CASE REPORT

The authors present the case of a 33-year-old female patient with dyspepsia. An esophagogastroduodenoscopy was performed (fig. 1). In the second portion of the duodenum (D2), a 15 mm bulge with normal mucosa, non-pulsatile, soft consistency, without pillow sign was observed.

Endoscopic ultrasonography (EUS) revealed a well-defined hypoechoic nodule arising from the second layer of the duodenal wall, measuring 11 x 4 mm (fig. 2). The nodule echotexture was homogenous, with no calcifications or lymphadenopathies.

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DISCUSSION

These findings were compatible with Brunner’s gland hyperplasia. An endoscopic mucosal resection was performed. Histopathological analysis revealed cystic Brunner glands, with no dysplasia or neoplasia. A final diagnosis of Brunner’s gland hyperplasia was made.

Brunner’s gland hyperplasia (BGH), also referred in the literature as Brunner’s gland adenoma and hamartoma, consists of a hyperplastic proliferation of mature Brunner’s glands [1,2]. These are acinotubular exocrine glands located in the submucosal layer of the duodenum that secrete mucin, an alkaline fluid that protects the duodenum from gastric acidity [2]. BGH is a rare lesion, comprising less than 1% of gastrointestinal neoplasms [1]. They usually present as an incidental finding, however occasionally they may be large in size and cause obstruction or bleeding [2,3,4].

Endoscopically BGH may present as a polyp or subepithelial lesion, and the ultrasonographic findings are variable: located mainly in the submucosal layer or extended to the mucosal layer (third and second EUS layers, respectively); variable echogenicity; solid, large, or small cystic; round and well-circumscribed [5]. Although it has generally been considered a benign lesion, there are a few cases reported in the literature where dysplasia and malignant transformation occurred, and therefore endoscopic resection can allow for diagnosis and exclude malignancy [2,6].

REFERENCES

1. Requena DO, Rojas C, Garcia-Buitrago M. Cytological diagnosis of Brunner’s gland adenoma (hyperplasia): A diagnostic challenge. Diagn Cytopathol. 2021;49(6):E222-E225.
2. McCafferty J, Tokhi A, Krishnamoorthy S, Pande G. Case report of Brunner’s gland hyperplasia: A rare “mimic” of malignant pathology. Int J Surg Case Rep. 2021;81:105827.
3. Lazaridis N, Murino A, Solonos F, et al. Saline-immersion therapeutic endoscopy (SITE) combined with endoscopic submucosal dissection (ESD) of a rare cause of intussusception: a giant Brunner gland adenoma. Endoscopy. 2021;53(2):E62-E64.
4. Dhouha B, Ahlem L, Sana BS, et al. Brunner’s gland hyperplasia: A rare cause of gastrointestinal bleeding. Pathologica. 2017;109(4):414-417.
5. Lee KJ, Park B, Kim HM. Endoscopic Ultrasonography Findings for Brunner’s Gland Hamartoma in the Duodenum. Clin Endosc. 2022;55(2):305-309
6. Ramay FH, Papadimitriou JC, Darwin PE. Brunner’s Gland Adenoma with High-Grade Dysplasia. ACG Case Rep J. 2018;5:e81.

AUTHORS

Diogo Bernardo Moura¹, Nuno Nunes, Carolina Chálim Rebelo¹, Francisca Côrte-Real¹, Maria Antónia Duarte¹.

1. Gastroenterology Department, Hospital do Divino Espírito Santo de Ponta Delgada, Ponta Delgada, Portugal.