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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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(A) Cut surface of an endoscopic submucosal dissected specimen shows dilated cysts with septation. (B) Low-power view shows a multilocular cyst containing amorphous fluid. Note the wall containing marked lymphoid cells with germinal center formation and some Brunner’s glands (arrow). (C) High magnification of the normal-appearing portion of Brunner’s glands (left). The cysts are lined by a single layer of mucinous columnar cells (white arrow) as well as the intervening smooth muscle bundle and overlying fundic glands (black arrow) (right).
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f2-kjpathol-48-5-371: (A) Cut surface of an endoscopic submucosal dissected specimen shows dilated cysts with septation. (B) Low-power view shows a multilocular cyst containing amorphous fluid. Note the wall containing marked lymphoid cells with germinal center formation and some Brunner’s glands (arrow). (C) High magnification of the normal-appearing portion of Brunner’s glands (left). The cysts are lined by a single layer of mucinous columnar cells (white arrow) as well as the intervening smooth muscle bundle and overlying fundic glands (black arrow) (right).

Mentions: On gross examination, the resected specimen was polypoid in appearance and had an intact surface. The cut surface showed a multiloculated cyst containing clear fluid (Fig. 2A). On microscopic examination, the polypoid cyst was covered by intact fundic mucosa, and the underlying multilocular cysts consisted of dilated ducts and intermixed fibromuscular bundles in the submucosa (Fig. 2B). The cysts deeply infiltrated mature lymphoid cells with germinal centers. 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). The epithelial lining was observable after staining with periodic-acid Schiff stain, but not with mucicarmine. The overlying fundic mucosa epithelial cells were positive for MUC5AC (1:500, CLH5, Novocastra Laboratories, Newcastle, UK) and negative for MUC6 (1:500, Ccp58, Novocastra Laboratories). These findings are all consistent with having cystic Brunner’s gland hamartoma in the stomach.


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) Cut surface of an endoscopic submucosal dissected specimen shows dilated cysts with septation. (B) Low-power view shows a multilocular cyst containing amorphous fluid. Note the wall containing marked lymphoid cells with germinal center formation and some Brunner’s glands (arrow). (C) High magnification of the normal-appearing portion of Brunner’s glands (left). The cysts are lined by a single layer of mucinous columnar cells (white arrow) as well as the intervening smooth muscle bundle and overlying fundic glands (black arrow) (right).
© Copyright Policy
Related In: Results  -  Collection

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

f2-kjpathol-48-5-371: (A) Cut surface of an endoscopic submucosal dissected specimen shows dilated cysts with septation. (B) Low-power view shows a multilocular cyst containing amorphous fluid. Note the wall containing marked lymphoid cells with germinal center formation and some Brunner’s glands (arrow). (C) High magnification of the normal-appearing portion of Brunner’s glands (left). The cysts are lined by a single layer of mucinous columnar cells (white arrow) as well as the intervening smooth muscle bundle and overlying fundic glands (black arrow) (right).
Mentions: On gross examination, the resected specimen was polypoid in appearance and had an intact surface. The cut surface showed a multiloculated cyst containing clear fluid (Fig. 2A). On microscopic examination, the polypoid cyst was covered by intact fundic mucosa, and the underlying multilocular cysts consisted of dilated ducts and intermixed fibromuscular bundles in the submucosa (Fig. 2B). The cysts deeply infiltrated mature lymphoid cells with germinal centers. 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). The epithelial lining was observable after staining with periodic-acid Schiff stain, but not with mucicarmine. The overlying fundic mucosa epithelial cells were positive for MUC5AC (1:500, CLH5, Novocastra Laboratories, Newcastle, UK) and negative for MUC6 (1:500, Ccp58, Novocastra Laboratories). These findings are all consistent with having cystic Brunner’s gland hamartoma in the stomach.

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