Brunnerʼs Gland Adenoma with High-Grade Dysplasia

Abstract

Brunner’s gland adenoma is a rare, benign, small-bowel neoplasm. In a few reported cases, it can cause gastrointestinal hemorrhage and can be associated with cellular atypia. We report an 84-year-old woman with a 12-mm Brunner’s gland adenoma in the second part of the duodenum that was successfully removed with a saline injection-lift technique using a hot snare, followed by placement of clips to prevent postpolypectomy bleeding. Pathological examination revealed Brunner’s gland adenoma with high-grade dysplasia and oncocytic features with negative resection margins. The patient recovered uneventfully. Brunner’s gland adenoma is traditionally considered a benign lesion, and few cases in the published literature have reported Brunner’s gland adenoma with dysplasia or neoplasia. This suggests a dysplastic stage in the natural history of Brunner’s gland adenoma and questions the malignant potential of such lesions.

Jaundice and double-duct sign: Always cancer?

“…Brunner's gland adenoma is a rare cause (less than 5% of benign duodenal tumors) of duodenal polyp with reported cases of bleeding and duodenal obstruction. [ 3 ] The pathogenesis of Brunner's gland adenoma remains poorly understood. [ 3 ] The risk of cancer remains debated, but cases of high-grade dysplasia and invasive cancer have been described.…”

“…[ 3 ] The pathogenesis of Brunner's gland adenoma remains poorly understood. [ 3 ] The risk of cancer remains debated, but cases of high-grade dysplasia and invasive cancer have been described. [ 3 ]…”

“…[ 3 ] The risk of cancer remains debated, but cases of high-grade dysplasia and invasive cancer have been described. [ 3 ]…”