Giant Brunner's Gland Adenoma of the Duodenal Bulb Presenting with Ampullary and Duodenal Obstruction Mimicking Pancreatic Malignancy

  • Vishal Gupta Department of Surgical Gastroenterology, Chhatrapati Shahuji Maharaj Medical University. Lucknow, Uttar Pradesh. India
  • Parul Gupta Department of Pathology, Era’s Lucknow Medical College. Lucknow, Uttar Pradesh. India
  • Ajay Jain Department of Gastroenterology, Choithram Hospital and Research Center. Indore, Madhya Pradesh, India
Keywords: Adenoma, Adenomatous Polyps, Brunner Glands, Duodenal Obstruction, Intussusception, Pancreatic Neoplasms, Pancreaticoduodenectomy


Context Brunner’s gland adenoma is a rare benign duodenal neoplasm. It usually presents with luminal obstruction or gastrointestinal bleeding. In rare cases, it may mimic a pancreatic malignancy and may present with obstructive jaundice. Case report A 65-year-old female presented with a two-month history of abdominal pain, early satiety and retrosternal burning pain. Liver function tests showed elevated enzymes with normal bilirubin. Imaging studies revealed a large mass in relation to the uncinate process of the pancreas and the distal duodenum along with the dilated common bile duct and the main pancreatic duct. Initial endoscopic evaluation failed to make a correct diagnosis. Repeat endoscopic evaluation combined with endoscopic sonography, however, revealed a large polypoid mass arising from the duodenal bulb. The patient underwent a transduodenal polypectomy. A diagnosis of Brunner’s gland adenoma was made on histopathological examination. Conclusion Giant Brunner’s adenoma may have unusual presentations. It may present with the features of ampullary obstruction mimicking periampullary or pancreatic malignancies. Extensive preoperative evaluation is required to reach a correct diagnosis in order to avoid more extensive surgery.

Image: Long pedicle-like structure.


Download data is not yet available.


Osborne R, Toffler R, Lowman RM. Brunner's gland adenoma of the duodenum. Am J Dig Dis 1973; 18:689-94. [PMID 4721129]

Hol JW, Stuifbergen WN, Teepen JL, van Laarhoven CJ. Giant Brunner's hamartomas of the duodenum and obstructive jaundice. An overview of the literature and suspicion of malignancy in a case. Dig Surg 2007; 24:452-5. [PMID 18025786]

Levine JA, Burgart LJ, Batts KP, Wang KK. Brunner's gland hamartomas: clinical presentation and pathological features of 27 cases. Am J Gastroenterol 1995; 90:290-4. [PMID 7847303]

Iusco D, Roncoroni L, Violi V, Donadei E, Sarli L. Brunner's gland hamartoma: 'over-treatment' of a voluminous mass simulating a malignancy of the pancreatic-duodenal area. JOP. J Pancreas (Online) 2005; 6:348-53. [PMID 16006686]

Silverman L, Waugh JM, Huizenga KA, Harrison EG Jr. Large adenomatous polyp of Brunner's glands. Am J Clin Pathol 1961; 36:438-43. [PMID 13912933]

Paimela H, Härkönen M, Karonen SL, Tallgren LG, Stenman S, Ahonen J. Relation between serum group II pepsinogen concentration and the degree of Brunner's gland hyperplasia in patients with chronic renal failure. Gut 1985; 26:198-202. [PMID 3967837]

Sáenz de Santa María J, Pajuelo F, Lozano F, Cordero R, Pérez Miranda M. Diffuse hyperplasia of Brunner's glands in relation to pancreatic and/or renal disease. Med Clin (Barc) 1983; 80:646. [PMID 6876924]

Fuse Y, Tsuchihashi Y, Takamasu M, Kawamoto K, Kodama T, Fujita S, Kashima K. Thickness of Brunner's glands and its clinical significance in peptic ulcer diseases. Gastroenterol Jpn 1989; 24:512-8. [PMID 2806830]

Kovacevic I, Ljubicic N, Cupic H, Doko M, Zovak M, Troskot B, et al. Helicobacter pylori infection in patients with Brunner's gland adenoma. Acta Med Croatica 2001; 55:157-60. [PMID 12398018]

de Nes LC, Ouwehand F, Peters SH, Boom MJ. A large Brunner's gland hamartoma causing gastrointestinal bleeding and obstruction. Dig Surg 2007; 24:450-2. [PMID 18025785]

Lingawi SS, Filipenko JD. Brunner's gland hamartoma causing gastric outlet obstructive symptoms. South Med J 1998; 91:964-5. [PMID 9786295]

Lempke RE. Intussusception of the duodenum: report of a case due to Brunner's gland hyperplasia. Ann Surg 1959; 150:160-6. [PMID 13661844]

Kellogg EL. Intussusception of the duodenum caused by adenoma originating in Brunner's glands. Med J Record 1931; 134:440-2.

Chuang JH, Chen WJ. Duodenojejunal intussusception secondary to hamartomatous polyp of Brunner's glands. J Pediatr Gastroenterol Nutr 1991; 13:96-100. [PMID 1919957]

Peetz ME, Moseley HS. Brunner's gland hyperplasia. Am Surg 1989; 55:474-7. [PMID 2662841]

Stermer E, Elias N, Keren D, Rainis T, Goldstein O, Lavy A. Acute pancreatitis and upper gastrointestinal bleeding as presenting symptoms of duodenal Brunner's gland hamartoma. Can J Gastroenterol 2006; 20:541-2. [PMID 16955152]

Hedges AR. Hamartoma of Brunner's gland causing pyloric obstruction and a biliary fistula. Case report. Acta Chir Scand 1988; 154:475-6. [PMID 3263743]

Shorrock K, Haldane JS, Kersham MJ, Leach RD. Obstructive jaundice secondary to carcinoma arising in Brunner's glands. J R Soc Med 1986; 79:173-4. [PMID 3701756]

Feyter F. Ouber Wucherun gender Brunners chen Drusen. Virchow Arch Path Anat 1934; 293:509.

Reisner RM, Nava HR. Large Brunner's gland hamartoma simulating a pancreatic mass with obstruction and bleeding. Surg Endosc 1996; 10:341-3. [PMID 8779074]

Mumtaz R, Shah IA, Ramirez FC. Brunner's gland hamartoma simulating a pancreatic mass with duodenal obstruction. Gastrointest Endosc 2002; 56:932-4. [PMID 12447318]

Lee WC, Yang HW, Lee YJ, Jung SH, Choi GY, Go H, et al. Brunner's gland hyperplasia: treatment of severe diffuse nodular hyperplasia mimicking a malignancy on pancreatic-duodenal area. J Korean Med Sci 2008; 23:540-3. [PMID 18583897]

Limi L, Liew NC, Badrul RH, Faisal MJ, Daniel YPK. Duodenal intussusception of Brunner's gland adenoma mimicking a pancreatic tumor. Med J Malaysia 2010; 65:313-4.

Skellenger ME, Kinner BM, Jordan PH Jr. Brunner's gland hamartomas can mimic carcinoma of the head of the pancreas. Surg Gynecol Obstet 1983; 156:774-6. [PMID 6857456]

Hizawa K, Iwai K, Esaki M, Suekane H, Inuzuka S, Matsumoto T, et al. Endosonographic features of Brunner's gland hamartomas which were subsequently resected endoscopically. Endoscopy 2002; 34:956-8. [PMID 12471538]

Patel ND, Levy AD, Mehrotra AK, Sobin LH. Brunner's gland hyperplasia and hamartoma: imaging features with clinicopathologic correlation. AJR Am J Roentgenol 2006; 187:715-22. [PMID 16928936]

Rajagopalan S, al-Arrayed S, Dhiman RK. Brunner's gland polyp with upper gastrointestinal bleeding managed by endoscopic polypectomy: a report of two cases. Trop Gastroenterol 2003; 24:133-4. [PMID 14978987]

Chen YY, Su WW, Soon MS, Yen HH. Hemoclip-assisted polypectomy of large duodenal Brunner's gland hamartoma. Dig Dis Sci 2006; 51:1670-2. [PMID 16927147]

Rocco A, Borriello P, Compare D, De Colibus P, Pica L, Iacono A, Nardone G. Large Brunner's gland adenoma: case report and literature review. World J Gastroenterol 2006; 12:1966-8. [PMID 16610009]

Baladas HG, Borody TJ, Smith GS, Dempsey MB, Richardson MA, Falk GL. Laparoscopic excision of a Brunner's gland hamartoma of the duodenum. Surg Endosc 2002; 16:1636. [PMID 12196895]

Gupta V, Singh V, Kalra N, Vaiphei K. Pancreas sparing resection for giant hamartoma of Brunner's glands. JOP. J Pancreas (Online) 2009; 10:196-9. [PMID 19287118]

Long pedicle-like structure
How to Cite
GuptaV., GuptaP., & JainA. (2011). Giant Brunner’s Gland Adenoma of the Duodenal Bulb Presenting with Ampullary and Duodenal Obstruction Mimicking Pancreatic Malignancy. JOP. Journal of the Pancreas, 12(4), 413-419.