Clin Endosc.  2013 Jan;46(1):102-105. 10.5946/ce.2013.46.1.102.

Giant Brunner's Gland Adenoma of the Proximal Jejunum Presenting as Iron Deficiency Anemia and Mimicking Intussusceptions

• So CS
• Jang HJ
• Choi YS
• Koh DH
• Choi MH
• Kae SH
• Min SJ
• Lee J

• KMID: 1792650
• DOI: http://doi.org/10.5946/ce.2013.46.1.102

Abstract

Brunner's gland adenoma is a rare benign proliferative lesion developing most commonly in the posterior wall of the duodenum. It is usually small in size and asymptomatic. Depending on its size or location, however, the clinical manifestations of this tumor may be variable from nonspecific symptoms to gastrointestinal bleeding or obstruction. Brunner's gland adenoma in the proximal jejunum is extremely rare. We report a very rare case of giant Brunner's gland adenoma developing in the proximal jejunum which presented as iron deficiency anemia and mimicked intussusceptions on radiologic studies.

Keyword

Brunner's gland adenoma; Jejunum; Enteroscopy

MeSH Terms

Adenoma
Anemia, Iron-Deficiency
Duodenum
Hemorrhage
Intussusception
Iron
Jejunum
Iron

Figure

• 

  Fig. 1 Abdominal computed tomography images. (A) Axial image shows suspected intussusception or intraluminal tumor less likely in the proximal jejunum. (B) Coronal reconstruction image also shows suspected intussusceptions or an elongated intraluminal mass with soft tissue attenuation.

• 

  Fig. 2 Small bowel follow-through. It shows a segmental dilatation with the contrast filled along the inner wall of the lumen in the proximal jejunum, which suggests suspected intussusceptions rather than an intraluminal mass as considered with computed tomography findings.

• 

  Fig. 3 Enteroscopic findings. (A) It shows a huge intraluminal mass with normal appearing mucosa in the proximal jejunum through double balloon enteroscopy. (B) It has a long stalk and wide base. (C) This tumor is resected by snare polypectomy after snaring Endo-loop through push enteroscopy. (D) After polypectomy, Endo-loop has been left at the base of stalk with no bleeding.

• 

  Fig. 4 Pathologic findings. (A) Gross finding right after the endoscopic resection. It shows a giant polypoid mass, 9×2 cm in size. (B) Microscopic finding showing the lobules forming the tumor composed of normal appearing Brunner's gland without unusual mixture of normal tissues including Brunners glands, ducts, adipose tissue, and lymphoid tissue (H&E stain, ×40).

Reference

1. Sleisenger MH, Feldman M, Friedman LS, Brandt LJ. Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 2006. 8th ed. Philadelphia: Saunders.

2. Hirasaki S, Kubo M, Inoue A, Miyake Y, Oshiro H. Pedunculated Brunner's gland hamartoma of the duodenum causing upper gastrointestinal hemorrhage. World J Gastroenterol. 2009; 15:373–375. PMID: 19140240.

3. El Faleh I, Lutz N, Osterheld MC, Reinberg O, Nydegger A. Gastric outlet obstruction by Brunner's gland hyperplasia in an 8-year-old child. J Pediatr Surg. 2009; 44:E21–E24. PMID: 19361619.

4. Cruveilhier J. Anatomie Pathologique du Corps Humain. 1835. Paris: Bailliere.

5. Krause WJ, Stevens R, Palmiter P. The effect of surgical ablation of Brunner's glands on the proximal duodenal mucosa. Anat Anz. 1988; 166:111–115. PMID: 3189825.

6. Stolte M, Schwabe H, Prestele H. Relationship between diseases of the pancreas and hyperplasia of Brunner's glands. Virchows Arch A Pathol Anat Histol. 1981; 394:75–87. PMID: 7336574.

7. Feyrter F. Über wucherungen der brunnerschen drüsen. Virchows Arch Pathol Anat Physiol Klin Med. 1934; 293:509–526.

8. Christie AC. Duodenal carcinoma with neoplastic transformation of the underlying Brunner's glands. Br J Cancer. 1953; 7:65–67. PMID: 13051506.

9. Fujimaki E, Nakamura S, Sugai T, Takeda Y. Brunner's gland adenoma with a focus of p53-positive atypical glands. J Gastroenterol. 2000; 35:155–158. PMID: 10680672.

10. Mayoral W, Salcedo JA, Montgomery E, Al-Kawas FH. Biliary obstruction and pancreatitis caused by Brunner's gland hyperplasia of the ampulla of Vater: a case report and review of the literature. Endoscopy. 2000; 32:998–1001. PMID: 11147953.

11. Henken EM, Forouhar F. Hamartoma of Brunner's gland causing partial obstruction of the ileum. J Can Assoc Radiol. 1983; 34:73–74. PMID: 6841428.

12. Palanivelu C, Rangarajan M, Jategaonkar PA, Annapoorni S, Prasad H. Laparoscopic antrectomy for a proximal duodenal Brunner gland hamartoma. JSLS. 2009; 13:110–115. PMID: 19366555.

13. Chen YY, Su WW, Soon MS, Yen HH. Hemoclip-assisted polypectomy of large duodenal Brunner's gland hamartoma. Dig Dis Sci. 2006; 51:1670–1672. PMID: 16927147.