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

Satoh, Tatsunori; Matsubayashi, Hiroyuki; Takizawa, Kohei; Ishiwatari, Hirotoshi; Kakushima, Naomi; Fujie, Shinya; Yoshida, Masao; Kawata, Noboru; Sasaki, Keiko; Terashima, Masanori; Ono, Hiroyuki

doi:10.2169/internalmedicine.2477-18

Cited by 7 publications

(11 citation statements)

References 21 publications

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“…4C‐F). There has been limited literature on the cytological findings of this entity, and reported cases were essentially nondiagnostic on FNA 18 . In retrospect, Brunner glands appeared as loosely cohesive columnar cells and were overlooked as intestinal epithelium.…”

Section: Discussionmentioning

confidence: 97%

Nondiagnostic fine‐needle aspirates of the pancreas: A root cause analysis

Gokozan

Michael

2020

Cancer Cytopathology

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BACKGROUND: Fine-needle aspiration (FNA) of the pancreas is considered the primary and least invasive diagnostic method in the evaluation of pancreatic lesions. A nondiagnostic sample may trigger repeat FNA or a more invasive diagnostic procedure. The goal of this study was to identify the root causes of nondiagnostic samples. METHODS: We performed a retrospective review of FNAs of the pancreas categorized as nondiagnostic at our institution between 2008 and 2019. Medical records and slides were reviewed to identify the features described by imaging, rapid on-site evaluation, fluid chemistry, final cytology diagnosis, and final histology. A root cause analysis was performed using the Ishikawa (or fishbone) diagram and the 5 Whys method. RESULTS: A total of 30 cases were identified: 11 adenocarcinomas, 6 cases of pancreatitis, 4 intraductal papillary mucinous neoplasms, 3 serous cystadenomas, 3 neuroendocrine tumors, 1 mucinous cystic neoplasm, 1 retention cyst, and 1 case of Brunner gland hyperplasia. The root causes identified were: man in 8 cases, machine in 1 case, method in 17 cases, and material in 18 cases. In many cases, more than 1 root cause contributed to the problem. CONCLUSION: Material related errors contributed to the majority of nondiagnostic results and were primarily related to fibrotic cancers, chronic pancreatitis, absence of diagnostic criteria of cystic lesions, and technically challenging cases. Only 1 major interpretation error was identified. Sampling and interpretive errors contributed equally to man-related causes. For mucinous cysts, neoplastic mucin was difficult to identify in liquid-based preparations. Pathologists tended to issue a nondiagnostic categorization when epithelial cells are lacking and particularly when the nature and radiological impression of the cyst was not communicated.

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Section: Discussionmentioning

confidence: 97%

Nondiagnostic fine‐needle aspirates of the pancreas: A root cause analysis

Gokozan

Michael

2020

Cancer Cytopathology

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“…By EUS, BGA/Hs dysplay characteristics findings, including involvement of the mucosa and submucosal layers without deeper extension, variable echogenicity, and cystic changes within the lesion 6 . Cytologically, Brunner's glands show loose clusters of flat, 2‐dimensional cells with minimal overlapping or atypia showing an abundant, finely granular, and vacuolated cytoplasm.…”

Section: Discussionmentioning

confidence: 99%

“…By EUS, BGA/Hs dysplay characteristics findings, including involvement of the mucosa and submucosal layers without deeper extension, variable echogenicity, and cystic changes within the lesion. 6 Cytologically, Brunner's glands show loose clusters of flat, Duodenal lesions are a heterogeneous group that ranges from non-neoplastic to neoplastic benign and malignant tumors. The differential diagnoses include pancreatic heterotopia, adenocarcinomas, GIST, leiomyomas, schwannomas, ampullary carcinomas, and pancreatic carcinomas (Table 1).…”

Section: Discussionmentioning

confidence: 99%

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

Requena

Rojas

García-Buitrago

2020

Diagnostic Cytopathology

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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.

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“…On EUS, Brunner’s gland hamartoma is shown as inhomogeneous solid or cystic mass in the submucosa [ 25 , 33 ]. There are some endoscopic ultrasonographic features, as follows: mucosal and submucosal involvement; variable echogenicity (sometimes mixed with hypoechoic); and multiple cystic changes inside the tumor [ 30 , 34 , 35 ]. EUS-guided fine-needle aspiration can improve the diagnostic accuracy, but needs high technical requirements for the operators [ 36 – 38 ].…”

Section: Diagnostic Approachesmentioning

confidence: 99%

“…Barium X-ray examination is noninvasive and safe, but sometimes it may not be easy for small lesions. For larger lesions, the findings of Brunner’s gland hamartoma are nonspecific with smooth and sessile or pedunculated polypoid-filling defects in the duodenum [ 3 , 5 , 6 ] without evidence of duodenal wall stiffening [ 34 ]. Bleeding spots, erosion, or superficial ulcers on the surface of the lesion are rarely seen [ 39 ].…”

Section: Diagnostic Approachesmentioning

confidence: 99%

Brunner’s Gland Hamartoma of the Duodenum: A Literature Review

Zhu

et al. 2021

Adv Ther

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Brunner's gland hamartoma is a benign tumor of the duodenum, but has malignant potential with a very low risk of progression into adenocarcinoma. It is uncommon with a frequency of less than 1.0% among the primary tumors of the small intestine. In addition, its clinical manifestations are nonspecific, etiology remains unclear, and treatment strategy needs to be further refined. This literature review mainly discusses the epidemiology, clinical features, possible etiology and pathogenesis, diagnostic methods, malignant potential, treatment, and prognosis of Brunner's gland hamartoma.

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

Cited by 7 publications

References 21 publications

Nondiagnostic fine‐needle aspirates of the pancreas: A root cause analysis

Nondiagnostic fine‐needle aspirates of the pancreas: A root cause analysis

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

Brunner’s Gland Hamartoma of the Duodenum: A Literature Review

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