Brunner Gland Hyperplasia

Published on 19/07/2015 by admin

Filed under Radiology

Last modified 19/07/2015

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 Upper GI barium study and endoscopic US

• Diffuse type (Brunner gland hyperplasia)

image Multiple, small, submucosal nodules < 5 mm in proximal duodenum
image “Cobblestone” or “strawberry” appearance
• Solitary type (Brunner gland hamartoma)

image Solitary, sessile, or pedunculate lesion > 5 mm in proximal duodenum
• Submucosal heterogeneous and hypoechoic lesion on endoscopic US

TOP DIFFERENTIAL DIAGNOSES

• Duodenitis

image Diffuse, inflammatory changes are seen
• Duodenal flexure pseudotumor

image Redundant mucosa can simulate luminal mass
• Hamartomatous polyposis (Peutz-Jeghers)

image Associated lesions (mucocutaneous pigmentation, etc.)
• Familial polyposis syndrome

image Associated extraintestinal manifestations (epidermoid cyst, lipoma, fibroma, desmoid tumors, etc.)
• Duodenal metastases and lymphoma

image Metastases: “Target” or bull’s-eye lesion with rounded submucosal mass; ulceration is common

CLINICAL ISSUES

• Epigastric pain is most common symptom
• No treatment needed for diffuse type
• Endoscopic or surgical resection for large hamartoma to verify histology
image
(Left) Spot film from an upper GI series shows multiple small submucosal filling defects image in the duodenal bulb, characteristic of Brunner gland hyperplasia.

image
(Right) Spot film from an upper GI series shows the duodenal bulb with a “strawberry” appearance due to innumerable small, submucosal nodules of hyperplastic Brunner glands.
image
(Left) Spot film from an upper GI shows multiple small polypoid masses image in the proximal duodenum. An endoscopic biopsy revealed hyperplasia and elements of hamartoma arising from Brunner glands.

image
(Right) Spot film from an upper GI demonstrates a polypoid mass image within the duodenal bulb. An endoscopic biopsy and resection revealed a hamartoma of a Brunner gland. Larger, isolated lesions, as in this case, are indistinguishable from many other duodenal masses and require a biopsy.

TERMINOLOGY

Synonyms

• Brunner gland hamartoma, Brunner gland adenoma (misnomer)

Definitions

• Nonneoplastic hyperplasia of duodenal submucosal glands

image Diffuse type (Brunner gland hyperplasia)

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