Carcinoma of duodenal bulb arising from the Brunner’s gland

Abstract

A 75-year-old man was diagnosed as having a sessile tumor measuring 1.4 x 1.0 cm in size in the duodenal bulb after upper gastroduodenal series. The biopsy specimens revealed a proliferation of the adenomatous glands showing an acinar structure with papillary infolding; type III mucus, which is characteristic of Brunner's glands. Antral glands and mucus neck cells of the fundic glands were also observed in the adenomatous glands by concanavalin A staining. Thus, it was clear that the tumor had originated from the Brunner's glands. Three years and four months later, the sessile tumor had developed into a fungating ulcerated tumor via a polypoid form. The biopsy specimens revealed a papillary adenocarcinoma with foci of undifferentiated carcinoma. Retrospectively, the adenomatous glands in the biopsy taken from the sessile tumor should have been regarded as low grade carcinoma. Therefore, we propose that when a polyp or tumor shows an increase in size or change in macroscopic appearance, surgery should be considered.

Gastric-type adenocarcinoma of the duodenal second portion histogenetically associated with hyperplasia and gastric-foveolar metaplasia of Brunner's glands

“…Adenocarcinomas very rarely arise in Brunner's glands [4,5,8,9,16,22,23,29], gastric metaplasia, or heterotopic gastric mucosa [3,13,19,21]. Most Brunner's gland tumors, so-called Brunner's gland adenomas or brunneriomas, are not true neoplasms but rather hyperplasia or hamartomas, which are composed of lobules of mature Brunner's glands surrounded by bands of smooth muscle [18,24,29].…”

“…Most Brunner's gland tumors, so-called Brunner's gland adenomas or brunneriomas, are not true neoplasms but rather hyperplasia or hamartomas, which are composed of lobules of mature Brunner's glands surrounded by bands of smooth muscle [18,24,29]. There have been only five well documented cases of carcinoma with neoplastic transformation of the underlying Brunner's glands [5,8,9,16,29]. However, little is known about gastric-type differentiation in Brunner's gland tumors.…”

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

“…Since macroscopic transformation of BGA in the natural history is considered indicating canceration within, it is proposed as the hallmark of malignant degeneration advocating endoscopic or surgical intervention [10,12]. The present case was, however, proven to be an exception to this law.…”

“…BGH or BGA was once not believed to undergo malignant degeneration [7] but the cases complicated with malignancy have been reported [5,[8][9][10][11][12][13]. Since macroscopic transformation of BGA in the natural history is considered indicating canceration within, it is proposed as the hallmark of malignant degeneration advocating endoscopic or surgical intervention [10,12].…”

“…Though canceration of them was once questioned [7], such very rare cases have been published [5,[8][9][10][11][12][13] and a definite association was reported of macroscopic transformation of the latter in the natural history with development of malignancy [10,12]. This report presents a case of BGA, which showed dramatic macroscopic metamorphosis during a 2 year-period but was revealed to harbor no carcinoma.…”