Brunner’s Gland Hamartoma: A Rare Cause of Gastrointestinal Bleeding – Case Report and Review of the Literature

Abstract

An unusual cause of upper gastrointestinal bleeding is described in a previously healthy 45-year-old man who was admitted to hospital with weakness and fatigue, and had experienced an episode of melena two days before admission. His medical and surgical history was unremarkable. Upon admission to hospital, he showed evidence of iron-deficiency anemia, with a hemoglobin concentration of 61 g/L (normal range 135 to 175 g/L), a mean corpuscular volume of 73 fL (normal range 85.0 to 95.0 fL) and a ferritin concentration of 1.0 microg/L (normal range in males 15 to 400 microg/L). Upper gastrointestinal endoscopy revealed a 3.5 cm ulcerated submucosal mass in the third portion of the duodenum, for which mucosal biopsies were nondiagnostic. A subsequent endoscopic ultrasound revealed a 2.7 x 4.0 cm hyperechoic, cystic, submucosal tumour in the third portion of the duodenum. Endoscopic ultrasound-guided fine needle aspiration revealed no malignant cells. The patient eventually underwent a resection of the third portion of his duodenum. Surgical pathology revealed that this tumour was a Brunner's gland hamartoma, 4.5 cm in its greatest dimension.

A Giant Brunneroma Causing Gastrointestinal Bleeding and Severe Anemia Requiring Transfusion and Surgery

“…This mostly concerns the hamartomas that are large in size and symptomatic. Symptomatic cases most often present with gastrointestinal bleeding or obstructive symptoms [1, 2, 6, 7, 9, 12–14]. In rare cases, Brunner's gland hamartomas have been reported to cause duodenal intussusception [15, 16], “idiopathic” pancreatitis by intermittent obstruction of the Ampulla of Vater [17, 18], and mimicking of pancreatic or duodenal malignancy [15, 19, 20].…”

“…A previously documented case of severe anemia due to Brunner's gland hamartoma was reported to present with similar symptoms of lightheadedness and melena and a hemoglobin level of 61 g/L (3.8 mmol/L). This case also required erythrocyte concentrate transfusions and as the size was relatively small (3 cm) a segmental duodenal resection was performed [7]. …”

Cystic Lesions of the Gastrointestinal Tract: Multimodality Imaging with Pathologic Correlations

“…Moreover, Brunner's gland hyperplasia may be detected on transabdominal US as a lesion with a heterogeneous echotexture because of multiple small cysts (27). Only a few reports have described the various CT findings of Brunner's gland hyperplasia, including findings of a homogeneously-enhancing mass or of a heterogeneous and hypoattenuating mass with contrast administration (28, 29). In our study, CT revealed a solitary cystic lesion with mild wall enhancement (Fig.…”

AIRP Best Cases in Radiologic-Pathologic Correlation: Brunner Gland Hamartoma

“…Pathologic changes of Brunner glands have also been classified into three types by Feyrter: diffuse nodular hyperplasia throughout the duodenum (type 1), circumscribed nodular hyperplasia limited to the duodenal bulb (type 2), and glandular adenoma with polypoid tumorlike dimensions (type 3) (2,4). It has been suggested that the term Brunner's gland hamartoma is better than Brunner's gland adenoma because of (a) the absence of dysplasia; (b) the lack of encapsulation; and (c) the admixture of tissues-including ducts, acini, smooth muscle tissue, adipose tissue, lymphoid tissue, and Brunner glands-within a single pathologic lesion (4).…”