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      Brunner’s gland hyperplasia: an unusual duodenal submucosal lesion seen in four patients

      case-report

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          Abstract

          Brunner’s gland hyperplasia is an extremely rare benign hamartomatous lesion seen in proximal duodenum. Difficulty in diagnosing the condition pre-operatively puts the surgeon in dilemma for deciding appropriate management. We retrieved details from prospectively maintained retrospective data from January 2014 to April 2018. Four patients were identified of which three were males and one was female. Symptoms ranged from 4 days to 4 years, with abdominal pain, vomiting and malena being predominant. No patients were identified with diagnosis pre-operatively. Diagnosis was made on histopathological examination of the resected specimen and none of them were having malignant features. At a median follow up of 11 months, no patient had recurrence and were symptom free. Brunner’s gland hyperplasia is a rare elusive duodenal pathology, symptomatically mimicking alarming duodenal lesions and mostly diagnosed on histopathology of specimen. Patients may harbour the lesion for long periods with little symptoms and upon treatment have good outcomes.

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          Most cited references10

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          Brunner's gland hamartomas: clinical presentation and pathological features of 27 cases.

          The aim of this study was to characterize the clinical presentation, pathological features, and outcome of a series of patients with Brunner's gland hamartomas. We reviewed the clinical and pathological features of 27 patients who presented with Brunner's gland hamartomas, and we obtained follow-up information. Patients (12 men and 15 women) presented predominantly in the fifth and sixth decades of life either with gastrointestinal hemorrhage (n = 10) or obstructive symptoms (n = 10); there were also patients whose tumors were discovered as an incidental finding (n = 7). The tumors were generally pedunculated, were located in the first portion of the duodenum, and were in the range of diameter from 1 to 6 cm. Histologically, the hamartomas were characterized by the presence of nondysplastic, lobulated Brunner's glands with intervening bands of fibrous tissue and variable adipose and lymphoid tissue. Focal sclerosis was found in 93% of the hamartomas, possibly mimicking an adenocarcinoma. Whether managed surgically (24 patients) or endoscopically (three patients), the outcome was uniformly favorable. After a median period of 7-yr-follow-up, no tumors recurred, and no additional morbidity was identified. Brunner's gland hamartomas are rare duodenal tumors occurring in middle age that present either with gastrointestinal hemorrhage, obstructive symptoms, or as an incidental finding. Surgical or endoscopic excision is uncomplicated, and the long-term outcome is favorable.
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            Brunner's gland adenoma of duodenum: a case report and literature review.

            To analyze the clinicopathological features of Brunner's gland adenoma of the duodenum. A rare case of Brunner's gland adenoma of the duodenum was described and related literature was reviewed. Brunner's gland adenoma of the duodenum appeared to be nodular hyperplasia of the normal Brunner's gland with an unusual admixture of normal tissues, including ducts, adipose tissue and lymphoid tissue. We suggested that it might be designated as a duodenal hamartoma rather than a true neoplasm. The most common location of the lesion is the posterior wall of the duodenum near the junction of its first and second portions. It can result in gastrointestinal hemorrhage and duodenal obstruction. Endoscopic polypectomy is a worthy treatment for benign Brunner's gland adenomas, as malignant changes in these tumors have never been proven. Copyright 2004 The WJG Press ISSN
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              Large Brunner's gland adenoma: case report and literature review.

              Brunner's gland adenoma (BGA) is a very rare benign tumour of the duodenum, which is usually asymptomatic and discovered incidentally at endoscopy. Occasionally, this lesion may be large, causing upper gastrointestinal haemorrhage or intestinal obstruction. The case had a large Brunner's gland adenoma, presenting melena that was managed by endoscopic excision.
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                Author and article information

                Journal
                J Surg Case Rep
                J Surg Case Rep
                jscr
                Journal of Surgical Case Reports
                Oxford University Press
                2042-8812
                November 2018
                30 November 2018
                30 November 2018
                : 2018
                : 11
                : rjy305
                Affiliations
                Department of Surgical Gastroenterology and Liver Transplantation, Old Rajinder Nagar, New Delhi, India
                Author notes
                Correspondence address. Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, Old Rajinder Nagar, No. 2222, 2nd Floor, SSRB Building, New Delhi 110060, India. Tel: +91-888-469-4233, Office: +011-42-25-1471; E-mail: docbsreenu@ 123456gmail.com
                Author information
                http://orcid.org/0000-0002-6506-4473
                Article
                rjy305
                10.1093/jscr/rjy305
                6267341
                9648dd43-d853-456a-b996-7e198399d550
                Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author(s) 2018.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@ 123456oup.com

                History
                : 10 September 2018
                : 27 November 2018
                Page count
                Pages: 5
                Categories
                Case Report

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