title: Giant Brunner's gland adenoma of the duodenal bulb presenting with ampullary and duodenal obstruction mimicking pancreatic malignancy.
abstract: BACKGROUND
  Brunner's gland adenoma is a rare benign duodenal neoplasm. It usually presents with luminal obstruction or gastrointestinal bleeding. In rare cases, it may mimic a pancreatic malignancy and may present with obstructive jaundice.
  
  
  METHODS
  A 65-year-old female presented with a two-month history of abdominal pain, early satiety and retrosternal burning pain. Liver function tests showed elevated enzymes with normal bilirubin. Imaging studies revealed a large mass in relation to the uncinate process of the pancreas and the distal duodenum along with the dilated common bile duct and the main pancreatic duct. Initial endoscopic evaluation failed to make a correct diagnosis. Repeat endoscopic evaluation combined with endoscopic sonography, however, revealed a large polypoid mass arising from the duodenal bulb. The patient underwent a transduodenal polypectomy. A diagnosis of Brunner's gland adenoma was made on histopathological examination.
  
  
  CONCLUSIONS
  Giant Brunner's adenoma may have unusual presentations. It may present with the features of ampullary obstruction mimicking periampullary or pancreatic malignancies. Extensive preoperative evaluation is required to reach a correct diagnosis in order to avoid more extensive surgery.
authors: Department of Surgical Gastroenterology, Chhatrapati Shahuji Maharaj Medical University, Erstwhile King George Medical University, Lucknow, Uttar Pradesh, India. vggis@yahoo.co.in
authors: Vishal
authors: V
authors: Gupta
authors: Parul
authors: P
authors: Gupta
authors: Ajay
authors: A
authors: Jain
mesh_terms: D000236:Adenoma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology; D002011:Brunner Glands / Q000473:pathology*; D003137:Common Bile Duct Diseases / Q000175:diagnosis / Q000209:etiology*; D003937:Diagnosis, Differential; D004379:Duodenal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D004380:Duodenal Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D010190:Pancreatic Neoplasms / Q000175:diagnosis*; D047368:Tumor Burden