PMID- 24422755
OWN - NLM
STAT- MEDLINE
DCOM- 20140911
LR  - 20211021
IS  - 1471-230X (Electronic)
IS  - 1471-230X (Linking)
VI  - 14
DP  - 2014 Jan 14
TI  - Duodenal mucosal damage is associated with proliferative activity of Brunner's 
      gland hamartoma: a case report.
PG  - 14
LID - 10.1186/1471-230X-14-14 [doi]
AB  - BACKGROUND: Brunner's gland hamartoma is a rare tumor, predominantly found in the 
      fifth to sixth decades of life. Generally, it is a single pedunculated polyp, 
      rarely larger than 5 cm. Asymptomatic cases are found incidentally, but cases 
      with a large polyp tend to have gastrointestinal bleeding and/or obstructive 
      symptoms. Polyp size increases in a time-dependent manner, however, the growth 
      mechanism is unknown. We report a Japanese male case in his mid-twenties with an 
      over 6 cm sized polyp. CASE PRESENTATION: A 26-year-old man presented black 
      stools and anemia. Endoscopic examination revealed a large pedunculated polyp at 
      gastroduodenal junction. The polyp, subsequently resected by distal gastrectomy, 
      was lobulated with random surface erosions and sized 6.4 x 3 cm. Histological 
      examination revealed that the polyp arose from duodenal mucosa and was composed 
      of hyperplastic Brunner's glands in lobules separated by fibromuscular septa, 
      associated with lymphocytic infiltrate and lymphoid follicles. No evidence of 
      malignancy was found. Thus, the lesion was diagnosed as Brunner's gland 
      hamartoma. Further immunohistochemical studies indicated that gastric foveolar 
      metaplasia is associated with surface epithelium covering upper two thirds of the 
      polyp, showing immunohistochemical positivity for mucin 5 AC (MUC5AC). Below the 
      metaplastic surface epithelium, Brunner's glands had high proliferative activity 
      (MIB-1 labeling index: 7.9%). The similar staining pattern was observed at 
      surface erosive sites (MIB-1 labeling index in Brunner's glands: 9%). On the 
      other hand, surface epithelium in the lower side of the polyp still preserved 
      intestinal nature, containing CDX2-positive nuclei and MUC2-positive goblet 
      cells. Brunner's glands below the surface epithelium with intestinal 
      characteristics showed low proliferative activity (MIB-1 labeling index: 0.77%). 
      CONCLUSION: Proliferative activity of Brunner's glands was high at the sites with 
      surface erosion and also below the epithelium showing gastric foveolar 
      metaplasia. As gastric foveolar metaplasia occurs along with a mucosal repair 
      process in the duodenum, mucosal damages underlay the hamartomatous proliferation 
      of Brunner's glands and eventually resulted in a formation of large polypoid mass 
      in this case.
FAU - Akaki, Mayumi
AU  - Akaki M
AD  - Clinical Laboratory, University of Miyazaki Hospital, 5200 Kihara, Kiyotake, 
      Miyazaki, Miyazaki, 889-1692, Japan. mayumi_akaki@med.miyazaki-u.ac.jp.
FAU - Taniguchi, Shoji
AU  - Taniguchi S
FAU - Hatakeyama, Kinta
AU  - Hatakeyama K
FAU - Kushima, Ryoji
AU  - Kushima R
FAU - Kataoka, Hiroaki
AU  - Kataoka H
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20140114
PL  - England
TA  - BMC Gastroenterol
JT  - BMC gastroenterology
JID - 100968547
RN  - 0 (Ki-67 Antigen)
RN  - 0 (Mucin 5AC)
SB  - IM
MH  - Adult
MH  - Brunner Glands/chemistry/*pathology
MH  - *Cell Proliferation
MH  - Duodenal Diseases/*pathology
MH  - Hamartoma/chemistry/*pathology
MH  - Humans
MH  - Intestinal Mucosa/chemistry/*pathology
MH  - Intestinal Polyps/chemistry/*pathology
MH  - Ki-67 Antigen/analysis
MH  - Male
MH  - Metaplasia/metabolism/pathology
MH  - Mucin 5AC/analysis
PMC - PMC3898372
EDAT- 2014/01/16 06:00
MHDA- 2014/09/12 06:00
PMCR- 2014/01/14
CRDT- 2014/01/16 06:00
PHST- 2012/11/13 00:00 [received]
PHST- 2014/01/10 00:00 [accepted]
PHST- 2014/01/16 06:00 [entrez]
PHST- 2014/01/16 06:00 [pubmed]
PHST- 2014/09/12 06:00 [medline]
PHST- 2014/01/14 00:00 [pmc-release]
AID - 1471-230X-14-14 [pii]
AID - 10.1186/1471-230X-14-14 [doi]
PST - epublish
SO  - BMC Gastroenterol. 2014 Jan 14;14:14. doi: 10.1186/1471-230X-14-14.