Duodenal Brunner's gland adenoma: Clinical analysis of eight cases

Background: Brunner's gland adenoma is an uncommon intestinal tumor, frequently located in the duodenal bulb. This investigation reports a series of patients with Brunner's adenoma treated at Chang Gang Memorial Hospital. Methods: The medical records of patients with Brunner's gland adenoma were reviewed. Their clinical characters, endoscopic features, radiological findings, management, and histological features were thoroughly investigated and discussed. Results: Totally, 8 patients (5 men and 3 women) were admitted to this study, with ages ranging between 24 and 60 years old. Patients presented with hemorrhage (n=4), obstruction (n=1), or incidental finding (n=1). Additionally, one patient had symptoms of hemorrhage concomitant with obstruction, and one patient suffered from long-term dull epigastralgia and epigastric fullness. Tumors were generally pedunculated and polypoid, located in the first portion of the duodenum, and ranged between 3 and 8 cm at their maximum dimension. These patients were managed with duodenotomy followed by polypectomy (n=3), endoscopic polypectomy (n=2), subtotal gastrectomy (n=2), and bypass with gastrojejunostomy (n=1). Histologically, Brunner's gland adenomas are composed of lobules of proliferating Brunner's glands separated by strands of smooth muscle fibers. The outcome of the patients reviewed herein was predominantly favorable, and no additional major morbidity was identified. Conclusion: Brunner's gland adenomas are uncommon duodenal tumors occurring in middle age. They present with gastrointestinal hemorrhage, obstructive symptoms, or incidentally. Panendoscopy and endoscopic ultrasonography might be helpful in diagnosing Brunner's gland adenoma, and surgical and endoscopic excision is uncomplicated and favorable. Small or asymptomatic tumors can be managed by either expectant or endoscopic excision, while larger tumors causing symptoms can be treated surgically either through resection or alternative bypass.