PMC5578567_01
Radiosopic features of Brunner gland hamartoma
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F1
An initial ultrasound was performed and a 4.4 x 3 x 2.7 cm oval, well-defined, isoechoic, intraluminal solid mass was found in the region of distal duodenum extending up to the duodeno-jejunal flexure (Fig. 1A). There was telescoping of the first part of the duodenum into the second part (Figs 1B to D).
Features of Brunner gland hamartoma
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F2
The patient underwent upper gastrointestinal endoscopy with EUS, which revealed a giant polypoidal lesion arising from the junction of the first and second parts of the duodenum with ulcerations at its tip (Figs 2A to C). EUS revealed approximately 4 x 2.8 x 2 cm large, mixed echoic duodenal submucosal lesion with a thick pedicle, leading to duodenal intussusception and obstruction. Endoscopic ultrasound also identified a feeding artery and possibility of GIST was suggested (Figs 2A to C).
Macroscopic and microscopic views of Brunner gland hamartoma
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F3
In view of broad-based pedicle and possibility of GIST, a supra-ampullary duodenectomy was performed .The polypoidal duodenal mass lesion (Figs 3A and B) was removed. There was no evidence of dysplasia or malignancy (Figs 3C and D).