Brunner Gland Cysts: Morphologic and Endoscopic Features
Donna J Lager, Jennifer A Nielsen, Matthew Lewin, Cory A Roberts. ProPath, Dallas, TX
Background: Brunner glands (BG) are mucosal and submucosal alkaline secreting glands concentrated in the first part of the duodenum decreasing in number in the second and third parts. The most common benign BG proliferative lesion is BG hyperplasia (BGHy) which is often associated with peptic duodenitis. Brunner gland hamartomas (BGHa) and BG cysts (BGCy) are less common; all can present as elevated duodenal lesions. The aim of this study is to more clearly define BGCy as a distinct entity.
Design: The Pathology files were searched from January 2008 to August 2012 for benign BG lesions in the duodenum. The H&E-stained slides from cases diagnosed as BGCy were reviewed, and endoscopic and demographic data were extracted from the patient records.
Results: Of the 236 specimens retrieved, 213 (90.2%) were classified as BGHy, 8 (3.4%) as BGHa and 15 (6.4%) as BGCy. The 8 females and 7 males with BGCy ranged in age from 25 to 86 years with a mean of 64 years. Indications for endoscopy were not directly attributable to the duodenal lesion. The lesion was described as a polyp in 7 patients, a nodule in 3, as submucosal in 3, as “polyp vs. nodule” in 1 and was not characterized in one patient. The BGCy was associated with a pyloric stricture in one patient, was ulcerated in one, was sessile in one and cystic/collapsible in two patients. The size of the lesion, indicated in 8 patients ranged from 3 to 10 mm and was described as “small” in one patient. The BGCy were located in the duodenal bulb or first part of the duodenum in 3 patients, the second part in 5, the third part in 2, and location was not indicated in 5 patients. Morphologically the cysts were unilocular and submucosal and were often multiple. Most had a thin rim of smooth muscle which was attenuated to absent in larger cysts. The cysts were adjacent to normal BG. The cyst-lining cells in all cases were cuboidal with finely granular, slightly eosinophilic cytoplasm resembling BG epithelium. No papillary structures or dysplastic features were present. Occasionally the cyst wall was partial and in two cases was separate from the duodenal mucosa.
Conclusions: Brunner gland cysts are an umcommon cause of duodenal mucosal elevation. They may be described as a nodule or polyp and may be obviously cystic. They occur in all portions of the duodenum and are not associated with overlying mucosal abnormalities. Because they are submucosal and may be only partially represented on biopsy, it is important that they not be overlooked in a duodenal biopsy as the explanation for a “polyp”, avoiding additional unnecessary procedures.
Wednesday, March 6, 2013 1:00 PM
Poster Session VI # 106, Wednesday Afternoon