HYPERPLASIA OF BRUNNER'S GLANDS.

Abstract

Hyperplasia of the duodenal glands of Brunner was first described by pathologic anatomists in 1876 and introduced as a radiologic entity by Erb and Johnson (2) in 1948. In 1934 Feyrter (3) classified hyperplasia of Brunner's glands into three types. The first is diffuse nodular hyperplasia consisting of coarse mucosal folds and irregularly circumscribed nodules composed of duodenal glands which are distributed throughout the greater portion of the duodenum. The second type is the circumscribed nodular hyperplasia in which isolated nodules of Brunner's glands are located in the suprapapillary portion of the duodenum, often accompanied by atrophy of the intervening glands. The third type is the single nodule of adenomatous hyperplasia varying in size up to several centimeters. The solitary nodule is usually located in the duodenal bulb and may be either sessile or pedunculated. Robertson (6) did extensive investigative work on the duodenum and concurred with Feyrter's classification although he used the term hypertrophy rather than hyperplasia to designate the changes. The purpose of this report is to describe the roentgenologic appearance of hyperplasia of Brunner's glands as encountered and proved in 2 patients. Case Reports Case I:A 77-year-old, Negro female was admitted to Michael Reese Hospital with the chief complaint of left lower abdominal pain of one month duration. The pain occurred intermittently with no apparent relation to food intake. On two occasions during the week prior to admission the patient noted black stools. In recent months generalized weakness and a weight loss of 12 pounds had occurred. Physical examination was unremarkable except for a palpably enlarged liver and minimal tenderness in the left lower quadrant of the abdomen. Significant laboratory findings were as follows: hemoglobin: 8.6 g per 100 ml; hematocrit: 25 per cent; guaiac-positive stools; total protein: 5.9 g per 100 ml with albumin/globulin ratio of 2.2/3.7; and a tetracycline fluorescence test suspicious but not positive for gastric carcinoma. Liver function tests were reported as normal, as was a barium enema study. An upper gastrointestinal roentgen examination revealed irregularity and rigidity of the body of the stomach with an intraluminal ulcer crater just above the incisura. A large round filling defect was demonstrated in the duodenal bulb (Fig. 1). At surgery a round ulcerated tumor measuring 8 × 8 cm. was found in the body of the stomach, arising from the posterior wall and extending over the greater curvature for a distance of 1 cm. Projecting from the mucosa of the duodenum at a point 1 cm from the pyloric sphincter was an ovoid nodule measuring 3.5 × 3 × 2.5 cm, completely covered with a slightly hyperemic smooth mucosa (Fig. 2). A subtotal gastric resection with a Billroth-I procedure was performed.