case report and literature review. World J Gastroenterol. 2006; 12:1966–8.

2. Christie AC. Duodenal carcinoma with neoplastic transformation of the underlying Brunner's glands. Br J cancer. 1953; 7:65–7.

3. So CH, Jang HJ, Choi YS, Koh DH, Choi MH, Kae SH, et al. Giant brunner's gland adenoma of the proximal jejunum presenting as iron deficiency anemia and mimicking intussusceptions. Clin Endosc. 2013; 46:102–5.

4. Park JS, Kim HS, Sohn HJ, Jin SL, Ahn JC, Moon JS, et al. A case of endoscopic polypectomy with a detachable snare in a huge duodenal Brunner's gland adenoma. Korean J Gastrointest Endosc. 1998; 18:239–43.

5. Kim SM, Cho MA, Kim SH, Kim SH, Park HS, Choi SH, et al. A case of a large pedunculated brunner's gland adenoma treated by endoscopic polypectomy using Metal Clip. Korean J Med. 2004; 67:194–8.

6. Levine JA, Burgart LJ, Batts KP, Wang KK. Brunner's gland hamartomas: clinical presentation and pathological features of 27 cases. Am J Gastroenterol. 1995; 90:290–4.

7. Feyrter F. Uüber wucherungen der brunnerschen drüsen. Virchow Arch Pathol Anat histol. 1934; 293:509.

8. Franzin G, Musola R, Ghidini O, Manfrini C, Fratton A. Nodular hyperplasia of Brunner's glands. Gastrointest Endosc. 1985; 31:374–8.

9. Perez A, Saltzaman JR, Carr-Locke DL, Brooks DC, Osteen RT, Zinner MJ, et al. Benign nonampullary duodenal neoplasms. J Gastrointest Surg. 2003; 7:536–41.

10. Hur S, Han JK, Kim MA, Bae JM, Choi BI. Brunner's gland hamartoma: computed tomographic findings with histopathologic correlation in 9 cases. J comput Assist Tomogr. 2010; 34:543–7.

11. Kim MS, Park JM, Lee CS, Kim CY, Lim YB, Lee YG, et al. A case of Brunner's gland hyperplasia with dysplasia. Korean J Med. 2012; 82:321–5.

12. Sakurai T, Sakashita H, Honjo G, Kasyu I, Manabe T. Gastric foveolar metaplasia with dysplastic changes in Brunner gland hyperplasia: possible precursor lesions for brunner gland adenocarcinoma. Am J Surg Pathol. 2005; 29:1442–8.

13. Kang JH, Lim YJ, Hahn SJ, Choi SJ, Koh MS, Lee JH. Clinical Characteristics of Large Brunner's Gland tumors in Korea. Korean J Gastrointest Endosc. 2010; 40:297–302.

Fig. 1.

Endoscopic finding. It shows a huge pedunculated polyp with bleeding arising from the bulb.

Fig. 2.

Endoscopic finding. It shows a cross-section of the resected stalk using an IT knife

Fig. 3.

Gross finding. The polyp is about 80mm long and 35mm wide.

Fig. 4.

Histological finding. The polyp consists of glands, dilated cystic ducts, adipose tissue and lymphoid cells revealing as hamartoma.(H&E staining, x 100)

TOOLS

Similar articles