Giant Brunner's hamartomas of the duodenum and obstructive jaundice. An overview of the literature and suspicion of malignancy in a case.
OBJECTIVE
150 cases of Brunner's gland hamartoma (BGH) have been reported in the literature. BGHs are benign and are thought not to cause bile obstruction.


METHODS
In this case report, a 60-year-old male is presented with unexplained obstructive jaundice who was also known for over 17 years with diffuse adenomatous hyperplasia of Brunner's glands in the duodenum. Despite the benign preoperative diagnosis, the choice of treatment was Whipple's procedure due to suspicion of a coexisting malignancy.


RESULTS
Pathological analysis of the resection specimen revealed multiple BGHs and an adenocarcinoma of the papilla of Vater (PoV). Molecular pathology using loss of heterogeneity analysis was used to confirm that both were different entities.


CONCLUSIONS
It is likely that previous reports of malignant degeneration of BGHs may actually have been cases involving the coexistence of a PoV adenocarcinoma. Physicians need to be alert when a patient presents with BGH accompanied with obstructive jaundice for simultaneously occurring PoV adenocarcinoma.
Hol
J W
JW
Elisabeth Ziekenhuis, Tilburg, The Netherlands. jaapwhol@yahoo.com
Stuifbergen
W N H M
WN
Teepen
J L J M
JL
van Laarhoven
C J H M
CJ
D000230:Adenocarcinoma / Q000150:complications / Q000453:epidemiology* / Q000601:surgery; D014670:Ampulla of Vater; D002011:Brunner Glands / Q000473:pathology; D003138:Common Bile Duct Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000601:surgery; D015897:Comorbidity; D013505:Digestive System Surgical Procedures; D004108:Dilatation, Pathologic; D004378:Duodenal Diseases / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D004386:Duodenum / Q000000981:diagnostic imaging / Q000473:pathology; D006222:Hamartoma / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D006984:Hypertrophy; D041781:Jaundice, Obstructive / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed