In addition, an association between chronic pancreatitis and Brunner’s gland hyperplasia may exist. As many as 76% of patients with pancreaticoduodenal resections for chronic pancreatitis show evidence of diffuse Brunner’s gland hyperplasia, and some suggest that this may be an adaptation in the setting of exocrine insufficiency of the pancreas.
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The differential diagnosis of the Brunner’s gland hamartoma includes adenomatous polyps, leiomyomas, leiomyosarcomas, gastrointestinal stromal tumours, lymphomas, pancreatic or ampullary carcinomas, carcinoid tumour or melanoma, among others.
The diagnosis of a Brunner’s gland hamartoma should be considered for any polypoid lesion in the duodenum. These lesions may appear either sessile or pedunculated; one series of 27 patients noted that the lesions were pedunculated in 89% of cases. As mentioned previously, most Brunner’s gland hamartomas occur in the proximal duodenum; the same series of 27 patients found that 70% had a hamartoma in the bulb, 26% in the second portion and 4% in the third portion. Because these lesions tend to be submucosal, routine endoscopic biopsies may not be adequate for establishing the diagnosis, and further studies are often required. Because EUS is considered to be the best modality to image submucosal structures, it has become the imaging modality of choice.