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Brunner's Gland Adenoma: Case Report
Brunner's Gland Adenoma: Case Report
Brunner's Gland Adenoma: Case Report
Department of General Surgery, Northside Medical Center, NEOMED, Youngstown, Ohio, USA
ABSTRACT
Brunner’s gland adenoma or hyperplasia is a rare benign mass most commonly found in the proximal part of the duodenum
due to a loss of a cell cycle regulator. This case study was done on a 60-year-old symptomatic male who had a history of
gastroesophageal reflux disease. A Brunner’s gland adenoma may become large enough to cause symptoms of obstruction and
upper gastrointestinal bleeding. The benign lesion successfully underwent endoscopic mucosal resection.
Key words: Brunner gland adenoma, Brunner hyperplasia, Brunner’s adenoma, Brunner’s hamartoma, Brunner’s neoplasm,
Brunneroma, small bowel neoplasm
DISCUSSION
Brunner glands are normal submucosal cells that are most Figure 2: Esophagogastroduodenoscopy (EGD) picture 2
abundant in the proximal duodenum and can extend to the
proximal jejunum.[8] These glands are made up of secretory an asymptomatic hamartoma is not clear, their increasing size
units of epithelial tubules that secrete a protective and may result in complications of obstruction or hemorrhage
lubricating substance for the duodenum.[9] The mucous as well as a potential for malignant transformation. This is
contains alkaline fluid, to protect the mucosa from gastric reason enough for removal.[13]
acidic secretions, a glycoprotein, that coats the intestinal
mucosa, and enterogastrone, which inhibits gastric acid In conclusion, not only is EGD with endoscopic mucosal
secretion.[8] It has been postulated that repeated duodenal resection a generally safe and low-risk procedure, but studies
mucosal injury either due to acidic gastric secretions or have shown also excellent post-operative outcomes with
Helicobacter pylori infections are the cause of Brunner gland no reoccurrences with both endoscopic mucosal resection
hyperplasia.[10] Brunner’s adenoma is usually asymptomatic and open laparotomy for removal.[12] While it remains
and found indecently during endoscopy. When the patient
controversial whether an asymptomatic Brunner’s gland
becomes symptomatic, it is usually due to the hamartoma
adenoma needs removed, removal of suspected Brunner
becoming large enough to cause signs of obstruction and even
adenomas is important to confirm diagnosis and prevent
hemorrhage.[7] Only 11% of patients with a case of Brunner’s
adenoma are asymptomatic.[11] For diagnosis, CT scans seem future complications such as obstruction, bleeding, or
to be ineffective unless the mass is large enough to visualize. malignant transformation.
The mainstay of diagnosis and treatment, according to
a study in Korea, is to perform and EGD polypectomy of REFERENCES
Brunner’s adenomas. Patients with large adenomas that have
been unsuccessful with EGD or if the size is too large, must 1. Michael JO, Kunitake H. Epidemiology, Clinical Features,
undergo open laparotomy for removal.[12] Whether to remove and Types of Small Bowel Neoplasms. Available from: