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Revista Española de Enfermedades Digestivas

versión impresa ISSN 1130-0108

Rev. esp. enferm. dig. vol.110 no.3 Madrid mar. 2018

http://dx.doi.org/10.17235/reed.2018.5344/2017 

PICTURES IN PATOLOGY DIGESTIVE

A rare mass in the duodenal bulb: Brunner's glands cystadenoma

Ting Guo1  , Yuyong Tan1  , Deliang Liu1 

1Department of Gastroenterology. The Second Xiangya Hospital of Central South University. Changsha, Hunan. China

CASE REPORT

A 56-year-old man was referred to our department for treatment of a mass in the duodenal bulb. Esophagogastroduodenoscopy (EGD) showed a large spherical mass extending from the pyloric canal to the anterior wall of the duodenal bulb (Fig. 1A). Endoscopic ultrasonography revealed a submucosal mass with heterogeneous echogenicity and a cystic structure (Fig. 1B). Computed tomography (CT) showed a solid cystic mass with rim enhancement and a lack of enhancement in the cystic spaces (Fig. 1C). The patient underwent an endoscopic submucosal dissection (ESD), which was uneventful, and a 4 × 3 × 2 cm mass was removed (Fig. 1D).

Fig. 1 A. EGD identified a large spherical mass measuring 4 cm in diameter with a clear border, which extended from the pyloric canal to the anterior wall of the duodenal bulb. B. Endoscopic ultrasonography revealed a submucosal mass with heterogeneous echogenicity and a cystic structure. C. CT identified a solid cystic mass with rim enhancement and lack of enhancement in the cystic spaces. D. The patient underwent ESD, which was uneventful, and a 4 × 3 × 2 cm mass was removed. 

Histologically, the mass was composed of hyperplastic Brunner's glands (Fig. 2A) and cystic dilations (Fig. 2B). The cysts were lined with a single layer of columnar epithelium similar to Brunner's gland ducts. Brunner's glands cystadenoma was the final diagnosis.

Fig. 2 A and B. The mass was composed of hyperplastic Brunner's glands and cystic dilations. The cysts were lined with a single layer of columnar epithelium similar to Brunner's gland ducts. 

DISCUSSION

Brunner's glands cystadenoma is extremely rare and only two cases have been reported previously 1) (2. The pathogenesis is unclear and a primary tumor in the duodenum may be asymptomatic or cause an obstruction or gastrointestinal hemorrhage. White light endoscopy and CT scan have limitations for diagnosis due to nonspecific features. Endoscopic ultrasonography has an important role in identifying the origin. Cystadenomas have a potential risk of malignancy when they arise from the ovaries or pancreas 3. A large mass may lead to symptoms of obstruction and surgical or endoscopic resection is recommended.

REFERENCES

1. Wolk DP, Knapper WH, Farr GH. Brunner's gland cystadenoma of the duodenum. Am J Surg 1973;126:439-40. DOI: 10.1016/S0002-9610(73)80141-2. [ Links ]

2. Tang J, Wang H, Liu F, et al. An unusual duodenal cyst: Brunner's glands cystadenoma. Gastrointest Endosc 2016;83(6)1295-6. DOI: 10.1016/j.gie.2015.10.052 [ Links ]

3. Cauchy F, Lefevre JH, Mourra N. Mucinous cystadenoma of the mesocolon, a rare entity frequently presenting with features of malignity: Two case reports and review of the literature. Clin Res Hepatol Gastroenterol 2012;36:12-6. DOI: 10.1016/j.clinre.2011.09.006 [ Links ]

Correspondence: Deliang Liu. e-mail: deliangliu@csu.edu.cn