J Korean Med Sci.  2008 Jun;23(3):540-543. 10.3346/jkms.2008.23.3.540.

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

• Lee WC
• Yang HW
• Lee YJ
• Jung SH
• Choi GY
• Go H
• Kim A
• Cha SW

• KMID: 1786899
• DOI: http://doi.org/10.3346/jkms.2008.23.3.540

Abstract

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.

Keyword

Brunner Glands; Duodenal Neoplasms; Duodenal Obstruction

MeSH Terms

Brunner Glands/*pathology/radiography
*Choristoma
Diagnosis, Differential
Duodenal Neoplasms/*pathology/radiography/surgery
Duodenum/pathology/radiography
Endoscopy, Gastrointestinal
Humans
Hyperplasia
Male
Middle Aged
Pancreatic Diseases/*pathology/radiography
Pancreaticoduodenectomy
Severity of Illness Index
Tomography, X-Ray Computed

Figure

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  Fig. 1 Endoscopic finding: the duodenal mass was an irregular and infiltrative type mass on the duodenal bulb area.

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  Fig. 2 Abdominal computed tomography: (A) obstruction finding due to circumference of the duodenal mass (B) lymph node enlargement circumference of the duodenal mass (C) pancreatic invasion with fat tissue loss between the duodenal mass and pancreatic head.

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  Fig. 3 Biopsy: (A) (×10) Brunner's gland hyperplasia, diffuse infiltrated type (B) (×100) Brunner's gland hyperplasia (C) (×400) pancreatic heterotopia in the serosa layer.

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