Giant duodenal Brunner’s gland hamartoma successfully treated via endoscopic mucosal resection

Application of balloon occluder for specimen collection after descending duodenal ESD

Endoscopic submucosal dissection (ESD) is a popular technique for resecting duodenal tumors. However, there is a risk of losing resected specimens during the procedure, particularly for lesions in the descending part of the duodenum. This study aims to introduce a simple and effective method for specimen collection after descending duodenal ESD using a self-made balloon occluder. The balloon occluder, made from a spray pipe and sterile rubber glove, is utilized to prevent the loss of resected specimens. The balloon is inflated under endoscopic visualization, occluding the descending lumen. With careful timing, the resected specimen can be safely collected by grasping it from the balloon using foreign forceps. This method has been successfully applied in several cases, demonstrating its practicality and efficacy. Further evaluation and validation of this technique in a larger patient population are warranted to establish its wider application in clinical practice.

Giant Brunner's gland hyperplasia of the duodenum successfully resected en bloc by endoscopic mucosal resection: A case report

BACKGROUND

Duodenal Brunner's gland hyperplasia (BGH) is a therapeutic target when complications such as bleeding or gastrointestinal obstruction occur or when malignancy cannot be ruled out. Herein, we present a case of large BGH treated with endoscopic mucosal resection (EMR).

CASE SUMMARY

An 83-year-old woman presented at our hospital with dizziness. Blood tests revealed severe anemia, esophagogastroduodenoscopy showed a 6.5 cm lesion protruding from the anterior wall of the duodenal bulb, and biopsy revealed the presence of glandular epithelium. Endoscopic ultrasonography (EUS) demonstrated relatively high echogenicity with a cystic component. The muscularis propria was slightly elevated at the base of the lesion. EMR was performed without complications. The formalin-fixed lesion size was 6 cm × 3.5 cm × 3 cm, showing nodular proliferation of non-dysplastic Brunner's glands compartmentalized by fibrous septa, confirming the diagnosis of BGH. Reports of EMR or hot snare polypectomy are rare for duodenal BGH > 6 cm. In this case, the choice of EMR was made by obtaining information on the base of the lesion as well as on the internal characteristics through EUS.

CONCLUSION

Large duodenal lesions with good endoscopic maneuverability and no evident muscular layer involvement on EUS may be resectable via EMR.

Brunner's gland hamartomas: Not always benign

Brunner's gland hamartoma (BGH) is a rare, benign tumor of the duodenum. It is mostly asymptomatic and usually found incidentally on routine esophagogastroduodenoscopy (EGD). However, some BGHs present with major complications including anemia, bleeding, obstruction, or dysplasia, requiring management and resection of these lesions. Herein, we present two cases of large BGHs of the duodenum, one presenting as severe gastrointestinal bleeding and the other, noted on EGD for iron deficiency anemia, found to have high grade dysplasia. This literature review discusses the rare serious complications of BGH, including iron deficiency anemia, overt gastrointestinal bleeding, and malignant potential.

A 10 cm pedunculated duodenal Brunner gland hamartoma, case report and literature review

INTRODUCTION

Brunner gland hamartoma is rare duodenal neoplasm. These benign lesions are usually presented by upper gastrointestinal bleeding and sometimes extend to cause intestinal obstruction.

PRESENTATION OF THE CASE

We report a case of a 43-year-old male patient manifested with iron deficiency anemia. Upon investigations, computed topography (CT) scan found a dilated first part of the duodenum with presence of large pedunculated polyp. The histopathological examination revealed a submucosal lobular proliferation of duodenal Brunner's gland separated by a fine fibrous septum. No dysplastic signs were observed. Immunohistochemical studies confirmed the nature of the glands and reveled absence of Helicobacter pylori gastritis. Diagnosis was confirmed.

DISCUSSION

Brunner glands hamartomas are rare tumors. They are commonly presented by upper GI bleeding and intestinal obstruction. The pathogenesis remains unclear. They are usually located in the first part (bulb) of the duodenum. Mucosal irritation and Helicobacter pylori infection are suggested causes. Different surgical and endoscopical modalities are applied in the management depending on the size and location of the mass. In our case, the tumor was removed by Endoscopic submucosal dissection.

CONCLUSION

Brunner gland hamartoma is a rare usually benign tumor. Presented clinically by upper GI bleeding and obstruction. Histopathologically Brunner gland Hamartoma characterized by lobular proliferation of Brunner gland associated with presence of other mature tissues. Although these tumors are benign it carries a minor risk of malignant transformation.

Giant Brunner's gland hamartoma diagnosed via endoscopic mucosal resection: A case report

We report the case of a patient with a giant Brunner's gland hamartoma that was pathologically diagnosed by endoscopic mucosal resection. A 69‐year‐old woman presented with intermittent abdominal pain, and imaging revealed a smooth saccular submucosal tumor, 40 mm in diameter, on the anterior wall of the duodenal bulb. Brunner's gland and smooth muscle tissue were observed on endoscopic ultrasound‐guided fine‐needle aspiration biopsy, which resulted in the preoperative diagnosis of a duplication cyst. However, subsequent endoscopic mucosal resection established a final histopathological diagnosis of Brunner's gland hamartoma.

Brunner's Gland Hamartoma of the Duodenum: A Literature Review

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.

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.

A giant Brunner's gland hamartoma being treated as a pedunculated polyp: a case report

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.