Brunner's gland hamartoma: 'over-treatment' of a voluminous mass simulating a malignancy of the pancreatic-duodenal area.
BACKGROUND
Brunner's gland hyperplasia is rarely associated with clinical symptoms. Most of the lesions are less than 1 cm in diameter and accounts for about 6.8% of all endoscopically removed duodenal polyps. When symptoms occur, this hyperplasia can be effectively treated with endoscopy. However, when the lesion is too large to pass through the endoscopic snare, endoscopic treatment is not possible and surgical treatment is necessary. This treatment may vary from local excision to more complex operations. When Brunner's gland hyperplasia does not have common dimensions, it may also mimic a malignancy of the duodenal-pancreatic area. In this case, a biopsy is indicated even though its result may be not informative.


METHODS
We report the case of a 60-year-old man with a large Brunner's gland hyperplasia mimicking a malignancy and in which the impossibility of a correct diagnosis by pre-operative and intra-operative biopsy led to 'over-treatment' involving a duodenocephalopancreatectomy.


CONCLUSIONS
This 'over-treatment' may be justified since nowadays the consequences of leaving an undiagnosed pancreatic cancer are much worse than the risk of undergoing a major pancreatic operation.
Iusco
Domenico
D
Surgical Department, Section of General Surgery and Surgical Therapy, University of Parma, Italy. minguccio73@hotmail.com
Roncoroni
Luigi
L
Violi
Vincenzo
V
Donadei
Enrico
E
Sarli
Leopoldo
L
D001706:Biopsy; D002011:Brunner Glands / Q000473:pathology*; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D004378:Duodenal Diseases / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D004379:Duodenal Neoplasms / Q000473:pathology; D006222:Hamartoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology; D016577:Pancreaticoduodenectomy; D011859:Radiography