Presentation on theme: "History F/49 Present illness : 3 개월전 건강 검진 상 시행한 EGD 에서 duodenal polyp 발견됨."— Presentation transcript:
History F/49 Present illness : 3 개월전 건강 검진 상 시행한 EGD 에서 duodenal polyp 발견됨
Endoscopic findings 3x2.2cm sized hyperemic protruding polypoid mass(YAMADA type 4) at junction of duodenal 1 st and 2 nd portion.
Cross section of a duodenal polyp (H&E, x1) Relatively well demarcated submucosal mass lesion Note the lobulated pattern and cystically dilated space
Proliferation of Brunner ’ s gland surrounded by muscle fiber and fibrous tissue. The cells of Brunner’s glands are eosinophilic with clear cytoplasm, and they typically contain basally oriented nuclei
Proliferation of Brunner ’ s gland intermixed with adipose tissue, smooth muscle fiber and lymphocyte. Note the cystically dilated gland.
Admixture of glandular, fatty element, lymphoid tissue and vascular structure. Note the cystically dilated Brunner ’ s gland
Brunner ’ s gland hamartoma - Solitary mass that contains a mixture of acini, ducts, smooth muscle, adipose tissue, and lymphoid tissue - Brunner’s gland hamartomas can occasionally contain heterotopic pancreatic acini and ducts - The lesion usually lie entirely beneath the muscularis mucosa - Dilatation of the glandular aicini or ducts show cystic appearance
c.f) Brunner’s gland hyperplasia : Multiple small polypoid or nodular lesions composed of excessive Brunner’s glands separated by fibrous septa
Brunner ’ s gland hamartoma -Mostly incidental finding (abdominal pain, duodenal abstruction, GI bleeding, intu, obx. Of CBD, pancreatic duct) -Incidence : fifth and sixth decades -No risk of malignancy -Rare complication : massive upper GI bleeding
Reference Gastrointestinal pathology Parakrama ’ Gastrointestinal pathology An atlas and text Brunner ’ s gland hyperplasia and hmartoma : imaging features with clinicopathologic correlation AJR 2006;187:751-722