Authors K. PAQUET (1), I. VAN DEN BERGHE (2) / [1] KULeuven, Leuven, Belgium, Pathology, [2] AZ Sint-Jan Brugge-Oostende, Brugge, Belgium, Pathologie Brunner’s gland hamartoma is a rarely reported lesion of unknown aetiology and pathogenesis. In contrast to the more common Brunner’s gland hyperplasia it generally presents as a single polyp, by definition larger than 5 mm. A Brunner’s gland hamartoma is an infrequent cause of gastrointestinal bleeding or obstruction. A need for invasive surgical intervention is rarer still. A review of the literature could only find a handful of cases treated by pancreaticoduodenectomy (Whipple procedure). Here we describe the case of a 67 year old female, originally presenting with chronic anaemia resulting in fatigue and shortness of breath. Endoscopy showed an ulcerated sessile tumour in the second portion of duodenum. Subsequent computed tomography revealed an underlying fusiform tumoral mass located in the duodenal wall, radiologically compatible with a gastro-intestinal stromal tumour. Biopsy results were inconclusive, with only granulation tissue in the acquired sample. A complete resection by means of pancreaticoduodenectomy ensued. Histopathological study revealed a mass, measuring 108 x 68 mm, fully composed of hyperplastic Brunner’s glands, mature fat and connective tissue. Therefore, a diagnosis of a giant Brunner’s gland hamartoma, was made. There was no dysplasia. Postoperative adverse events included haemoptysis and an associated aspiration pneumonia. The patient was free of adverse events at 3 months follow up. Diagnostic modalities such as endoscopy and radiological imaging help in guiding the clinicians towards a correct preoperative differential diagnostic landscape. Our case serves as a reminder of the fallibility of these investigations. Despite a relative low rate of incidence, sources state that Brunner’s gland hamartoma’s make up approximately 5% of all duodenal masses. Tumours > 100 mm are however a rare entity, generally being pedunculated masses instead of more sessile polyps. We propose that awareness of this rare entity, and the potential giant proportion of these, is vital in order to prevent overtreatment and subsequent intra- and postoperative morbidity. In light of diagnostic amelioration, we report this case to illustrate the rare benign entity of a giant Brunner’s gland hamartoma.
