A Duodenal Tumor That Causes Partial Obstruction

Abstract

Question: A 67-year-old woman, who is a hepatitis C virus carrier, suffered from early satiety, indigestion, and occasional abdominal fullness since 2013. Physical examination and laboratory tests were unremarkable. Esophagogastroduodenoscopy disclosed a polypoid nodule at anterior wall of duodenal bulb (Figure A). Biopsy showed inflammatory changes. Abdominal computed tomography revealed a 1.4-cm protruding, heterogeneously hypodense nodule at the duodenal bulb (Figure B, C; black arrow). Endoscopic ultrasonography with 12-MHz miniprobe showed an 18.6 Â 10.8-mm isoechoic tumor with cystic change arising from the submucosal layer (Figure D). The patient underwent endoscopic resection of the tumor. What is your diagnosis of this duodenal tumor? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.

A Rare Tumor of the Duodenum, Brunner s Gland Adenoma: A Case Report

“…However, because it can coexist with adenocarcinoma, high-grade dysplasia, and neuroendocrine tumors, resection of the BGA is recommended (1,3,11,12). While endoscopic mucosal resection (EMR) and snare polypectomy are preferred for resection of pediculated, small, and superficial submucosal localized BGA lesions, surgical resection is used for lesions in large and difficult anatomical regions that spread deep into the submucosa (2,5,10). We decided to pursue our case cautiously.…”

“…It has the potential to mimic lesions that cause duodenal filling defects, such as leiomyoma, lipoma, or lymphoma (8). Endoscopic ultrasonography (EUS), which is widely used in the differential diagnosis of submucosal lesions, aids in determining the echogenicity, vascularity, depth, and intestinal layer from which the lesion originates (2,4,6,8,10). Lipoma, neuroendocrin tumors, leiomyoma, pancreatic heterotopia, adenocarcinoma, GIST, leiomyomas, schwannomas, duplication cysts, and carcinoid should all be considered in the differential diagnosis (2,4,5,8,10).…”

“…Endoscopic ultrasonography (EUS), which is widely used in the differential diagnosis of submucosal lesions, aids in determining the echogenicity, vascularity, depth, and intestinal layer from which the lesion originates (2,4,6,8,10). Lipoma, neuroendocrin tumors, leiomyoma, pancreatic heterotopia, adenocarcinoma, GIST, leiomyomas, schwannomas, duplication cysts, and carcinoid should all be considered in the differential diagnosis (2,4,5,8,10). In the literature, there is no accepted or applied formal guideline for the follow-up and treatment of BGA.…”

Endoscopic Endolooping for giant Brunner’s gland adenoma

“…BGH refers to lesions that are < 1 cm in size and arise as multiple sessile submucosal nodules in the first and/or second part of the duodenum. It appears as pedunculated polypoid lesions that range in size from 0.7 to 12 cm (average, 4 cm) 5 . These lesions microscopically comprise Brunner"s glands, ducts, adipose tissue, lymphoid cells and smooth muscle 6 .…”

Endosonographic Appearances of a Rare Duodenal Tumour, Brunner’s Gland Hamartoma

“…EUS is an excellent imaging modality to assess GI sub-epithelial lesions. Only a few cases have reported the endosonographic appearances of BGHs (Table 1) [6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18]. The lesions arise from deep mucosa or submucosa and do not breach the muscularis propria layer.…”