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17 January 2013 - Case of the Week #263 February 4-8, 2013
The Canyons Resort
Park City, Utah (USA)

26th Annual Park City
Combined AP/CP Pathology Update For more information, contact:
Leita Rogers
Telephone: (801) 581-2034


Website news:

(6) Our Feature Page for January highlights Billing / consulting / management, and includes AdvantEdge Healthcare Solutions, APS Medical Billing, Pathology Service Associates, LLC, Vachette Pathology. We also have a new Mystery Case on the right side of the Home Page.

Case of the Week #263

Clinical History:

A 53 year old woman presented with a 3 week history of epigastric pain. Endoscopsy showed a 1.8 x 1.5 cm pedunculated mass in the proximal duodenum, which was biopsied.

Micro images: What is your diagnosis?


Brunner gland hamartoma


Brunner gland hamartoma, also called Brunner gland adenoma, is a rare benign lesion of the duodenum composed of adipose tissue, hyperplastic Brunner’s glands and cystic ducts lined by ciliated cells (World J Gastroenterol 2004;10:2616). Rare cystic cases have been reported. Most cases (89%) are pedunculated. The cause is unknown, although relationships with chronic pancreatitis, hyperacidity, hyperchlorhydria, H. pylori gastritis (South Med J 2008;101:648) and uremia have been suggested.

Symptoms include upper GI hemorrhage and obstruction and less commonly intussusception, biliary obstruction, or pancreatitis (Radiographics 2012;32:213). They also occur as an incidental finding in 2% of gastroscopies, usually in the duodenal bulb. Superficial endoscopic biopsies are often unremarkable because the masses are submucosal.

These tumors are benign, and excision is curative.