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Pyloric Brunner's gland hamartoma
PYLORIC BRUNNER’S GLAND HAMARTOMA
A 54-year-old woman was hospitalized for treatment of a duodenal polyp found incidentally at an EGD performed as part of a routine health survey. At initial endoscopy, the polyp was large, with a lobulated surface and long stalk, and was located in the duodenal bulb. The origin was not identified. Biopsy specimens revealed only non-specific, chronic inflammation. At admission, the only complaint offered by the patient was vague, intermittent epigastric discomfort. The medical history, examination, and standard laboratory tests were unremarkable except for hypertension. At EGD, a 4.0 3 2.0-cm polyp with a long stalk was found in the duodenal bulb (A). Careful inspection during withdrawal of the endoscope revealed that the polyp originated from the pyloric ring (B). By using a grasping forceps, the polyp was retracted into the stomach, and a detachable snare was placed on the stalk (C). The polyp was
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GASTROINTESTINAL ENDOSCOPY
removed by electrosurgical snare polypectomy without complication, and the specimen was retrieved (D). Histopathologically, the polyp was composed of mature Brunner’s glands, connective tissue septa and ducts, and was covered with normal mucosa without evidence of cellular atypia, findings consistent with a diagnosis of Brunner’s gland hamartoma. Yon Soo Jeong, MD Jun Pyo Chung, MD Dok Yong Lee, MD Sang Won Ji, MD Se Joon Lee, MD Kwan Sik Lee, MD Sang In Lee, MD Chanil Park, MD Departments of Internal Medicine and Pathology Yonsei University College of Medicine Seoul, Korea PII: S0016-5107(03)02290-9
VOLUME 59, NO. 1, 2004
A 54-year-old woman was hospitalized for treatment of a duodenal polyp found incidentally at an EGD performed as part of a routine health survey. At initial endoscopy, the polyp was large, with a lobulated surface and long stalk, and was located in the duodenal bulb. The origin was not identified. Biopsy specimens revealed only non-specific, chronic inflammation. At admission, the only complaint offered by the patient was vague, intermittent epigastric discomfort. The medical history, examination, and standard laboratory tests were unremarkable except for hypertension. At EGD, a 4.0 3 2.0-cm polyp with a long stalk was found in the duodenal bulb (A). Careful inspection during withdrawal of the endoscope revealed that the polyp originated from the pyloric ring (B). By using a grasping forceps, the polyp was retracted into the stomach, and a detachable snare was placed on the stalk (C). The polyp was
76
GASTROINTESTINAL ENDOSCOPY
removed by electrosurgical snare polypectomy without complication, and the specimen was retrieved (D). Histopathologically, the polyp was composed of mature Brunner’s glands, connective tissue septa and ducts, and was covered with normal mucosa without evidence of cellular atypia, findings consistent with a diagnosis of Brunner’s gland hamartoma. Yon Soo Jeong, MD Jun Pyo Chung, MD Dok Yong Lee, MD Sang Won Ji, MD Se Joon Lee, MD Kwan Sik Lee, MD Sang In Lee, MD Chanil Park, MD Departments of Internal Medicine and Pathology Yonsei University College of Medicine Seoul, Korea PII: S0016-5107(03)02290-9
VOLUME 59, NO. 1, 2004