The endoscopic ultrasonographic appearance of Brunner's gland hamartoma

Weisselberg, Batia; Melzer, Ehud; Liokumovich, Pavel; Kurnik, Daniel; Koller, Moshe; Bar‐Meir, Simon

doi:10.1016/s0016-5107(97)70070-1

Cited by 24 publications

(18 citation statements)

References 3 publications

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“…6,7 Brunner's gland hamartoma and heterotopic gastric mucosa are rare conditions, and there have been few descriptions concerning these endosonographic features. 8,9 As a result of our findings, these hamartomas manifested a variety of internal echo patterns ranging from pure cystic to mixed solid masses (type I-VII), according to the degree and extent of the cystic glands. As described in our previous report, multilocular spaces measuring less than 1 mm tend to demonstrate increased echogenicity due to sonographic interference.…”

Section: Discussionmentioning

confidence: 53%

Endosonographic Classifications of Gastrointestinal Submucosal Tumors

Hizawa

Kawasaki

Kouzuki

et al. 2000

Digestive Endoscopy

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CF-UM3, or CF-UM20; Olympus, Tokyo, Japan), after deaerated (boiled) water was filled around the lesions following routine preparation. For 30 small lesions, an ultrasound miniature probe (UM2R or UM3R; Olympus) was used under the direct observation of a video-endoscope. A waterfilled balloon technique was performed for esophageal and anorectal lesions.On EUS, the normal gastrointestinal wall was basically visualized as a five-layered structure, and we could thus clearly see if the tumors were limited to the submucosal layer or not. The echogenicity of the lesions was judged based on the echo level of the third hyperechoic layer (submucosa), the fourth hypoechoic layer (proper muscle), and the anechoic intraluminal de-aerated water. The internal echo patterns were thus divided into seven types including: a localized anechoic internal echo mass (type I, simple cystic), a cystic mass with either septal structures or multiple anechoic areas (type II, multicystic), a cystic mass accompanied by intramural solid components (type III, solid cystic), a homogeneous hyperechoic mass (type IV, hyperechoic), a localized homogeneous mass with an internal low echo (type V, hypoechoic) or more internal echogenicity (type VI, isoechoic), and a heterogeneous solid mass intermingled with internal hyper-and hypoecho (type VII, mixed solid).A histologic confirmation was made based on the findings of surgical resection specimens in 63 lesions, endoscopic resection specimens in 70 lesions, and conventional biopsy specimens in four lesions. As a result, the diagnoses included cysts, lymphangioma, lipoma, Brunner's gland hamartoma, heterotopic gastric mucosa, heterotopic pancreas, inflammatory fibroid polyps, granular cell tumors, Digestive Endoscopy (2000) 12, [120][121][122][123][124][125] Aim: The aim of this study was to classify the endosonographic features of gastrointestinal submucosal tumors. Methods: The endosonographic and clinicopathologic findings of 302 submucosal elevated lesions from 295 patients were compared. Results: Endoscopic ultrasound was able to clearly demonstrate the anatomical layer origin of the lesions. The internal echo patterns of the submucosal tumors could be categorized into seven types consisting of simple cystic (I), multicystic (II), solid cystic (III), hyperechoic (IV), isoechoic (V), hypoechoic (VI), and mixed solid (VII). Cysts, lymphangioma, and lipoma were characterized as type I, II, and IV images, respectively. Brunner's gland hamartoma and heterotopic gastric mucosa showed various patterns of cystic and solid echoes (I-VII). Inflammatory fibroid polyps, granular cell tumors, and carcinoid tumors often manifested type VI images. Malignant tumors, particularly leiomyosarcoma, tended to show VII images. Conclusions:The endosonographic classification is considered to be important in the diagnosis of gastrointestinal submucosal elevated lesions.

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Section: Discussionmentioning

confidence: 53%

Endosonographic Classifications of Gastrointestinal Submucosal Tumors

Hizawa

Kawasaki

Kouzuki

et al. 2000

Digestive Endoscopy

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“…As the tumors are located in the deep mucosa or submucosa, endoscopic biopsy of Brunner's gland hamartomas might be non‐diagnostic, as was evident with our case. The features of Brunner's gland hamartoma on EUS examination, including involvement of only the mucosa and submucosa, a smoth border, and variable echogenicity representing the dilated glands within the tumor, have recently been reported 5 . Maeda et al .…”

Section: Discussionmentioning

confidence: 95%

Safe Endoscopic Resection Using a Detachable Snare: Large Pedunculated Brunner's Gland Hyperplasia

Kubokawa¹,

Hata²,

Ochiai³

et al. 2002

Digestive Endoscopy

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We report a case of Brunner's gland hyperplasia that was resected by an endoscopic polypectomy using a two‐channel fiberscope and a detachable snare. A 59‐year‐old woman had tarry stool and anemia. Upper endoscopy revealed a large pedunculated polyp that arose from the anterior wall of the duodenal bulb. As we thought this polyp to be the source of bleeding, we performed an endoscopic removal. The lesion was removed by using a detachable snare without any complications. The resected specimen revealed a Brunner's gland hyperplasia. Endoscopic resection using the detachable snare was found to be a useful method for the prevention of the polypectomy‐related bleeding in the treatment of Brunner's gland hyperplasia.

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“…The mainly cystic component of the tumor made the diagnosis of a solid submucosal tumor, such as fibroma, lipoma, carcinoid tumors, or lymphoma unlikely. The differential diagnosis of cystic submucosal tumors in the gastrointestinal tract includes Brunner's gland hamartoma, 12 heterotopic gastric mucosa, 13 heterotropic pancreas, 10,14,15 lymphangioma, 16,17 hemangioma, 17 gastric leiomyoma with cystic formation, 17 gastric leiomyosarcoma, 17 duplication cysts, 18,19 and diffuse cystic malformation of the stomach. 20 On ES, Brunner's gland hamartoma appears as a polypoid tumor involving the mucosa and submucosal layers with multiple small cystic lesions within it.…”

Section: Discussionmentioning

confidence: 99%

Heterotopic pancreas presenting as gastric submucosal cyst on endoscopic sonography

Yen

Soon

2006

J of Clinical Ultrasound

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A 50-year-old Chinese woman with vague epigastric discomfort underwent upper gastrointestinal endoscopy that revealed a saddle-shaped submucosal tumor in the antrum along the greater curvature. Endoscopic sonography showed that the tumor consisted of two cystic lesions. Because of persisting symptoms, the tumor was resected 8 months later. Pathological examination revealed scattered heterotopic pancreatic acini and ducts in the submucosa and muscularis propria. We suggest that heterotopic pancreas, though rare, should be considered in the differential diagnosis of cystic lesions of the gastric wall.

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The endoscopic ultrasonographic appearance of Brunner's gland hamartoma

Cited by 24 publications

References 3 publications

Endosonographic Classifications of Gastrointestinal Submucosal Tumors

Endosonographic Classifications of Gastrointestinal Submucosal Tumors

Safe Endoscopic Resection Using a Detachable Snare: Large Pedunculated Brunner's Gland Hyperplasia

Heterotopic pancreas presenting as gastric submucosal cyst on endoscopic sonography

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