Gland Hamartoma Research Articles

A case of primary duodenal Brunner's gland hamartoma that gradually underwent morphological changes over a period of 10 years.

Brunner's gland hamartoma (BGH) is a benign tumor occurring in the duodenal bulb. BGH is typically asymptomatic, but it has been shown to occasionally cause anemia. The patient was a 76-year-old male. In October 2011, he was diagnosed with prostate cancer with multiple bone metastases and was referred to us for the treatment and examination of anemia. Hormonal therapy with androgen receptor antagonists and bisphosphonate administration following orchiectomy improved his symptoms. In August 2012, esophagogastroduodenoscopy (EGD) was performed due to stomach discomfort, revealing a 5 mm semi-pedunculated polyp in the duodenal bulb, Yamada-Fukutomi classification type II. Over the next 5 years, the prostate cancer treatment proceeded smoothly, and no endoscopic follow-up was conducted. In January 2017, during a health checkup, EGD revealed that the polyp in the duodenum bulb had changed morphologically with a distinct stalk measuring 10 mm. As there were no symptoms and only minimal tumor growth, a watchful waiting approach was adopted. In April 2022, due to the rapid progression of anemia, EGD was performed again, showing that the pedunculated polyp had enlarged to 20 mm in maximum diameter with an eroded surface and a stalk extending to 40 mm. Given the tumor enlargement and further examination of anemia, an endoscopic polypectomy was performed in May 2022. Histopathological examination confirmed the diagnosis of BGH. We observed a case of primary duodenal BGH during treatment for advanced prostate cancer, with endoscopic monitoring over 10 years. The morphological changes of BGH were clearly documented via EGD.

Spectrum of endoscopic gastric subepithelial lesions encountered on EUS-FNA: A single center experience.

Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) is a minimally invasive and reliable non-surgical technique for the diagnosis of gastrointestinal lesions. The present study aimed to evaluate the spectrum of lesions encountered in the gastric subepithelium on EUS-FNA at a tertiary care center. Archival data of all patients undergoing EUS-FNA for gastric submucosal lesions over a period of 5 years was retrieved. Patient demographics, clinical presentation, and EUS findings were recorded along with the FNA results. A total of 78 EUS-FNA samples were analyzed. Material was adequate in 62 cases (79.48%) and inadequate in 16 cases (12.82%) patients due to scant cellularity. Of the adequate samples, 34 (43.5%) were reported as neoplastic while 20 (25.64%) were non-neoplastic, and 8 (10.25%) were reported as suspicious of a neoplasm. In the neoplastic category, the predominant diagnosis was of spindle cell neoplasm comprising gastrointestinal stromal tumor (13), benign neural tumor (03), leiomyoma (02), and spindle cell tumors (03). The latter could not be categorized further due to a lack of IHC material. The next common diagnosis was adenocarcinoma (06) followed by neuroendocrine tumor (02) and poorly differentiated carcinoma (01). The non-neoplastic lesions included non-specific pathology (15), inflammatory lesions (08), and one case each of tuberculosis, pancreatic rest, and Brunner gland hamartoma. Cell blocks for ancillary testing were available in 54 cases (65.23%) and follow-up was available in 42 cases (53.84%). EUS-FNA is a good modality for the diagnosis of gastric submucosal lesions with a high diagnostic yield.

S3079 Brunners Gland Hamartoma Presenting as an Upper GI Bleed

S3079 Brunners Gland Hamartoma Presenting as an Upper GI Bleed

Gastric Neoplasm – A Diagnostic Puzzle

Introduction: Paragangliomas are non-epithelial neuroendocrine tumors originating from neural crest derived paraganglion cells situated in the region of the autonomic nervous system ganglia and accompanying nerves. Very few cases of primary gastric paraganglioma have been reported in the literature till date. We report a rare case of primary gastric paraganglioma. Case Report: A 38 year old woman presented with history of melena and dyspepsia. Physical examination revealed mild tenderness in the right hypochondrium, and she was diagnosed to have gall stone disease. However, upper gastrointestinal endoscopy and contrast enhanced computed tomography whole abdomen revealed presence of a small elevated intraluminal lesion at the body of stomach along greater curvature and clinically diagnosed as gastrointestinal stromal tumor(GIST). Endoscopic biopsy report revealed a diagnosis of submucosal Brunner’s gland hamartoma. Laparoscopic cholecystectomy and laparoscopy assisted wedge resection of the stomach mass was done and the specimens were sent for histopathological examination. The stomach mass was diagnosed as paraganglioma which was confirmed by immunohistochemistry. Conclusion: Primary gastric paraganglioma is a very rare tumor. They are more difficult to diagnose if they are non-functional. Complete surgical excision is the first line treatment that can be performed with open surgical resection or laparoscopic technique.

Brunner's Gland Hamartoma Masquerades as a Neoplastic Mass – A Case Report

Background: Brunner's gland proliferation can mimic malignancy; the preoperative diagnosis of this lesion is challenging, and it is accidentally identified during imaging. Most of these lesions are identified as gastrointestinal stromal tumour or malignant tumour. The diagnosis of these lesions requires a histopathological examination. Case Presentation: Herein, we present a case of Brunner's gland hyperplasia/hamartoma, which was identified as a gastrointestinal stromal tumour at radiography and as submucosal thickening in endoscopy during the routine workup of anemia. However, histopathological examination revealed it to be a Brunner's gland hyperplasia/hamartoma. Conclusion: A preoperative diagnosis is challenging, so Brunner's gland hyperplasia/hamartoma should be considered as a differential diagnosis. The patient was found to be doing well on follow-up.

Giant brunner gland hamartoma: An unusual cause of upper gastrointestinal bleed

Brunneroma also known as Brunner gland hamartoma (BGH) is a rare benign tumor of Brunner gland. The incidence varies from 5% to 10% and comprises merely 1% of total duodenal tumors. BGHs are asymptomatic most times, whereas few presents with nonspecific features. Treatment of BGH is indicated only if symptomatic, large, or develop complications. Various approaches for successful endoscopic excision of BGH have been documented in the literature. We present a giant BGH, removed by Hot Snare Polypectomy (HSP) without any procedural related complications. A middle-aged man presented with melena and dyspnea. On examination, the patient had tachycardia and a hemic murmur. Laboratory investigations showed hemoglobin of 3.7 g/dl. The patient was managed with packet red blood cells, intravenous fluids, injection pantoprazole, and other supportive medications. Esophagogastroduodenoscopy revealed a large finger-like polypoidal lesion arising from the posterosuperior wall of the duodenal bulb extending to the 2nd part of the duodenum. The lesion was removed successfully by hot snare. No postprocedural complications were noted. Large pedunculated BGHs can be removed safely by HSP. Effective pretreatment of the stalk, especially endoloop prevents postpolypectomy bleeding. Further, prospective studies with large samples are necessary to validate.

Giant Brunner's gland hamartoma of the duodenal bulb removed by endoscopic submucosal dissection.

Giant Brunner's gland hamartoma of the duodenal bulb removed by endoscopic submucosal dissection.

Nonpolypous Hamartomas of the Gastrointestinal Tract: An Updated Review on Classification, Denominations, and Clinical Management.

Purpose To perform the first systematic report about histological subtypes of nonpolypous hamartomas of the gastrointestinal (GI) tract, from esophagus to anal canal. Design From over 19,000 studies about hamartomas, most of them published as case series or case presentations, we have selected the most representative ones for the GI tract, excluding polyposis syndromes. To have a whole picture of these hamartomas, all of the data were combined with the personal experience of the authors who are GI pathologists. Results The examined articles showed predominance of vascular and combined vascular and mesenchymal hamartomas. Arteriovenous hamartomas or Brunner gland hamartomas are mainly diagnosed in the small intestine, with preponderance for duodenum. Other malformations such cavernous hamartomas are more specific for the colorectal segments, whereas chondromatous hamartomas or those derived from the neural ectoderm were mostly reported in the esophagus. As newly recognized entities were admitted in the last years, misdiagnosis is frequent, and the best therapeutic approach is far to be known. Conclusion Even rare, hamartomas of the GI tract need to be differentiated from tumors and familial polyposis syndromes. Knowing their proper denominations and possible complications is valuable for gastroenterologists, pathologists, and surgeons, to be aware in the differential diagnosis.

Hamartomas of Body: A Revisited Entity - An Experience of a Tertiary Care Hospital

Introduction/Background: Hamartoma is a mass of disorganized tissue indigenous to the particular site. Although traditionally considered as developmental malformations, many hamartomas have clonal chromosomal aberration that is acquired through somatic mutation, thus now considered to be neoplastic. They arise virtually in all organs, either sporadically or in association with autosomal dominant syndrome. Materials and Methods: A retrospective study was carried out in a tertiary care health institute for 3-year period (January 2013 to December 2016), which included all visceral hamartomas from head to toe. Detailed clinicoradiological and pathological examination was done along with ancillary tests for definite diagnosis. Observation: The study included nine cases, categorized site wise as head and neck (one case of cystic lymphangioma), cardiothoracic (one case of chondroid hamartoma), gastrointestinal tract (GIT) (one case of Brunner's gland hamartoma), hepatic (one case of cystic lymphangioma), and genitourinary tract (four cases of angiomyolipoma [AML] and one case of myelolipoma). The age ranged from 1 year to 70 years showing a male predilection. The tumors were variable sized ranging from 0.5 to 20 cm in dimension either solitary or multiple. Some large tumors clinically masqueraded as malignant tumors and presented with complications. The postsurgical course and prognosis of all patients were uneventful. Conclusion: Hamartomas are usually not associated with significant morbidity but for the size and location of the tumor. Despite slow-growing and self-limiting behavior, some predispose to malignancy especially in the epithelioid AML and familial GIT hamartoma or may be seen associated with malignancy in syndromic forms.

Surgical Outcome of Brunner's Gland Hamartoma: A Single-Centre Experience.

Introduction Brunner's gland hamartomas (BGH) are rare benign lesions with an incidence of <0.01%, accounting for 5 to 10% of all benign tumors of the duodenum. It requires expeditious management by a multidisciplinary team. The aim of the study is to report our experience with surgery for BGH. Methodology Data of all patients who underwent surgical intervention for duodenal polypoidal mass between August 2007 and March 2020 were retrieved from our prospectively maintained gastrointestinal (GI) surgery database. All patients whose histopathology report of the resected specimen confirmed BGH ( n = 9) were included in the present study. Other pathological diagnosis like duodenal lipoma ( n = 2), ganglioneuroma ( n = 1), adenoma ( n = 10), and adenocarcinoma ( n = 4) were excluded. Results Nine patients had confirmatory histopathological diagnosis of BGH and met our inclusion criteria. Three (33.3%) of them were men with a median age of 45 (range: 24–61) years. The median interval between onset of symptoms and diagnosis of duodenal polyp was 14 (range: 4–180) days. Five patients (55.5%) presented with upper GI hemorrhage. Three (33.3%) patients presented with abdominal pain, and one (11.1%) patient presented with episodes of bilious vomiting. Diagnostic endoscopy could detect the lesion in all (100%) patients. Contrast-enhanced computed tomography detected duodenal polypoidal lesion in five (55.5%) patients. The mean size of tumor was 4.78 ± 1.36 cm. These lesions were symptomatic in all the patients and warranted intervention. In view of failed endoscopic intervention ( n = 7, 77.7%), or extramural extension of the tumor ( n = 2, 22.2%), surgical intervention was considered. Most commonly performed operation was duodenal polypectomy ( n = 6, 66.6%). Three postoperative complications developed in two (22.2%) patients. There was no surgery-related mortality. After a median follow-up of 60 (12 -78) months, no patient developed GI bleed or intestinal obstruction. Conclusion In this study, the clinical profile of BGH was explored from the surgeon's point of view. Although endoscopic management is the first-line treatment, surgery plays an important role, particularly, if this fails or is not feasible. In experienced hand, surgery can be performed with acceptable perioperative morbidity and mortality and long-term satisfactory outcomes.

Brunner’s Gland Hamartoma: A Case Report, Meta-Analysis, and Algorithm Approach to Obstructing Duodenal Masses

Brunner’s Gland Hamartomas (BGH) are rare, benign lesions. First described by Cruveilhier in 1835, there are fewer than 200 cases reported in the English literature and no large characterizing studies.

Resección endoscópica de hamartoma gigante de glándulas de Brunner. Reporte de un caso

Brunner's gland hamartoma or hyperplasia is a rare benign neoplasm of the small intestine, usually small, that is discovered incidentally on an upper digestive endoscopy or imaging tests. When it reaches a large size, it can cause digestive bleeding or intestinal obstruction. The pathogenesis is unknown. The endoscopic presentation can be nodular, polypoid or a diffuse glandular proliferation with thickening of the duodenal wall, and may be mistaken for a malignant neoplasm. Endoscopic resections of large Brunner's gland hamartomas in the duodenum is little reported in literature, due to its low incidence and diagnostic difficulty. The surgical approach is associated to greater morbidity compared to an endoscopic approach. The case of a 62-year-old patient is reported, who presented melena and symptomatic anemia, secondary to a giant polyp in the duodenal bulb. The polyp was successfully resected endoscopically without complications, which made it possible to avoid a more extensive surgical procedure. Histopathological examination of the whole specimen showed a Brunner's gland hamartoma. Conclusion: Brunner's gland hyperplasia or hamartoma is a benign neoplasm that rarely produces symptoms. Large lesions can become symptomatic and a high clinical-endoscopic suspicion and an evaluation of the extension are necessary before applying any therapeutic procedure, in order to avoid complex surgeries and favor a complete and safe endoscopic resection.

Brunner's Gland Hamartomas: Two Cases of This (Sometimes) Distinctive Lesion.

Brunner's gland hamartomas (BGHs) are rare, benign, primary duodenal tumors. The clinical presentations can vary, and confirming a diagnosis can be challenging because of the submucosal nature of the lesions. We report two cases of BGHs with different clinical presentations. The diagnoses were not determined initially, despite utilizing endoscopy, mucosal biopsies, endoscopic ultrasound, and, in one case, fine-needle aspiration. Confirmation of BGHs was subsequently made following endoscopic or surgical resection.

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 CASE OF BRUNNERS GLAND HAMARTOMA CAUSING OBSTRUCTIVE JAUNDICE

Brunner’s gland hamartoma is a rare benign tumor of duodenum .We present a case of large pedunculated duodenal hamartoma causing obstructive jaundice and significant dilatation of intrahepatic biliary radicles. Duodenal polyp is a rare benign tumor formed from a proliferation of Brunner gland, typically forming polypoid growth in proximal duodenum and can extend up to 3rd part of duodenum. It may be incidental finding but can present in emergency with obstruction and hemorrhage requiring surgical endoscopic resection.

Endoscopic resection of a giant symptomatic Brunner’s gland hamartoma of duodenal bulb

Brunner's gland hamartoma is a very rare benign tumor arising from the Brunner’s gland of duodenum and is usually asymptomatic, but may present with the symptom of duodenal obstruction or upper gastrointestinal bleeding due to ulceration from the tumor, requiring endoscopic or surgical resection. In our study, we report the case of a 57 year-old male who presented with pain over epigastrium, recurrent vomiting, black stool and dizziness with a lowering of hemoglobin up to 7.5 gm/dl. The blood transfusion was done to raise the hemoglobin. The upper gastrointestinal endoscopy revealed a giant submucosal polypoidal mass with a thick short stalk in duodenal bulb causing almost complete obstruction of the lumen of duodenum and there was a superficial ulceration on the under-surface of the mass. The endoscopic ultrasound revealed a submucosal lesion arising from the echo layer three. The computed tomography of abdomen showed that the polypoidal mass was confined to the duodenal lumen with no significant lumphadenopathy and normal biliary and pancreas. The endoscopic polypectomy was attempted, but the lesion was too large to grab the polyp as a whole with the conventional snare. Hence, the repeated partial snare polypectomies were done, followed by submucosal dissection to ensure the complete removal of the mass. There were no complications after the procedure. The histopathology examination of the duodenal mass confirmed the diagnosis of Brunner’s gland hamartoma and showed the presence of Helicobacter pylori as well. The endoscopic treatment of giant Brunner’s gland hamartoma avoided the need of unnecessary more invasive surgical procedure.

A giant Brunner\u2019s gland hamartoma being treated as a pedunculated polyp: a case report

BackgroundWith 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 presentationHere, 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.ConclusionIt 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.

AB160. 181. Duodenal hamartoma—unusual cause for symptomatic anaemia

: A 67-year-old lady presented with melena for 2 months, no medical or surgical history of note, no regular medications, hemoglobin was 9.1 mg/dL at initial presentation. Endoscopy revealed a large pedunculated polyp in second part of the duodenum, not amenable to endoscopic removal. Computerized tomographic abdominal imaging revealed a well circumscribed lesion with no evidence of invasion, supporting a benign process. Given our patient’s persistent symptoms an elective laparotomy was scheduled. The duodenum was kocherised, an anterior longitudinal duodenotomy revealed a 3.8 cm pedunculated polyp. This was excised and Heineke-Mikulicz closure was performed. Final histopathology reports revealed a Brunner gland hamartoma on a background of chronic inflammation. The post-operative period was uneventful and was discharged on the 7th post-operative day. Our patient was commenced on oral proton pump inhibitors with regular following up indicating normal haemoglobin level within 1 month. The aetiology of Brunner gland hamartomas is thought to be chronic inflammation. They represent 5–10% of all benign duodenal tumours with an estimated incidence of less than 0.01%. The clinical manifestations of Brunner’s gland hamartomas are wide and varied from non-specific epigastric discomfort to gastric outlet obstruction. The diagnosis of Brunner gland hamartoma is supported by endoscopy and radiological findings. However, the sensitivity of endoscopy is 72–89%, endoscopic mucosal biopsy is often non-diagnostic because often the biopsy does not penetrate into the submucosa. Thus, computed tomography (CT) imaging aids the surgeon and their patient on management strategy. In this case with continuously falling hemoglobin definitive surgical management was sought.

Giant Brunner’s Gland Adenoma Presenting as Upper Gastrointestinal Bleeding in 76 Years Old Male: A Case Report

Brunner's gland adenoma is a rare benign tumor of small bowel, often incidentally discovered during endoscopy or radiological imaging. Mostly they are asymptomatic or often present with nonspecific symptoms such as nausea, vomiting, gastrointestinal hemorrhage, iron deficiency anemia. We reported a 76 years old male case presented with chief complaints of vomiting and black tarry stool. General physical examination was normal except mild tenderness over epigastrium. Esophagogastroduodenoscopy revealed a pedunculated polypoid tubular structure with blind end distally of length approximately 10-12* 3.5*1.5 cm in the second section of the duodenum with multiple skipped ulcers on the exposed surface of it. Additionally, there were few erosions in the duodenum proximally and multiple superficial ulcerations in the antrum, associated with helicobacter pylori confirmed by rapid urease test kit. Surgical or endoscopic excision is the treatment of choice. We consider our case is the eldest case among Brunner's gland adenoma case in literature. Keywords: Brunner's gland adenoma; Brunner's gland hamartoma; Brunner's gland hyperplasia; case report.

Brunner Gland Hamartoma Presenting as Recurrent Melena

INTRODUCTION Benign small bowel neoplasms are rare, among them brunner gland hamartoma is uncommon benign tumour of duodenum. Most of them are asymptomatic and small but very few attain large size and produce various manifestations like duodenal obstruction or upper gastrointestinal bleeding. CASE REPORT A 55 yr female presented to the outpatient with complaints of fatigue, weakness and recurrent melena. She had previous history of epigastric discomfort and melena for which she used to take iron infusion. There was pallor but no other remarkable finding on examination. Her investigations showed Hb 8.8 gm/dl (11.0 -17.0). Upper G I endoscopy was done and showed a large pedunculated polypoidal mass in D1 extending till D2 occupying the whole lumen(figure 1). Subsequently CT Abdomen was done and showed a large pedunculated polyp with smooth margins arising from D1 and prolapsing into the second part, measuring 5.3 x 1.8 x1.5 cm(figure 2). Local excision of the lesion was done by endoscopic snare cautery technique after applying endoloop. Histological examination showed hyperplastic brunner,s gland in the submucosa and in the lamina propria with overlying intact mucosa. The nests of brunner,s gland were separated by smooth muscle and vascular septae with chronic inflammatory infiltrate and occasional cystic change. Patient remained asymptomatic on regular follow up visits. Discussion Brunner's gland hamartoma is a rare benign tumor of the duodenum accounting for about 10.6% of benign duodenal tumors and occurred in about 0.008% of individuals in a single series of 215,000 autopsies. Since its first description by Cruveilhier in 1835 and Salvioli in 1876, less than 200 cases have been reported in the literature. The differential diagnosis includes gastrointestinal stromal tumor, benign or malignant (previously known as gastrointestinal leiomyoma or leiomyosarcoma), lipoma, endocrine cell tumor (carcinoid tumor), lymphoma, vascular tumor, aberrant pancreatic tissue, adenocarcinoma, adenomyomatous polyp, prolapsed pyloric mucosa, ampullary neoplasm and even a foreign object. At present, the most accredited pathogenetic hypothesis remains that BGA is a duodenal dysembryoplastic lesion or hamartoma.Figure: endoscopic image of brunner,s gland polyp.Figure: CT abdomen showing polypoidal mass in duodenum.