Issn Print: 0954-691X

Publication Date: 2001/12/01


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Endoscopic resection of a large Brunner's gland adenoma.

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Brunner's gland adenoma is a rare benign tumour of the duodenum. Less than 150 cases have been reported in English literature. We report a 73-year-old woman presenting with dyspnea, upper gastrointestinal obstructive symptoms and melena. Laboratory tests showed a microcytic anaemia (Hb 3.9 mmol/l and MCV 67). Duodenoscopy revealed a large pedunculated tumour in the bulbus duodeni of which biopsies were taken. On histological examination these biopsies showed signs of active chronic inflammation with erosion. Enteroclysis showed no other small bowel abnormalities. Endoscopic snare polypectomy was successfully performed and a superficially ulcerated polyp measuring 4.5 × 2.8 × 2.4 cm was removed. Histological examination confirmed the putative diagnosis of a Brunner's gland adenoma. Benign tumours of the duodenum are rare. They are reported in 0.008% of patients at autopsy, Brunner's gland adenoma comprising 10.6% of these lesions. Brunner's glands are mucus-secreting submucosal glands located in the duodenum, although occasionally observed in the pylorus and distally as far as the jejunum. Their alkaline mucus secretion probably protects the duodenum from the acid chyme of the stomach. In addition they produce urogastrone, an inhibitor of gastric acid secretion. Differential diagnosis includes adenoma of the Islet cells, polypoid adenoma, leiomyoma, lipoma, angioma, aberrant pancreatic tissue, prolapsed pyloric mucosa and malignant tumours. Brunner's gland adenomas are asymptomatic in most patients and the lesion my be an incidental finding during endoscopy or other duodenal imaging procedures. However, bleeding and/or obstructive complications may occur, necessitating endoscopic or surgical resection in a minority of cases.
J.M. Jansen, W.N.H.M. Stuifbergen and A.W.M. van Milligen de Wit Department of Internal Medicine and Gastroenterology, St. Elisabeth Hospital, Tilburg, The Netherlands.
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