An Uncommon Lesion of the Duodenum

Abstract

Brunner's gland cystadenomas are rare benign lesion of the duodenum and encompass a spectrum of fluid-filled to semi-solid duodenal wall cysts. We present a case of a 66-year-old male who presented for the evaluation of early satiety and dyspepsia. A 77-year-old male presented for the evaluation of a 3-month history of early satiety. The patient denied abdominal pain, weight loss, nausea, vomiting, and signs of gastrointestinal blood loss. Laboratory evaluation revealed a normal complete blood count and complete metabolic panel. An esophagogastroduodenoscopy (EGD) was performed which revealed a 2.0 x 1.4 cm submucosal cystic lesion located between the first and second portions of the duodenum. Biopsies were taken from the lesion using a tunnel technique, which resulted in the expression of a clear fluid from the cystic lesion. The lesion then subsequently flattening out. Biopsy results revealed normal overlying duodenal mucosa with hyperplastic Brunner's glands, consistent with Brunner's glands cystadenoma. Brunner's glands cystadenomas are a rare benign lesion of the duodenum that have a hallmark appearance of a submucosal lesion that will rupture when biopsied and then subsequently flatten out. Differential diagnosis of submucosal lesions in the duodenum, include leiomyoma, gastrointestinal stromal tumor (GIST), ectopic pancreatic tissue, neuroendocrine tumors, and granular cell tumors. This case served as a reminded of an uncommon lesion of the duodenum that may not be familiar to gastroenterologists because of their rarity.Figure 1Figure 2