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Pathology of Brunner's Gland Adenoma

Dr Sampurna Roy MD    

 

Pathology Quiz Case 87: Case history and images

Diagnosis: Brunner's Gland Adenoma

 

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Curveilhier reported the first case of Brunner's gland adenoma in 1835 and Salvioli reported a case in 1876.  

Brunner's gland adenoma (BGA) of the duodenum appear to be nodular hyperplasia of the normal Brunner's gland with an unusual admixture of normal tissues, including ducts, adipose tissue and lymphoid tissue.

Overgrowth of Brunner's gland forming a tumour larger than 1cm in size in diameter is referred to as BGA and less than 1cm as Brunner's gland hyperplasia.

The etiology of Brunner's gland adenoma remains obscure.

Concurrent H.pylori infection is very common in patients with Brunner's gland adenoma.

However, the role of H. pylori infection in the pathogenesis and development of Brunner's gland hyperplasia remains unclear.

Age: The lesion presents predominantly in the fifth and sixth decades of man's life with no sex predominance.

Clinical presentation:

Patients may present with obstructive symptoms or gastrointestinal hemorrhage, but the lesion is usually an incidental finding.

The patient may complain of dyspepsia, nausea, diarrhea or jaundice.

Anemia may results from chronic blood loss.

In some cases patient may present with congestive heart failure secondary to profound iron deficiency anemia.

Enlarged Brunner glands have also been associated with uremia and duodenal ulcers.

Site:  

Most common location for the lesion is the posterior wall of the duodenum near the junction of its first and second portions.  Brunner's gland adenoma is rarely found extending to the proximal jejunum

Gross:  

Brunner's gland adenoma can be multinodular or a single polyp.

It is usually non-encapsulated but well-circumscribed nodules of white, pink, or tan tissue.

Size of adenoma might extend from 1-12 cm, it is generally 1-2 cm in diameter.

The surface is typically smooth and nodular, but can be eroded. 

Microscopic features:

Normal Histology of Brunner's Gland:  

These are branched acinotubular glands located in the submucosa.

Glands are lined by cells with cytoplasm which stain strongly for mucin.

The normal function of brunner's gland is to secrete alkaline secretion which empty into the Crypts of Lieberkuhn in the duodenum and protects the duodenal mucosa from the damaging action of acid chyme.

Histopathological features of Brunner's Gland Adenoma:

In Brunner's gland adenoma histologically normal Brunner glands are arranged in a nodular manner and is separated by thin fibromuscular bands. 

Ducts are distributed normally. Inspissated secretions of periodic acid–Schiff (PAS)-positive neutral mucin admixed with nuclei, due to the extrusion of glandular material into the ducts, may dilate the latter.

It has been referred to as an adenoma, but its lobular structure, presence of ductal elements, and lack of dysplasia are more consistent with hyperplasia.

(Some authors reserve the term "hamartoma" for those lesions greater than 5 mm and hyperplasia for those smaller ).

Note:  Diagnosing well-preserved tissue is not difficult, but small crushed biopsy fragments can appear neoplastic, especially in a PAS reaction where cells are admixed with abundant mucin.

 

Further reading:

Large Brunner's gland adenoma: case report and literature review.

Brunner's gland adenoma: a rare cause of vomiting.

Brunner's gland adenoma: a report of two cases.

Brunner's gland adenoma of duodenum: a case report and literature review.

The pathological expressions of Brunners gland hyperplasia into adenoma and hamartoma.  

Gastrointestinal bleeding after endoscopic treatment of polypoid hamartoma (adenoma of Brunner's glands).

Helicobacter pylori infection in patients with Brunner's gland adenoma.

Brunner's gland adenoma with circumferential duodenal involvement.  

A giant Brunner's gland adenoma presenting as gastrointestinal hemorrhage.

Brunner's adenoma, esophageal reflux and gastric ulcer. A case report.

Brunner's gland adenoma with a focus of p53-positive atypical glands.

A Brunner's gland adenoma as a cause of anemia.

Polypoid hamartoma of Brunner's gland of the duodenum.  

 

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Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)


 

 

 

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