Cytological diagnosis of Brunner's gland adenoma (hyperplasia): A diagnostic challenge

Abstract

Brunner's gland adenoma (hyperplasia) (BGA/H) is a benign gastrointestinal lesion, usually asymptomatic and frequently detected incidentally by endoscopy as a submucosal nodule. Most BGA/Hs are diagnosed by their typical cytological morphology and immunohistochemical features, characterized by monomorphic cells arranged as loosely clusters of epithelial cells with abundant, clear, and granular cytoplasm, eccentrically located nuclei, and immunoreactivity for MUC‐6. The combination of the clinical and pathological features is essential for rendering a correct diagnosis. Herein, we report two cases of BGA/H, including their cytologic and histologic features, and a literature review of the clinicopathologic findings along with its differential diagnoses.

The Characteristics and Treatment Outcomes of 71 Duodenal Brunner’s Gland Adenomas with Endoscopic Submucosal Dissection

“…Thus, an ESD resection serves both diagnostic and therapeutic purposes. Most BGAs/BGHs are diagnosed by their typical histomorphology and immunohistochemical features, characterized by monomorphic epithelial cells arranged in loose clusters with abundant, vacuolated, and finely granular cytoplasm, round, eccentrically located, and inconspicuous nuclei [18]. BGH is defined as the proliferating glands maintaining their lobular architecture with fibrous septa, separating the hyperplastic lobules and scant amounts of other components, while BGAs, interchangeable with Brunner’s gland hamartoma, are characterized as nodular hyperplasia admixture of Brunner’s glands, ducts, capillaries, smooth muscle, adipose tissue, and lymphoid cells.…”

“…BGAs are diagnosed by their typical histomorphologic and immunohistochemical features, characterized by monomorphic epithelial cells arranged in loose clusters with abundant, vacuolated, and finely granular cytoplasm, eccentrically located, and inconspicuous nuclei [18]. BGAs, interchangeable with Brunner's gland hamartoma, are characterized as nodular hyperplastic admixture of Brunner's glands, ducts, capillaries, smooth muscle, adipose tissue, and lymphoid cells.…”

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

“…BGA is a benign small intestine lesion that accounts for approximately 5-10% of all duodenal masses and less than 1% of all gastrointestinal tumors (4, 7). It is estimated that 0.008% of the population is affected (8). The first BGA cases were reported in the literature by Cruveilhier in 1835 and Savioli in 1876.…”

“…BGA is typically discovered incidentally during endoscopy and manifests as nodular, polypoid, pediculoid lesions ranging in size from 0.7 to 12 cm (2, 4, 9). BGA lesions are more common in the fifth to sixth decades of life and are not associated with race or gender (8). Although there are several hypotheses such as BGA is a duodenal dysembryoplastic lesion or hamartoma, ethiopathogenesis has not been explained yet (8).…”

Brunner’s gland adenoma of duodenum

“…Brunner gland tumor, known as a hamartomatous or hyperplastic collection of mature glands, is a rare benign duodenal lesion with no known potential for malignant transformation [1,2]. Brunner's gland adenoma, whose alkaline mucin secretions may protect the epithelium from gastric chyme, often originates from the posterior wall of the first or second duodenal segment [3,4]. Brunner's gland adenoma is often typically found incidentally on endoscopy [5,6].…”