Giant Brunner's gland hamartoma

Abstract

A 26-year-old woman with a 2-year history of postprandial abdominal pain, weight loss, and fatigue presented with pruritis and jaundice. Laboratory test results were as follows: hemoglobin, 5.1 g/dL (normal: 11.5-16.5 g/dL); total bilirubin, 31 μmol/L (5-20 μmol/L); alanine aminotransferase, 249 IU/L (10-40 IU/L); and alkaline phosphatase, 404 IU/L (30-135 IU/L). US disclosed dilation of intrahepatic and extrahepatic bile ducts, but ERCP was unsuccessful because of unusual distortion of the duodenum. Barium contrast radiography demonstrated a large multilobulated polypoid mass apparently arising from the proximal jejunum (A). CT revealed a 4 × 5-cm mass in the left flank and a distorted, dilated bile duct crossing the midline (B, arrow) caused by traction exerted by the mass. At laparotomy a 90 × 50 × 45-mm polyp was resected by means of a jejunal enterotomy (C, note ulcerated distal third). It arose just proximal to the major duodenal papilla, intussuscepting to lie in the jejunum. Histopathologically it was composed of Brunner's glands (D, arrows; H&E, orig. mag. ×400) without evidence of atypia, findings consistent with a diagnosis of hamartoma.