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Luchini C, Pernick N. Benign Tumors and Tumor-Like Conditions of Ampulla and Small Intestine: The PathologyOutlines.com Review. Int J Surg Pathol 2024:10668969241283748. [PMID: 39377108 DOI: 10.1177/10668969241283748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/09/2024]
Abstract
Small intestine and ampulla can be involved in a heterogeneous group of benign tumors and tumor-like diseases, potentially mimicking malignant neoplasms. In-depth knowledge of them is critical for practicing pathologists since they represent potential pitfalls in routine diagnostic activity. Such conditions include the following: (1) Brunner gland lesions, including Brunner gland hyperplasia and hamartoma; (2) polyps, such as adenoma, hyperplastic, hamartomatous, and inflammatory; (3) mesenchymal proliferations encompassing inflammatory fibroid polyp, inflammatory myofibroblastic tumor, leiomyomas, lipomas, and lipomatosis of the ileocecal valve; (4) fibrosis-associated diseases, such as idiopathic retroperitoneal fibrosis, reactive nodular fibrous pseudotumor, and sclerosing peritonitis; (5) disorders of lymphatic vessels, including lymphangiectasia and lymphangiomas; and (6) other rare conditions/miscellanea, such as enteritis cystica profunda, intussusception, ischemia, and pneumatosis cystoides intestinalis. This review, inspired by the content of the PathologyOutlines website (https://www.pathologyoutlines.com), aims to provide a reference point in this complex scenario, summarizing the essential histopathological features of all these entities for better addressing routine practice and differential diagnoses.
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Affiliation(s)
- Claudio Luchini
- Department of Diagnostics and Public Health, Section of Pathology, and ARC-NET Research Center, University of Verona, Verona, Italy
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2
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Xiang Y, Liu J, Wang NY, Tang D, Wang L, Zou PX, Xu G, Huang Q. The Characteristics and Treatment Outcomes of 71 Duodenal Brunner's Gland Adenomas with Endoscopic Submucosal Dissection. Dig Dis 2023; 41:852-859. [PMID: 37591214 DOI: 10.1159/000531231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 05/09/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION The aim of this study was to investigate outcomes of patients with duodenal Brunner's gland adenomas (BGAs) that were treated endoscopically. METHODS We identified 71 consecutive patients treated at our center with endoscopic submucosal dissection (ESD) for their duodenal tumors diagnosed pathologically as BGAs over the period between January 1, 2011 and December 31, 2021. We retrospectively analyzed our experience and short- and long-term outcomes of ESD therapy on patients with BGAs. RESULTS Among 71 BGA patients with an average age of 57 ± 11.7 years (range: 30-82), 48 (67.6%) were male and 23 (32.4%) were female. The accuracy of preoperative diagnosis with endoscopic ultrasonography was 44.0% (22/50). The H. pylori infection was found in 29 patients (29/71, 40.8%). The median size of BGAs was 1.5 cm (interquartile range [IQR] 0.8-2.7 cm). The most common location was the duodenum bulb (50/71, 64.8%). For the ESD procedure, the median operation time was 15.0 min (IQR 9.5-25.5 min). The en bloc and the complete resection rates were 97.2% and 92.3%, respectively. ESD-related mild acute obstructive pancreatitis was present in 2 patients (2/4, 50%) with BGAs located in the ampulla region. During the follow-up period, 1 patient with a positive peripheral margin experienced tumor recurrence 2 years after the initial ESD. There was no disease-related death for the cohort. CONCLUSION ESD was an effective and safe therapeutic option for BGA patients with excellent outcomes. Long-term follow-up is needed.
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Affiliation(s)
- Ying Xiang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China,
| | - Jinyan Liu
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Nan Ya Wang
- Department of Gastroenterology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Dehua Tang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Lei Wang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Ping Xiao Zou
- Department of Gastroenterology, Taikang Xianlin Drum Tower Hospital, Nanjing, China
| | - Guifang Xu
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Qin Huang
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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3
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Khalifa A, Wu YC, Velpari S, Korman A. Brunner Gland Hamartomas-Uncommon Presentations and Endoscopic Management. J Investig Med High Impact Case Rep 2023; 11:23247096231159811. [PMID: 36891571 PMCID: PMC9998406 DOI: 10.1177/23247096231159811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
Brunner gland hamartoma (BGH) is a rare condition that requires a high clinical suspicion to diagnose. Large hamartomas may initially present with iron deficiency anemia (IDA) or symptoms suggesting intestinal obstruction. Barium swallow may demonstrate the lesion, but endoscopic evaluation is the acceptable first line management unless a concern for underlying malignancy. The present case report and literature review highlight the uncommon presentations and endoscopic role in large BGHs management. Internists should consider BGH in their differential, especially in patient with occult bleeding, IDA, or obstruction, which can be treated with endoscopic resection of large sized tumors by trained experts.
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Affiliation(s)
| | - Yi-Chia Wu
- Rutgers University, New Brunswick, NJ, USA
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4
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Nguyen LC, Vu KT, Vo TTT, Trinh CH, Do TD, Pham NTV, Pham TV, Nguyen TT, Nguyen HC, Byeon JS. Brunner’s gland hyperplasia associated with lipomatous pseudohypertrophy of the pancreas presenting with gastrointestinal bleeding: A case report. World J Clin Cases 2021; 9:9670-9679. [PMID: 34877305 PMCID: PMC8610885 DOI: 10.12998/wjcc.v9.i31.9670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/26/2021] [Accepted: 09/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Brunner’s gland hyperplasia (BGH) is a rare benign lesion of the duodenum. Lipomatous pseudohypertrophy (LiPH) of the pancreas is an extremely rare disease. Because each condition is rare, the probability of purely coincidental coexistence of both conditions is extremely low.
CASE SUMMARY We report a 26-year-old man presenting to our hospital with symptoms of recurrent upper gastrointestinal bleeding. Upper gastrointestinal endoscopy showed a huge pedunculated polypoid lesion in the duodenum with bleeding at the base of the lesion. Histopathological examination of the duodenal biopsy specimens showed BGH. Besides, abdominal computed tomography and magnetic resonance imaging revealed marked fat replacement over the entire pancreas, confirmed by histopathological evaluation on percutaneous pancreatic biopsies. Based on the radiological and histological findings, LiPH of the pancreas and BGH were diagnosed. The patient refused any surgical intervention. Therefore, he was managed with supportive treatment. The patient’s symptoms improved and there was no further bleeding.
CONCLUSION This is the first well-documented case showing the coexistence of LiPH of the pancreas and BGH.
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Affiliation(s)
- Long Cong Nguyen
- Gastroenterology and Hepatology Center, Bach Mai Hospital, Hanoi 10000, Viet Nam
- Department of Gastroenterology, School of Medicine and Pharmacy, Vietnam National University Hanoi, Hanoi 10000, Viet Nam
| | - Khanh Truong Vu
- Gastroenterology and Hepatology Center, Bach Mai Hospital, Hanoi 10000, Viet Nam
- Department of Gastroenterology, School of Medicine and Pharmacy, Vietnam National University Hanoi, Hanoi 10000, Viet Nam
| | - Trang Thi Thuy Vo
- Gastroenterology and Hepatology Center, Bach Mai Hospital, Hanoi 10000, Viet Nam
| | - Chau Ha Trinh
- Radiology Center, Bach Mai Hospital, Hanoi 10000, Viet Nam
| | - Tan Dang Do
- Radiology Center, Bach Mai Hospital, Hanoi 10000, Viet Nam
| | - Ngoc Thi Van Pham
- Gastroenterology and Hepatology Center, Bach Mai Hospital, Hanoi 10000, Viet Nam
| | - Tuyen Van Pham
- Pathology Center, Bach Mai Hospital, Hanoi 10000, Viet Nam
| | | | - Hiep Canh Nguyen
- Pathology Center, Bach Mai Hospital, Hanoi 10000, Viet Nam
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa 920-8640, Japan
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
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5
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Olcina Domínguez P, Estela Villa L, Villadóniga Sánchez A, Avellana Moreno R, Gil Rojas S, García-Cano Lizcano J. Brunneroma: an infrequent duodenal neoplasm. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 114:124. [PMID: 34607439 DOI: 10.17235/reed.2021.8349/2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Brunneroma or Brunner gland's adenoma is an uncommon type of gastrointestinal tumor, frequently asymptomatic and rarely has malignant transformation. After an initial finding at upper endoscopy, endoscopic ultrasound and computer tomography are helpflul in planning treatment. Resection offers a definitive diagnosis.
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Affiliation(s)
| | - Luis Estela Villa
- Cirugía General y Aparato Digestivo, Hospital Virgen de la Luz, España
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6
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Zhu M, Li H, Wu Y, An Y, Wang Y, Ye C, Zhang D, Ma R, Wang X, Shao X, Guo X, Qi X. Brunner's Gland Hamartoma of the Duodenum: A Literature Review. Adv Ther 2021; 38:2779-2794. [PMID: 33914269 PMCID: PMC8189944 DOI: 10.1007/s12325-021-01750-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/15/2021] [Indexed: 02/07/2023]
Abstract
Brunner's gland hamartoma is a benign tumor of the duodenum, but has malignant potential with a very low risk of progression into adenocarcinoma. It is uncommon with a frequency of less than 1.0% among the primary tumors of the small intestine. In addition, its clinical manifestations are nonspecific, etiology remains unclear, and treatment strategy needs to be further refined. This literature review mainly discusses the epidemiology, clinical features, possible etiology and pathogenesis, diagnostic methods, malignant potential, treatment, and prognosis of Brunner's gland hamartoma.
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Affiliation(s)
- Menghua Zhu
- Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China
- Postgraduate College, Jinzhou Medical University, Jinzhou, People's Republic of China
| | - Hongyu Li
- Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China
| | - Yanyan Wu
- Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China
- Postgraduate College, Jinzhou Medical University, Jinzhou, People's Republic of China
| | - Yang An
- Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China
- Postgraduate College, Shenyang Pharmaceutical University, Shenyang, People's Republic of China
| | - Yuye Wang
- Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China
- Postgraduate College, Jinzhou Medical University, Jinzhou, People's Republic of China
| | - Chun Ye
- Department of General Surgery, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China
| | - Dan Zhang
- Department of General Surgery, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China
| | - Rui Ma
- Department of General Surgery, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China
| | - Xuehan Wang
- Department of Pathology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China
| | - Xiaodong Shao
- Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China.
| | - Xiaozhong Guo
- Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China.
| | - Xingshun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, People's Republic of China.
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7
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Pereira D, Kővári B, Brown I, Chaves P, Choi WT, Clauditz T, Ghayouri M, Jiang K, Miller GC, Nakanishi Y, Kim KM, Kim BH, Kumarasinghe MP, Kushima R, Ushiku T, Yozu M, Srivastava A, Goldblum JR, Pai RK, Lauwers GY. Non-conventional dysplasias of the tubular gut: a review and illustration of their histomorphological spectrum. Histopathology 2021; 78:658-675. [PMID: 33124049 DOI: 10.1111/his.14294] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The increasing use of gastrointestinal endoscopic procedures has led to the recognition by histopathologists of non-conventional (or special-type) dysplasias of the gastrointestinal tract. These lesions can be recognised in association with prevalent underlying gastrointestinal conditions, such as Barrett oesophagus, chronic atrophic gastritis, and inflammatory bowel disease. The diagnosis of these special types can be challenging, and their biological behaviours are not fully characterised. The aim of this review is to provide a global view of non-conventional dysplastic lesions observed in the various segments of the tubular gastrointestinal tract and describe their salient features. Furthermore, as the clinical implications of these various subtypes have not been broadly tested in practice and are not represented in most management guidelines, we offer guidance on the best management practices for these lesions.
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Affiliation(s)
- Daniela Pereira
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa de Francisco Gentil-EPE (IPOLFG EPE), Lisboa, Portugal.,Faculdade de Ciências da Saúde, Universidade da Beira Interior (FCS UBI), Covilhã, Portugal
| | - Bence Kővári
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Pathology, University of Szeged, Szeged, Hungary.,Albert Szent-Györgyi Health Centre, Szeged, Hungary
| | - Ian Brown
- Envoi Specialist Pathologists, Brisbane, Qld, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Paula Chaves
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa de Francisco Gentil-EPE (IPOLFG EPE), Lisboa, Portugal.,Faculdade de Ciências da Saúde, Universidade da Beira Interior (FCS UBI), Covilhã, Portugal
| | - Won-Tak Choi
- Department of Pathology, University of California at San Francisco, San Francisco, CA, USA
| | - Till Clauditz
- Department of Pathology, University-Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Masoumeh Ghayouri
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Pathology and Cell Biology, University of South Florida, Tampa, FL, USA.,Department of Oncological Sciences, University of South Florida, Tampa, FL, USA
| | - Kun Jiang
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Pathology and Cell Biology, University of South Florida, Tampa, FL, USA.,Department of Oncological Sciences, University of South Florida, Tampa, FL, USA
| | - Gregory C Miller
- Envoi Specialist Pathologists, Brisbane, Qld, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Qld, Australia
| | - Yukihiro Nakanishi
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Pathology and Cell Biology, University of South Florida, Tampa, FL, USA.,Department of Oncological Sciences, University of South Florida, Tampa, FL, USA
| | - Kyoung M Kim
- Department of Pathology, Samsung Medical Centre, Seoul, Korea
| | - Baek H Kim
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
| | | | - Ryoji Kushima
- Department of Pathology, Shiga University of Medical Science, Otsu, Japan
| | - Tetsuo Ushiku
- Department of Pathology, The University of Tokyo, Tokyo, Japan
| | - Masato Yozu
- Histopathology Department, Middlemore Hospital, Auckland, New Zealand
| | | | - John R Goldblum
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Rish K Pai
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Gregory Y Lauwers
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Pathology and Cell Biology, University of South Florida, Tampa, FL, USA.,Department of Oncological Sciences, University of South Florida, Tampa, FL, USA
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8
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Kővári B, Kim BH, Lauwers GY. The pathology of gastric and duodenal polyps: current concepts. Histopathology 2020; 78:106-124. [PMID: 33382489 DOI: 10.1111/his.14275] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/25/2020] [Accepted: 10/01/2020] [Indexed: 12/26/2022]
Abstract
The liberal use of upper endoscopy has led to an increased detection of gastric and duodenal polyps, which are identified in as many as 6 and 4.6% of patient examinations, respectively. Gastroduodenal polyps are a heterogeneous group of lesions that can be neoplastic or non-neoplastic (e.g. hyperplastic or heterotopical). Most polyps present characteristic topographical features, as well as endoscopic appearance and size. Evaluation of the surrounding mucosa is essential in assessing the underlying pathology (e.g. Helicobacter pylori, autoimmune gastritis or inherited polyposis syndromes). Phylogenetically, gastric and duodenal polyps can be classified according to the epithelial compartment from which they derive. Polyps that arise from the surface epithelium can either be of foveolar or intestinal type, and they can develop from either the native mucosa or the metaplastic epithelium (gastric intestinal metaplasia or duodenal foveolar metaplasia). Other polyps develop from the deeper glandular component, such as pyloric/oxyntic gland derived subtypes. In this review we focus upon epithelial polyps, with an emphasis on the most common and clinically relevant lesions, and present recently described entities.
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Affiliation(s)
- Bence Kővári
- Department of Pathology, University of Szeged and Albert Szent-Györgyi Health Center, Szeged, Hungary.,Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute and Departments of Pathology and Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Baek H Kim
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute and Departments of Pathology and Oncologic Sciences, University of South Florida, Tampa, FL, USA.,Department of Pathology, Korea University Guro Hospital, Seoul, Korea
| | - Gregory Y Lauwers
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute and Departments of Pathology and Oncologic Sciences, University of South Florida, Tampa, FL, USA
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9
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Mastrodonato M, Calamita G, Mentino D, Scillitani G. High-fat Diet Alters the Glycosylation Patterns of Duodenal Mucins in a Murine Model. J Histochem Cytochem 2020; 68:279-294. [PMID: 32141795 DOI: 10.1369/0022155420911930] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
High-fat diet (HFD) alters the glycosylation patterns of intestinal mucins leading to several health problems. We studied by histochemical and lectin-binding methods mucin alterations in the duodenum of mice fed a HFD for 25 weeks. Histochemical methods included periodic acid-Schiff, alcian blue pH 2.5, and high-iron diamine. Lectin-binding experiments were performed with SBA, PNA, WGA, MAA-II, SNA, ConA, UEA-I, LTA, and AAA. SBA, PNA, WGA, MAA-II, and SNA were tested also after desulfation and ConA after periodate-sodium borohydrate treatments (paradoxical ConA). Duodenal mucins are secreted by Brunner's glands and goblet cells in the villi. Brunner's glands of HFD mice showed increased secreting activity and a general reduction of glycosylated residuals, such as fucose and terminal α1,4-linked GlcNAc. Moreover, a general reduction of glycosylated residuals in the goblet cells of villi such as the fucosylated and sulfated ones was observed. Since the cited residuals are involved in cytoprotective and cytostatic functions, as well as in interactions with the intestinal microbiota and protection against parasites and inflammatory disorders, we conclude that HFD can predispose duodenum to several possible health disorders.
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Affiliation(s)
| | - Giuseppe Calamita
- Department of Biosciences, Biotechnology and Biopharmaceutics, University of Bari "Aldo Moro," Bari, Italy
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10
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Miller GC, Kumarasinghe MP, Borowsky J, Choi WT, Setia N, Clauditz T, Gidwani R, Sufiyan W, Lauwers GY, Brown IS. Clinicopathological features of pyloric gland adenomas of the duodenum: a multicentre study of 57 cases. Histopathology 2019; 76:404-410. [PMID: 31529725 DOI: 10.1111/his.13996] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/15/2019] [Indexed: 12/15/2022]
Abstract
AIMS To determine the clinicopathological features of pyloric gland adenomas (PGA) that arise in the duodenum. METHODS AND RESULTS Fifty-seven cases of duodenal PGA were identified and analysed from 56 patients. Clinicopathological and immunohistochemical analyses were performed. PGA tend to occur in older individuals (median age = 73.5), with a slight female predominance (25 males, 31 females). PGA arise more commonly in the proximal duodenum (68.75% in D1, 25% in D2 and 6.25% in D3) and usually present as mucosal nodules (98.2%) or plaques (1.8%), with a mean size of 14.8 mm. There is associated gastric heterotopia in 22.8% of cases. PGA showing features of high-grade dysplasia were significantly larger in size than PGA, showing only low-grade dysplasia (23.1 versus 8.7 mm; P = 0.0001) and more likely to show a tubulovillous rather than a pure tubular architecture (P = 0.025). In our series, 10 of 56 patients had intramucosal or invasive carcinoma associated with the duodenal PGA (17.9%). Three of these carcinomas showed lymph node metastasis. Following definitive treatment, local recurrence occurred in only three patients. CONCLUSIONS Duodenal PGA tend to occur in the proximal duodenum of older individuals. Larger size and tubulovillous architecture correlates with high-grade dysplasia and associated adenocarcinoma. The low recurrence rate of these lesions would suggest that endoscopic management is appropriate, provided that the lesion can be completely resected.
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Affiliation(s)
- Gregory C Miller
- Envoi Specialist Pathologists, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Marian P Kumarasinghe
- PathWest Laboratory Medicine, Perth, WA, Australia.,University of Western Australia, Perth, WA, Australia
| | - Jennifer Borowsky
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Pathology Queensland, Brisbane, QLD, Australia
| | - Won-Tak Choi
- Department of Pathology, University of California at San Francisco, San Francisco, CA, USA
| | - Namrata Setia
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Till Clauditz
- Institute of Pathology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Wajiha Sufiyan
- Department of Pathology, Royal Darwin Hospital, Casuarina, NT, Australia
| | - Gregory Y Lauwers
- Department of Pathology, H. Lee Moffitt Cancer Centre, Tampa, FL, USA.,Department of Pathology and Cell Biology and Oncologics, University of South Florida, Tampa, FL, USA
| | - Ian S Brown
- Envoi Specialist Pathologists, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Pathology Queensland, Brisbane, QLD, Australia
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11
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Yi L, Cheng Z, Qiu H, Yang J, Wang T, Liu K. A giant Brunner's gland hamartoma being treated as a pedunculated polyp: a case report. BMC Gastroenterol 2019; 19:151. [PMID: 31443637 PMCID: PMC6708166 DOI: 10.1186/s12876-019-1074-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/19/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND With the development and application of endoscopic technology, most pedunculated polyps can be absolutely resected with a complete specimen by hot snare polypectomy (HSP). Brunner's gland hamartoma (BGH) is a rare benign small bowel tumor. The majority of BGH measuring about 2 cm in diameter, rarely larger than 5 cm. Most patients are asymptomatic, some may present with gastrointestinal hemorrhage or intestinal obstruction. Symptomatic larger lesions leading to bleeding or obstruction should be excised either endoscopically or surgically. Whether it is safe and effective that removing a BGH measuring about 7 cm by HSP is not known. CASE PRESENTATION Here, we reported a rare case of a proximal duodenum pedunculated mass measuring about 7 cm which was responsible for the patient's severe anemia. we treated it as a pedunculated polyp. After being pretreated the stalk with an endoloop which was placed around the base of the mass to prevent post-polypectomy bleeding (PPB), the pedunculated BGH was removed by HSP completely. The stalk of the mass was negative. We achieved a curative resection. CONCLUSION It is a safe and effective for our patient to treat the pedunculated BGH measuring about 7 cm as a pedunculated polyp and remove it by HSP. And future prospective studies in larger cohorts are needed to confirm it.
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Affiliation(s)
- Lizhi Yi
- Department of Gastroenterology, People's Hospital of Leshan, 238 Baita Street, Leshan, Sichuan, 614000, People's Republic of China.
| | - Zhengyu Cheng
- Department of Gastroenterology, People's Hospital of Leshan, 238 Baita Street, Leshan, Sichuan, 614000, People's Republic of China
| | - Huarong Qiu
- Department of Gastroenterology, People's Hospital of Leshan, 238 Baita Street, Leshan, Sichuan, 614000, People's Republic of China
| | - Jianjun Yang
- Department of pathology, People's Hospital of Leshan, Leshan, City, 614000, Sichuan province, People's Republic of China
| | - Tao Wang
- Department of radiology, People's Hospital of Leshan, Leshan, City, 614000, Sichuan province, People's Republic of China
| | - Ke Liu
- Department of Gastroenterology, People's Hospital of Leshan, 238 Baita Street, Leshan, Sichuan, 614000, People's Republic of China
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12
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Brunner's Gland Hyperplasias and Hamartomas in Association with Helicobacter pylori. Can J Gastroenterol Hepatol 2019; 2019:6340565. [PMID: 31187029 PMCID: PMC6521441 DOI: 10.1155/2019/6340565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/25/2019] [Accepted: 04/14/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The proliferative lesions of the Brunner's glands (BGs) are hyperplasia and hamartomas, and they are usually asymptomatic and very rarely diagnosed. The aetiology of these lesions is not yet clear. The aim of this study is to evaluate the clinical presentations of patients with BG hyperplasia and hamartomas and to assess the pathological features of these lesions in association with Helicobacter pylori (H. pylori). METHODS Our retrospective study included patients who underwent upper gastrointestinal system endoscopy between 2010 and 2015. The hospital records of 18 patients diagnosed with hyperplasia or hamartoma of BG were reviewed for the clinical and pathological findings. Data from patients with BG lesion were compared with 37 patients who had nonspecific duodenitis as the control group. RESULTS Female/male ratio in our study sample was 1/1. The age range was between 16 and 85 years with a mean age of 48.61. BG hyperplasia and hamartomas were found in 72.22 and 27.78% of the patients, respectively. The rate of H. pylori in gastric mucosa was 43.2% in the control group and 66.7% in the BG lesion group. In the BG lesion group, the rate of H. pylori was higher. H. pylori was identified in 60% of BG hamartomas and in 69.2% of hyperplastic BGs. CONCLUSION Our study demonstrated that H. pylori may play an important role in the development of BG hyperplasia and hamartomas in association with chronic gastritis and duodenitis. This is probably due to chronic irritation.
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Abstract
CONTEXT.— Duodenal epithelial polyps are reported in 1.5% to 3% of individuals referred for upper endoscopy. Most duodenal epithelial polyps are asymptomatic and nonneoplastic; however, a small subset is neoplastic and may progress to adenocarcinoma. Recent advances in immunohistochemical and molecular techniques have helped further characterize these polyps, shedding light on their origin, classification, and risk of progression to adenocarcinoma. OBJECTIVE.— To provide a comprehensive clinicopathologic review of nonneoplastic and neoplastic duodenal epithelial polyps, with particular emphasis on recent developments in classification schemes and risk stratification based upon immunohistochemical and molecular profiles. DATA SOURCES.— This review is based on peer-reviewed literature and the authors' experiences. CONCLUSIONS.— In this review we provide an update on the clinicopathologic, immunohistochemical, and molecular features of duodenal epithelial polyps and discuss the surveillance recommendations and treatment options available. Particular attention should be placed on recognizing duodenal adenomas with intestinal, gastric, and serrated phenotype, as they have an increased risk of malignant transformation if not completely excised.
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Affiliation(s)
- Katrina Collins
- From the Department of Pathology & Laboratory Medicine, Hartford Hospital, Hartford, Connecticut
| | - Saverio Ligato
- From the Department of Pathology & Laboratory Medicine, Hartford Hospital, Hartford, Connecticut
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Moon JH, Lee K, Yang HK, Kim WH. Duodenal Adenocarcinoma of Brunner Gland Origin: A Case Report. J Pathol Transl Med 2017; 52:179-182. [PMID: 29281782 PMCID: PMC5964285 DOI: 10.4132/jptm.2017.10.09] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/26/2017] [Accepted: 10/09/2017] [Indexed: 01/14/2023] Open
Abstract
We report a case of adenocarcinoma originating from the duodenal Brunner glands in a 47-year-old female patient. The lesion was 0.8 cm in extent and located at the posterior wall of the first part of the duodenum. Histologically, the tumor showed transition from non-neoplastic Brunner glands through dysplastic epithelium into adenocarcinoma. The carcinoma cells were strongly positive for MUC6 protein, which is an epithelial marker for the Brunner glands. Tumor protein p53 was overexpressed in the carcinoma cells, but not in the non-neoplastic or dysplastic epithelium. Dystrophic calcification was predominant. This is the first case report of duodenal adenocarcinoma of Brunner gland origin in Korea.
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Affiliation(s)
- Ji Hye Moon
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoungbun Lee
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.,Department of Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Woo Ho Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea.,Department of Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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15
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Nam YJ, Kim BW, Kim JS, Kim GJ. Sporadic Non-ampullary Duodenal Adenoma Overriding the Cystic Dilatation of Brunner's Gland Hyperplasia. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 70:141-144. [PMID: 28934830 DOI: 10.4166/kjg.2017.70.3.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Sporadic non-ampullary duodenal adenoma is uncommon and found incidentally during endoscopic examinations. Brunner's gland hyperplasia is commonly encountered during endoscopic examinations. Adenomas arising from Brunner's gland hyperplasia originate from the glandular cells, and the surface epithelia are usually intact. Little has been reported on adenomas originating from the surface epithelium that overrides Brunner's gland hyperplasia. Here, we report a case of a sporadic non-ampullary duodenal adenoma overriding the cystic dilatation of Brunner's gland hyperplasia.
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Affiliation(s)
- Yun Jung Nam
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Byung Wook Kim
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Joon Sung Kim
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Gi Jun Kim
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
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16
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Peloso A, Viganò J, Vanoli A, Dominioni T, Zonta S, Bugada D, Bianchi CM, Calabrese F, Benzoni I, Maestri M, Dionigi P, Cobianchi L. Saving from unnecessary pancreaticoduodenectomy. Brunner's gland hamartoma: Case report on a rare duodenal lesion and exhaustive literature review. Ann Med Surg (Lond) 2017; 17:43-49. [PMID: 28408987 PMCID: PMC5382022 DOI: 10.1016/j.amsu.2017.03.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/24/2017] [Accepted: 03/25/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Brunner's gland hamartoma (BGH) is an infrequently encountered, benign, polypoid proliferation of Brunner's glands. Usually these lesions are asymptomatic, just only occasionally presenting with duodenal obstruction or bleeding signs and mimicking a tumoral lesion. CASE PRESENTATION A 72-year-old male, referred for recurrent vomiting and epigastralgia, was investigated and all preoperative findings were suggestive of a tumour of the duodenum. During the scheduled pancreaticoduodenectomy a mass, resultant to a polyp, was palpatory felt inside the duodenum and then successfully and completely resected through a duodenotomy avoiding surgical overtreatment and connected postoperative morbidities. Histological analysis showed hyperplasia of Brunner's glands correspondent to a Brunner's gland hamartoma. BGH was undiagnosed before surgery, due to its particular sub-mucosal growth simulating an expanding process starting from the duodenum, and secondly due to unsuccessful biopsies performed during endoscopic procedure. CONCLUSION BGH is a rare lesion featuring, when symptomatic, obstructive or bleeding symptoms. Surgical treatment represents the gold standard approach in case of lesions that are technically impossible to remove endoscopically or in case of an undiagnosed lesion. Herein, we report a case of a patient presenting with a duodenal lesion mimicking, in all preoperative findings, a tumour of the duodenum. Duodenotomy and resection of the BGH provided a definitive cure avoiding surgical overtreatment. An intraoperative deep analysis of all surgical cases still remain crucial for a right therapeutic choice even in a new era for surgical technology. For similar intraoperative findings we recommend this technique.
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Affiliation(s)
- Andrea Peloso
- Department of Clinical Surgical Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
- IRCCS Policlinico San Matteo Foundation, General Surgery 1, Piazzale Golgi, 27100, Pavia, Italy
| | - Jacopo Viganò
- Department of Clinical Surgical Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
- IRCCS Policlinico San Matteo Foundation, General Surgery 1, Piazzale Golgi, 27100, Pavia, Italy
| | - Alessandro Vanoli
- IRCCS Policlinico San Matteo Foundation, University of Pavia, Department of Molecular Medicine, Piazzale Golgi, 27100, Pavia, Italy
| | - Tommaso Dominioni
- Department of Clinical Surgical Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
- IRCCS Policlinico San Matteo Foundation, General Surgery 1, Piazzale Golgi, 27100, Pavia, Italy
| | - Sandro Zonta
- Department of Clinical Surgical Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
- IRCCS Policlinico San Matteo Foundation, General Surgery 1, Piazzale Golgi, 27100, Pavia, Italy
| | - Dario Bugada
- Department of Surgical Science, University of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Carlo Maria Bianchi
- Department of Clinical Surgical Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
- IRCCS Policlinico San Matteo Foundation, General Surgery 1, Piazzale Golgi, 27100, Pavia, Italy
| | - Francesco Calabrese
- Department of Clinical Surgical Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
- IRCCS Policlinico San Matteo Foundation, General Surgery 1, Piazzale Golgi, 27100, Pavia, Italy
| | - Ilaria Benzoni
- Department of Clinical Surgical Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
- IRCCS Policlinico San Matteo Foundation, General Surgery 1, Piazzale Golgi, 27100, Pavia, Italy
| | - Marcello Maestri
- Department of Clinical Surgical Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
- IRCCS Policlinico San Matteo Foundation, General Surgery 1, Piazzale Golgi, 27100, Pavia, Italy
| | - Paolo Dionigi
- Department of Clinical Surgical Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
- IRCCS Policlinico San Matteo Foundation, General Surgery 1, Piazzale Golgi, 27100, Pavia, Italy
| | - Lorenzo Cobianchi
- Department of Clinical Surgical Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
- IRCCS Policlinico San Matteo Foundation, General Surgery 1, Piazzale Golgi, 27100, Pavia, Italy
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Mitsuishi T, Hamatani S, Hirooka S, Fukasawa N, Aizawa D, Hara Y, Dobashi A, Goda K, Fukuda T, Saruta M, Urashima M, Ikegami M. Clinicopathological characteristics of duodenal epithelial neoplasms: Focus on tumors with a gastric mucin phenotype (pyloric gland-type tumors). PLoS One 2017; 12:e0174985. [PMID: 28376132 PMCID: PMC5380350 DOI: 10.1371/journal.pone.0174985] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/18/2017] [Indexed: 12/16/2022] Open
Abstract
Objective Epithelial tumors less commonly occur in the duodenum than in the stomach or large intestine. The clinicopathological characteristics of duodenal epithelial tumors remain a matter of debate. We therefore studied resected specimens to investigate the clinicopathological characteristics of duodenal epithelial tumors. Materials and methods Among duodenal epithelial tumors resected endoscopically or surgically in our hospital, we studied the clinicopathological characteristics of 110 adenomas or intramucosal carcinomas. The grade of atypia of all tumors was classified into 3 groups according to the World Health Organization (WHO) 2010 classification. The tumors were immunohistochemically evaluated to determine the frequency of differentiation toward fundic glands. Results As for patient characteristics, there were 76 men (75.2%) and 25 women (24.8%), with a median age of 65 years (range, 34 to 84). The tumors most commonly arose in the first to second part of the duodenum. Many lesions were flat, and the median tumor diameter was 8.0 mm. The lesions were classified into 2 types according to mucin phenotype: intestinal-type tumors (98 lesions, 89.1%) and gastric-type tumors (12 lesions, 10.9%). Intestinal-type tumors were subdivided into 2 groups: tubular-type tumors (91 lesions, 82.7%) and tubulovillous-type tumors (7 lesions, 6.4%). Gastric-type tumors were classified into 2 types: foveolar type (3 lesions, 2.7%) and pyloric gland-type (PG) tumors (9 lesions, 8.2%). The grade of atypia was significantly higher in gastric-type tumors (p<0.01). PG tumors were gastric-type tumors characterized by pyloric glands and findings suggesting differentiation toward fundic glands. Conclusions About 10% of the duodenal tumors had a gastric-type mucin phenotype. Gastric-type tumors showed high-grade atypia. In particular, PG tumors showed similarities to PG tumors of the stomach, such as differentiation toward fundic glands.
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Affiliation(s)
- Takehiro Mitsuishi
- Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
- * E-mail:
| | - Shigeharu Hamatani
- Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Shinichi Hirooka
- Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Nei Fukasawa
- Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Daisuke Aizawa
- Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Yuko Hara
- Department of Endoscopy, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Akira Dobashi
- Department of Endoscopy, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Kenichi Goda
- Department of Endoscopy, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Takahiro Fukuda
- Division of Neuropathology, Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Masayuki Saruta
- Division of Gastroenterology and Hepatology, Department of Internal medicine, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Mitsuyoshi Urashima
- Division of Molecular Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Masahiro Ikegami
- Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
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19
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A Giant Brunneroma Causing Gastrointestinal Bleeding and Severe Anemia Requiring Transfusion and Surgery. Case Rep Surg 2017; 2017:6940649. [PMID: 28299229 PMCID: PMC5337360 DOI: 10.1155/2017/6940649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 01/26/2017] [Accepted: 01/29/2017] [Indexed: 12/29/2022] Open
Abstract
Brunner's gland hamartoma, also called hyperplasia, adenoma, and Brunneroma, is an extremely rare benign proliferative lesion of Brunner's glands in the duodenum. While being mostly small and asymptomatic, they can result in gastrointestinal bleeding and obstruction. We report the case of a 54-year-old man presenting with melena and severe anemia requiring blood transfusion. CT scans showed a large mass of 8 cm in diameter, presumably arising in the duodenum. Endoscopic biopsies were not conclusive. As we were unable to determine the nature of the mass preoperatively and due to the severe symptoms, its size, and the uncertain malignant potential, a classic Whipple procedure was performed. The resected specimen showed extensive proliferation of Brunner's glands without signs of malignancy.
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20
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Endoscopic Resection of a Pedunculated Brunner's Gland Hamartoma of the Duodenum. Case Rep Gastrointest Med 2016; 2016:6707235. [PMID: 27579190 PMCID: PMC4992794 DOI: 10.1155/2016/6707235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 07/17/2016] [Indexed: 12/25/2022] Open
Abstract
A 68-year-old Japanese woman presented with a solitary pedunculated polyp in the duodenum. Endoscopic ultrasonography showed multiple cystic structures in the polyp. The polyp was successfully resected by endoscopic snare polypectomy and pathologically diagnosed as Brunner's gland hamartoma. Because hamartomatous components were not identified in the stalk of the polyp, we speculate that the stalk developed from traction of the normal duodenal mucosa. When a solitary, pedunculated polyp with cystic structure within the submucosa is found in the duodenum, Brunner's gland hamartoma should be considered in the differential diagnosis, despite the rarity of the disease. This case underscores the usefulness of endoscopic ultrasonography for the diagnosis of duodenal subepithelial tumors.
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21
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Huo X, Wei J, Liu X, Wu J, Gao W, Li Q, Jiang K, Dai C, Miao YI. Brunner's gland cyst in combination with gastrointestinal stromal tumor: A case report. Oncol Lett 2016; 11:3409-3412. [PMID: 27123125 DOI: 10.3892/ol.2016.4382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 02/01/2016] [Indexed: 12/12/2022] Open
Abstract
Brunner's gland cysts are rare benign lesions that are mainly observed in the first and the second regions of the duodenum. Patients with Brunner's gland cyst demonstrate no specific symptoms. The present study reports the case of a patient with Brunner's gland cyst located in the duodenum in combination with a gastrointestinal stromal tumor (GIST) in the same region. To the best of our knowledge, the present study reports the first case of Brunner's gland cyst with GIST. A 58-year-old female patient was referred to Tianchang Hospital of Traditional Chinese Medicine (Tianchang, China) with a one-month history of upper abdominal discomfort, diarrhea and recurrent vomiting following the intake of food. Upper gastrointestinal endoscopy and a computed tomography scan revealed the presence of a round, cystic-like lesion with internal low density located within the duodenum. Pathological examination revealed that the cyst measured 0.3 cm in diameter and was consistent with a diagnosis of Brunner's gland cyst. Histopathology revealed that the cyst possessed characteristics of GIST. The patient underwent surgical exploration and tumor resection, and was discharged 2 weeks post-surgery. During the 12 month post-operative follow-up period, the outcome of the patient was good. This case study of Brunner's gland cyst combined with GIST enriches the present literature and promotes better understanding of the two diseases. Further investigation is required to explain the mechanism and association between the two rare diseases.
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Affiliation(s)
- Xiqian Huo
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Jishu Wei
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Xinchun Liu
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Junli Wu
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Wentao Gao
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Qiang Li
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Kuirong Jiang
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Cuncai Dai
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Y I Miao
- Pancreas Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
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Scillitani G, Mentino D. Comparative glycopattern analysis of mucins in the Brunner's glands of the guinea-pig and the house mouse (Rodentia). Acta Histochem 2015; 117:612-23. [PMID: 26105998 DOI: 10.1016/j.acthis.2015.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 05/28/2015] [Accepted: 06/04/2015] [Indexed: 12/18/2022]
Abstract
The mucins secreted by the Brunner's glands and the duodenal goblet cells of the Guinea-pig and the house mouse were compared by conventional and FITC-conjugated lectin histochemistry. Methylation/saponification and sialidase digestion were performed prior to lectin binding to detect the residues subterminal to sulfated groups and sialic acid, respectively. In the Guinea-pig the Brunner's glands produce class-III stable sulfosialomucins. Sialic acid is mostly 2,6-linked to galactose or to N-acetylgalactosamine and is in part O-acetylated in C7, C8, and C9. Sulfated groups are probably linked to sialic acid and N-acetylgalactosamine. Terminal residuals of N-acetylglucosamine, galactose, N-acetylgalactosamine and fucose linked in α1,2, α1,3, and α1,4 are also present. Duodenal goblet cells of the Guinea-pig present a lower number of residuals in respect to the Brunner's glandular ones, with sialic acid and N-acetylgalactosamine subterminal to sulfated groups. In the house mouse the Brunner's glands produce class-III stable neutral mucins, binding to same lectins as in the Guinea-pig except for those specific to sialic acid. A diversity of fucosylated residuals higher than in the Guinea-pig is observed. The mouse duodenal goblet cells lack stable class-III mucins, have little sialic acid and present a lower number of residuals in respect to the correspondent Brunner's glands. Regulation of the acidic intestinal microenvironment, prevention of pathologies and hosting of microflora can explain the observed results and the differences observed between the two rodents.
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Curcio G, Ligresti D, Granata A, Tarantino I, Barresi L, Liotta R, Traina M. Grasping forceps assisted endoloop/snare polypectomy of a giant duodenal hamartoma. Therap Adv Gastroenterol 2015; 8:313-5. [PMID: 26327921 PMCID: PMC4530430 DOI: 10.1177/1756283x15582140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Gabriele Curcio
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS–ISMETT, Via Tricomi 5, Palermo, Italy
| | - Dario Ligresti
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS–ISMETT, Palermo, Italy
| | - Antonino Granata
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS–ISMETT, Palermo, Italy
| | - Ilaria Tarantino
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS–ISMETT, Palermo, Italy
| | - Luca Barresi
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS–ISMETT, Palermo, Italy
| | - Rosa Liotta
- Pathology Service, Department of Diagnostic and Therapeutic Services, IRCCS–ISMETT, Palermo, Italy
| | - Mario Traina
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS–ISMETT, Palermo, Italy
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Namikawa T, Kobayashi M, Hanazaki K. An unusual giant duodenal mass lesion. Gastroenterology 2015; 148:e5-6. [PMID: 25824353 DOI: 10.1053/j.gastro.2014.10.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 10/15/2014] [Indexed: 02/08/2023]
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25
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Vieth M, Montgomery EA. Some observations on pyloric gland adenoma: an uncommon and long ignored entity! J Clin Pathol 2014; 67:883-90. [DOI: 10.1136/jclinpath-2014-202553] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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26
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Akaki M, Taniguchi S, Hatakeyama K, Kushima R, Kataoka H. Duodenal mucosal damage is associated with proliferative activity of Brunner's gland hamartoma: a case report. BMC Gastroenterol 2014; 14:14. [PMID: 24422755 PMCID: PMC3898372 DOI: 10.1186/1471-230x-14-14] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 01/10/2014] [Indexed: 12/16/2022] Open
Abstract
Background Brunner’s gland hamartoma is a rare tumor, predominantly found in the fifth to sixth decades of life. Generally, it is a single pedunculated polyp, rarely larger than 5 cm. Asymptomatic cases are found incidentally, but cases with a large polyp tend to have gastrointestinal bleeding and/or obstructive symptoms. Polyp size increases in a time-dependent manner, however, the growth mechanism is unknown. We report a Japanese male case in his mid-twenties with an over 6 cm sized polyp. Case presentation A 26-year-old man presented black stools and anemia. Endoscopic examination revealed a large pedunculated polyp at gastroduodenal junction. The polyp, subsequently resected by distal gastrectomy, was lobulated with random surface erosions and sized 6.4 × 3 cm. Histological examination revealed that the polyp arose from duodenal mucosa and was composed of hyperplastic Brunner’s glands in lobules separated by fibromuscular septa, associated with lymphocytic infiltrate and lymphoid follicles. No evidence of malignancy was found. Thus, the lesion was diagnosed as Brunner’s gland hamartoma. Further immunohistochemical studies indicated that gastric foveolar metaplasia is associated with surface epithelium covering upper two thirds of the polyp, showing immunohistochemical positivity for mucin 5 AC (MUC5AC). Below the metaplastic surface epithelium, Brunner’s glands had high proliferative activity (MIB-1 labeling index: 7.9%). The similar staining pattern was observed at surface erosive sites (MIB-1 labeling index in Brunner’s glands: 9%). On the other hand, surface epithelium in the lower side of the polyp still preserved intestinal nature, containing CDX2-positive nuclei and MUC2-positive goblet cells. Brunner’s glands below the surface epithelium with intestinal characteristics showed low proliferative activity (MIB-1 labeling index: 0.77%). Conclusion Proliferative activity of Brunner’s glands was high at the sites with surface erosion and also below the epithelium showing gastric foveolar metaplasia. As gastric foveolar metaplasia occurs along with a mucosal repair process in the duodenum, mucosal damages underlay the hamartomatous proliferation of Brunner’s glands and eventually resulted in a formation of large polypoid mass in this case.
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Affiliation(s)
- Mayumi Akaki
- Clinical Laboratory, University of Miyazaki Hospital, 5200 Kihara, Kiyotake, Miyazaki, Miyazaki, 889-1692, Japan.
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Lenz L, Felipe-Silva A, Nakao F, Miyajima N, Della Libera E, Chaves DM, Sugai BM, Rohr MRDS. Pyloric Brunner's gland hamartoma with atypical hyperplasia. AUTOPSY AND CASE REPORTS 2013; 3:49-51. [PMID: 28584807 PMCID: PMC5453661 DOI: 10.4322/acr.2013.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 12/03/2013] [Indexed: 11/23/2022] Open
Abstract
Brunner's gland hamartoma (BGH) is an extremely rare benign digestive tumor, generally located in the duodenal bulb. We report the case of a 51-year-old asymptomatic man with a large pedunculated BGH arising from the pylorus. It was successfully removed en bloc by endoscopic resection.
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Affiliation(s)
- Luciano Lenz
- Fleury Medicina e Saúde, São Paulo/SP - Brazil.,Department of Endoscopy - Universidade Federal de São Paulo, São Paulo/SP - Brazil
| | - Aloísio Felipe-Silva
- Fleury Medicina e Saúde, São Paulo/SP - Brazil.,Anatomic Pathology Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Frank Nakao
- Fleury Medicina e Saúde, São Paulo/SP - Brazil.,Department of Endoscopy - Universidade Federal de São Paulo, São Paulo/SP - Brazil
| | - Nelson Miyajima
- Fleury Medicina e Saúde, São Paulo/SP - Brazil.,Gastrointestinal Endoscopy Service - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Ermelindo Della Libera
- Fleury Medicina e Saúde, São Paulo/SP - Brazil.,Department of Endoscopy - Universidade Federal de São Paulo, São Paulo/SP - Brazil
| | - Dalton Marques Chaves
- Fleury Medicina e Saúde, São Paulo/SP - Brazil.,Gastrointestinal Endoscopy Service - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | | | - Maria Rachel da Silveira Rohr
- Fleury Medicina e Saúde, São Paulo/SP - Brazil.,Department of Endoscopy - Universidade Federal de São Paulo, São Paulo/SP - Brazil
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