EUS–FNA of Brunner’s gland hamartoma: a case report

Abstract

We describe endoscopic ultrasound, cytomorphological and immunocytochemical features of a large BrunnerÕs gland hamartoma (BGH). To the best of our knowledge, cytological findings of BGH have not yet been reported in detail, although Stewart et al. 1 reported a case in which endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) was performed. Case historyA 50-year-old woman was evaluated at an outside institution for iron deficiency anaemia. Esophagogastroduodenoscopy demonstrated a polypoid tumour in the distal duodenum. Punch biopsy was unremarkable. Multi-sliced computed tomography revealed a mass inseparable from the pancreatic head. Apart from anaemia (Hb 108 g ⁄ l), other laboratory findings were unremarkable. The patient was referred to our institution for EUS, which revealed a 40 · 63-mm mostly hypoechogenic mass with small cystic spaces, not in contact with the pancreatic head. The lesion was sited within the duodenal wall and probably originated in the fourth echolayer (Figure 1), so suspicion of gastrointestinal stromal tumour (GIST) was raised.Methods EUS-FNA was performed using a 22-gauge needle (Olympus EZ-Shot). A cytopathologist was present in the endoscopy room. Direct cytological smears were made and rapid on-site evaluation revealed uniform, benign looking cells, probably of epithelial origin. Two additional passes were made. All smears were airdried, and subsequently stained with May-Grü nwaldGiemsa (MGG) or stored for immunocytochemistry.

Giant Brunner’s Gland Hamartoma of the Duodenal Bulb Presenting with Upper Gastrointestinal Bleeding and Obstruction

“…Brunner’s gland harmartomas have characteristic histological features [4-8]. They consist of an unusual mix of normal tissue and Brunner’s glands, adipose cells, lymphoid cells, as well as ductal tissue.…”

Giant Brunner's Gland Hyperplasia of the Duodenum Diagnosed by Endoscopic Ultrasonography-guided Fine Needle Biopsy and Treated by Laparoscopic Endoscopic Cooperative Surgery

“…EUS-FNB is a method for sampling from the pancreatic masses (10), lymph nodes and gastrointestinal SMTs, and is thought to be most suitable in this case. To date, including our patient, four cases of BGHs diagnosed using EUS-guide fine needle aspiration (EUS-FNA) have been reported (Table) (7, 11, 12). The main purpose of this procedure was to exclude malignancy, and tissue fragments of proliferative Brunner's glands in combination with image findings can normally provide a fairly accurate diagnosis.…”

Pre‐operative diagnosis of a Brunner's gland hamartoma by endoscopic ultrasound‐guided fine needle aspiration

“…Since the first case of BGH described by Cruveilhier in 1835, there have been fewer than 200 cases reported in the English literature 5 . Only one case reported to date describes detailed FNA findings 6 . In that instance, the FNA results were considered not specifically diagnostic.…”