Upper GI barium study and endoscopic US
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Diffuse type (Brunner gland hyperplasia)
Multiple, small, submucosal nodules < 5 mm in proximal duodenum
“Cobblestone” or “strawberry” appearance
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Solitary type (Brunner gland hamartoma)
Solitary, sessile, or pedunculate lesion > 5 mm in proximal duodenum
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Submucosal heterogeneous and hypoechoic lesion on endoscopic US
TOP DIFFERENTIAL DIAGNOSES
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Duodenitis
Diffuse, inflammatory changes are seen
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Duodenal flexure pseudotumor
Redundant mucosa can simulate luminal mass
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Hamartomatous polyposis (Peutz-Jeghers)
Associated lesions (mucocutaneous pigmentation, etc.)
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Familial polyposis syndrome
Associated extraintestinal manifestations (epidermoid cyst, lipoma, fibroma, desmoid tumors, etc.)
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Duodenal metastases and lymphoma
Metastases: “Target” or bull’s-eye lesion with rounded submucosal mass; ulceration is common
CLINICAL ISSUES
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Epigastric pain is most common symptom
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No treatment needed for diffuse type
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Endoscopic or surgical resection for large hamartoma to verify histology
TERMINOLOGY
Synonyms
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Brunner gland hamartoma, Brunner gland adenoma (misnomer)
Definitions
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Nonneoplastic hyperplasia of duodenal submucosal glands
Diffuse type (Brunner gland hyperplasia)
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Diagnostic Imaging_ Gastrointes - Michael P Federle