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17 January 2013 - Case of the Week #263
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Thanks to Dr. Saroona Haroon, The Aga Khan University Hospital (Pakistan), for contributing this case and the discussion. To contribute a Case of the Week, follow the guidelines on our Case of the Week page.
(1) Recent chapter updates include:
- Ampulla of Vater: Hanni Gulwani, M.D.
- Kidney Non Tumor: Nikhil Sangle, M.D.
- Liver and intrahepatic bile ducts-Tumor: Deepali Jain, M.D.
- Pancreas: Deepali Jain, M.D.
- Small Bowel: Hanni Gulwani, M.D.
- Stains: Cytokeratin 34betaE12, FLT3 / CD135, HER2, KRAS, MALT1, MelanA / MART1, PAX5, progesterone receptor (PR), S100.
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Case of the Week #263
A 53 year old woman presented with a 3 week history of epigastric pain. Endoscopsy showed a 1.8 x 1.5 cm pedunculated mass in the proximal duodenum, which was biopsied.
What is your diagnosis?
Brunner gland hamartoma
Brunner gland hamartoma, also called Brunner gland adenoma, is a rare benign lesion of the duodenum composed of adipose tissue, hyperplastic Brunnerís glands and cystic ducts lined by ciliated cells (World J Gastroenterol 2004;10:2616). Rare cystic cases have been reported. Most cases (89%) are pedunculated. The cause is unknown, although relationships with chronic pancreatitis, hyperacidity, hyperchlorhydria, H. pylori gastritis (South Med J 2008;101:648) and uremia have been suggested.
Symptoms include upper GI hemorrhage and obstruction and less commonly intussusception, biliary obstruction, or pancreatitis (Radiographics 2012;32:213). They also occur as an incidental finding in 2% of gastroscopies, usually in the duodenal bulb. Superficial endoscopic biopsies are often unremarkable because the masses are submucosal.
These tumors are benign, and excision is curative.
Nat Pernick, M.D., President
and Palak Thakore, Associate Medical Editor
30100 Telegraph Road, Suite 408
Bingham Farms, Michigan (USA) 48025
Alternate email: NatPernick@gmail.com