PMC8214502_01
(a, b) Duodenoscopy showing a pedunculated (arrowheads in (a)), polypoid, 4 cm mass at the duodenal bulb. A secretory portion at the top of the tumor is visible (arrow in (b)) as well as an ulcerated lesion without bleeding (arrow in (a) and arrowheads in (b)).
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There was a secretory portion at the top of the tumor and an ulcerative lesion without bleeding (Figures 1(a) and 1(b)).
Abdominal CT showing a 7 cm mass extending from the bulb to the descending duodenum, with intussusception. The intrahepatic bile duct is not dilated.
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The common bile duct was not dilated (Figure 2).
Magnetic resonance imaging (MRI) showing high- and low-signal intensities in the tumor on T2WI (a, b) and no enhancement during the arterial phase (c). The surface of the mass gradually enhanced during the delayed phase (d).
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T2-weighted image (T2WI). The tumor was not enhanced during the arterial phase; however, the tumor surface was gradually enhanced during the delayed phase (Figures 3(a)-3(d)).
(a, b) The tumor stalk is located at the anterior wall of the bulb (a), and the ampulla is not involved. We opened the anterior duodenal wall (white arrows in (b)) and identified the tumor (black arrows in (b)). We resected the tumor with part of the wall of the duodenal bulb.
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We resected the tumor with the wall of the duodenal bulb (Figures 4(a) and 4(b)).
The resected tumor measured 7 x 4 x 2.3 cm. The surface epithelium consisted of normal duodenal mucosa with areas of focal ulceration and a secretory portion at the top.
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Macroscopically, the size of the resected tumor was 7 x 4 x 2.3 cm, the surface was smooth, and there were cystic lesions inside the mass (Figure 5).
(a, b) The mass consists mostly of lobules of Brunner's glands showing no cellular atypia, with a small cluster of eosinophilic cells in the fibrotic lesion. Immunohistochemically, hyperplastic lobules of Brunner's glands were positive for Muc 6 (B).
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The histological diagnosis was Brunner's gland hyperplasia (BGH) without malignancy (Figures 6(a) and 6(b)).