history f/49 present illness : 3 개월전 건강 검진 상 시행한 egd 에서 duodenal polyp...
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History
F/49
Present illness : 3 개월전 건강 검진 상 시행한 EGD 에서
duodenal polyp 발견됨
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Endoscopic findings
3x2.2cm sized hyperemic protruding polypoid mass(YAMADA type 4) at junction of duodenal 1st and 2nd portion.
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Cross section of a duodenal polyp (H&E, x1)
Relatively well demarcated submucosal mass lesion
Note the lobulated pattern and cystically dilated space
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Proliferation of Brunner’s gland surrounded by muscle fiber and fibrous tissue.
The cells of Brunner’s glands are eosinophilic with clear cytoplasm, and they typically contain basally oriented nuclei
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Proliferation of Brunner’s gland intermixed with adipose tissue, smooth muscle fiber and lymphocyte. Note the cystically dilated gland.
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Admixture of glandular, fatty element, lymphoid tissue and
vascular structure. Note the cystically dilated Brunner’s gland
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Brunner’s gland hamartoma- Solitary mass that contains a mixture of acini, du
cts, smooth muscle, adipose tissue, and lymphoid tissue
- Brunner’s gland hamartomas can occasionally contain heterotopic pancreatic acini and ducts
- The lesion usually lie entirely beneath the muscularis mucosa
- Dilatation of the glandular aicini or ducts show cystic appearance
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c.f) Brunner’s gland hyperplasia
: Multiple small polypoid or nodular lesions composed of excessive Brunner’s glands separated by fibrous septa
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Brunner’s gland hamartoma
-Mostly incidental finding (abdominal pain, duodenal abstruction, GI bleeding, intu, ob
x. Of CBD, pancreatic duct)
-Incidence : fifth and sixth decades
-No risk of malignancy
-Rare complication : massive upper GI bleeding
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Reference
Gastrointestinal pathology Parakrama’
Gastrointestinal pathology An atlas and text
Brunner’s gland hyperplasia and hmartoma : imaging features with clinicopathologic correlation
AJR 2006;187:751-722