Brunner's gland adenoma with a focus of p53-positive atypical glands

Abstract

A submucosal tumor was resected endoscopically from the duodenal bulb in a 43-year-old man complaining of epigastric discomfort. The tumor, measuring 22 x 20 x 19mm, consisted mainly of Brunner's glands with no atypia. However, close histologic examination disclosed a focus of glands with cellular and structural atypia. The atypical glands showed staining by periodic acid-Schiff, alcian blue, and high iron-diamine methods. Mucin histochemistry was examined, and the atypical glands resembled the excretory ducts rather than the acinar cells of the tumor. Immunohistochemically, positivity for MIB-1 was high (38.0%), and p53-positive cells were detected sporadically in the atypical glands. These results indicated that the atypical glands probably represented a neoplastic lesion. Brunner's gland adenomas associated with foci of true neoplasm are very rare; only two cases, including one patient with microcarcinoid tumors, have been reported.

A Large Brunner’s Gland Hamartoma Causing Gastrointestinal Bleeding and Obstruction

“…Very few cases of BG hamartomas have been reported in association with epithelial dysplasia, adenocarcinoma, and carcinoid tumors [10]. …”

Pedunculated Brunner’s gland hamartoma of the duodenum causing upper gastrointestinal hemorrhage

“…However, endoscopists should be aware that there have been rare case reports of malignancy arising from Brunner's gland [1,4,15,16] . Endoscopic or surgical treatment is necessary if GI bleeding occurs [4,7,[11][12][13][14] , as in the present case.…”

A Case of Brunner Gland Adenoma, which Exhibited Dramatic Macroscopic Metamorphosis in 2 Years without Canceration

“…It appears pedunculated, semipedunculated, or sessile or assumes a form of a flat elevation with a central depression located in the duodenal bulb and descending part of the duodenum [5,6,14]. The term BGA has rather loosely been used.…”