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• W2912766493 abstract "Brunner gland (BG) nodule greater than 5 mm in diameter, a rare lesion, is regarded as BG hyperplasia (BGH) regardless of coexistence of other tissues. It is only the nodule whose epithelium is dysplastic that deserves the term BG adenoma (BGA), which is still less common. Though two extremely rare cases of cancerating BGA have been reported, which proved a definite association of macroscopic transformation of the lesion with canceration, we present a case, which casts doubt upon it. A spherical semipedunculated submucosal tumor with a small central depression was incidentally located opposite the inferior duodenal angle of a 68-year-old Japanese diabetic male with noncontributory past and family histories. Laboratory data were unremarkable. He was followed up under the diagnosis of BGH by biopsy. The tumor was found to have turned bowl-shaped with a wide central depression occupying almost all the top of it 2 years later. The disrupted surface was uneven, more reddened and lobuated by the groove-like excavations, in and around which the mucosal pattern was obscured and abnormal vessels were observed. As the glandular epithelium showed dysplastic, it was interpreted as BGA. An imminent risk of complicating cancer got it treated with endoscopic mucosal resection, when the central depression more deepened and the excavations coalesced into a wider deeper one. Measuring 17x12x10 mm, it was proven to be composed of nothing but BGs with dysplastic, cystically dilatated epithelium. It demonstrated papillary growth with the large round nuclei having the larger nuclear-cellular ratio but no conspicuous nuclear crowding with stratification. No fibrous septa existed separating the lobules. Relatively larger proportion of the cells was Ki 67-positive in the superficial part but only few p53-positive ones were strewn. Though diffusely immunolabeled with MUC6 but not with MUC2, the lesion, in contrast to the normal BG, had the foci positive for MUC5AC not only in the superficial but in the deeper part, where no regenerative impact extended, reflecting the neoplastic trait. Showing positivity for PAS but not for AB, pepsinogen1 or H+K+-ATPase, it was differentiated from pyloric gland adenoma and definitely diagnosed as BGA without cancer. The present case explicitly proclaims that macroscopic transformation of BGA in a natural history, though omens possible canceration through the neoplastic features, does not necessarily herald such degeneration within.Figure: Endoscopic picture demonstrating a spherical semipedunculated SMT with a small central depression located opposite the inferior duodenal angle.Figure: The SMT turned from spherical to inverted dome-shaped with a wide central depression in 23 months.Figure: The oral J-shaped excavation extended anally to merge with the inverted V-shaped one another 2 months later." @default.
• W2912766493 created "2019-02-21" @default.
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• W2912766493 date "2017-10-01" @default.
• W2912766493 modified "2023-09-27" @default.
• W2912766493 title "A Case of Brunner Gland Adenoma, Which Exhibited Dramatic Macroscopic Metamorphosis in 2 Years Without Canceration" @default.
• W2912766493 doi "https://doi.org/10.14309/00000434-201710001-02437" @default.
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