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Cystic Brunner's Gland Hamartoma in the Gastric Body: A Case Report.

Chung DH, Kim NR, Cho HY, Kim YJ - Korean J Pathol (2014)

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Gachon University Gil Medical Center, Incheon, Korea.

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Cystic Brunner’s gland hamartoma has been described under the various names including cystic hamartoma of Brunner’s glands, cystic Brunner’s gland heterotopia, Brunner’s gland cysts, Brunner’s gland cystadenoma, Brunner’s cyst, mucocele of Brunner’s glands, and cyst of Brunner’s glands... A few dilated lymphatics and capillaries were observed... The cysts were lined by clear columnar epithelia, similar to that found in Brunner’s gland ducts (Fig. 2C)... During the ten-month follow-up period, the patient remained asymptomatic and her follow-up endoscopic biopsy was unremarkable... Brunner’s glands are mucus-secreting acinar glands, which are normally found in the deep portion of the duodenal mucosa and the submucosal layer... Findings such as submucosal cysts within disorganized smooth muscle and infiltration of mixed inflammatory cells in the lamina propria are also consistent with cystic Brunner’s gland hamartoma... However, hyperplastic Brunner’s glands do not include GCP... Fundic gland polyps are characterized by cystic dilatations of the oxyntic glands, which are lined by flattened parietal and chief cells, with or without mucous gastric foveolar epithelial cells... Irregular proliferation of deep fundic glands and the smooth muscle portion were found, but stromal inflammation was minimal and Brunner’s glands were not present in the fundic gland polyp... Anechoic cysts in the third or fifth layer with a compressible nature are suggestive of a duplication cyst... Pancreatic heterotopia can also be submucosally located and are often found in the gastric antrum, which may appear as hypoechoic or mixed echogenicity lesions in the second, third, or fourth layer... Cystic Brunner’s gland hamartomas are exceedingly rare, and only 13 cases have been described, all of which were reported in the first or second portion of the duodenum or, most rarely, in the gastric antrum... Here, we report on a gastric cystic Brunner’s gland hamartoma based on EUS findings and an endoscopic submucosal dissection... The current case is unique in the following aspects: 1) it is a rare cystic Brunner’s gland hamartoma, 2) it showed multilocular cystic changes, 3) the hamartoma presented in a rare location—the gastric angle—and was composed of fundic glands, as seen under light microscopy.

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Related in: MedlinePlus

(A) Upper gastroesophageal endoscopy reveals a pedunculated polyp in the anterior wall of the gastric angle. Note the polyp is covered by normal-appearing mucosa. (B) Endoscopic ultrasound reveals a heterogeneous mixed echoic lesion in the submucosal layer.
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f1-kjpathol-48-5-371: (A) Upper gastroesophageal endoscopy reveals a pedunculated polyp in the anterior wall of the gastric angle. Note the polyp is covered by normal-appearing mucosa. (B) Endoscopic ultrasound reveals a heterogeneous mixed echoic lesion in the submucosal layer.

Mentions: A previously healthy 72-year-old female presented with a gastric submucosal tumor at the gastric angle. She had been under evaluation for ten years and over this follow-up period, the tumor size increased from 10 mm to 20 mm (Fig. 1A). Endoscopic ultrasound (EUS) showed a heterogeneous mixed hypoechoic lesion in the third layer of the gastric wall, measuring 20 mm (Fig. 1B). Multiple small compartments were separated by thin-walled septae and a regular border. Because we expected that the patient had a gastric cystic submucosal tumor, including a gastrointestinal stromal tumor with cystic change or a heterotopic pancreas, endoscopic submucosal dissection was performed using a dual knife and hemostatic forceps. There were no acute complications during the procedure.


Cystic Brunner's Gland Hamartoma in the Gastric Body: A Case Report.

Chung DH, Kim NR, Cho HY, Kim YJ - Korean J Pathol (2014)

(A) Upper gastroesophageal endoscopy reveals a pedunculated polyp in the anterior wall of the gastric angle. Note the polyp is covered by normal-appearing mucosa. (B) Endoscopic ultrasound reveals a heterogeneous mixed echoic lesion in the submucosal layer.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4215963&req=5

f1-kjpathol-48-5-371: (A) Upper gastroesophageal endoscopy reveals a pedunculated polyp in the anterior wall of the gastric angle. Note the polyp is covered by normal-appearing mucosa. (B) Endoscopic ultrasound reveals a heterogeneous mixed echoic lesion in the submucosal layer.
Mentions: A previously healthy 72-year-old female presented with a gastric submucosal tumor at the gastric angle. She had been under evaluation for ten years and over this follow-up period, the tumor size increased from 10 mm to 20 mm (Fig. 1A). Endoscopic ultrasound (EUS) showed a heterogeneous mixed hypoechoic lesion in the third layer of the gastric wall, measuring 20 mm (Fig. 1B). Multiple small compartments were separated by thin-walled septae and a regular border. Because we expected that the patient had a gastric cystic submucosal tumor, including a gastrointestinal stromal tumor with cystic change or a heterotopic pancreas, endoscopic submucosal dissection was performed using a dual knife and hemostatic forceps. There were no acute complications during the procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Gachon University Gil Medical Center, Incheon, Korea.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Cystic Brunner’s gland hamartoma has been described under the various names including cystic hamartoma of Brunner’s glands, cystic Brunner’s gland heterotopia, Brunner’s gland cysts, Brunner’s gland cystadenoma, Brunner’s cyst, mucocele of Brunner’s glands, and cyst of Brunner’s glands... A few dilated lymphatics and capillaries were observed... The cysts were lined by clear columnar epithelia, similar to that found in Brunner’s gland ducts (Fig. 2C)... During the ten-month follow-up period, the patient remained asymptomatic and her follow-up endoscopic biopsy was unremarkable... Brunner’s glands are mucus-secreting acinar glands, which are normally found in the deep portion of the duodenal mucosa and the submucosal layer... Findings such as submucosal cysts within disorganized smooth muscle and infiltration of mixed inflammatory cells in the lamina propria are also consistent with cystic Brunner’s gland hamartoma... However, hyperplastic Brunner’s glands do not include GCP... Fundic gland polyps are characterized by cystic dilatations of the oxyntic glands, which are lined by flattened parietal and chief cells, with or without mucous gastric foveolar epithelial cells... Irregular proliferation of deep fundic glands and the smooth muscle portion were found, but stromal inflammation was minimal and Brunner’s glands were not present in the fundic gland polyp... Anechoic cysts in the third or fifth layer with a compressible nature are suggestive of a duplication cyst... Pancreatic heterotopia can also be submucosally located and are often found in the gastric antrum, which may appear as hypoechoic or mixed echogenicity lesions in the second, third, or fourth layer... Cystic Brunner’s gland hamartomas are exceedingly rare, and only 13 cases have been described, all of which were reported in the first or second portion of the duodenum or, most rarely, in the gastric antrum... Here, we report on a gastric cystic Brunner’s gland hamartoma based on EUS findings and an endoscopic submucosal dissection... The current case is unique in the following aspects: 1) it is a rare cystic Brunner’s gland hamartoma, 2) it showed multilocular cystic changes, 3) the hamartoma presented in a rare location—the gastric angle—and was composed of fundic glands, as seen under light microscopy.

No MeSH data available.


Related in: MedlinePlus