Brunner’s gland hamartoma: DISCUSSION Part 4

DISCUSSION

EUS may be helpful in establishing a preliminary diagnosis by evaluating characteristics of the mass. Certain lesions tend to have reproducible characteristics on endosonography, and the Brunner’s gland hamartoma is no exception. Whereas a typical Brunner’s gland appears as a heterogeneous hyperechoic structure, the Brunner’s gland hamartoma appears as a heterogeneous hypoechoic mass marked by multiple small cystic areas within the lesion and indistinct margins. Furthermore, it characteristically arises from the second and third echolayer. The multiple small cystic areas and the heterogeneity seen on EUS are secondary to the presence of smooth muscle bundles, fibrous stoma and clusters of glands within the lesion, some of which may be dilated.

Of course, the definitive diagnosis depends on histological evaluation. Characteristics include a well circumscribed, nonencapsulated lesion with lobular architecture, in which glandular structures may be embedded in fibrous stroma. Normal-appearing Brunner’s glands are typically present, as are variable combinations of ducts, smooth muscle, adipose tissue, sclerotic glands and lymphoid aggregates. Best quality drugs available at best online pharmacy at prices that you are going to enjoy every time: get your cialis professional with no problems and no prescription of any kind any time you need some treatment that works 100%.

Because of the benign nature of Brunner’s gland hamartomas, in most cases, therapy should be reserved for lesions that have become symptomatic. The traditional approach has been surgical excision through a duodenotomy or segmental duodenal resection. Recently, however, endoscopic polypectomy has been been shown to be safe and effective, and may be associated with decreased morbidity, shortened hospital stay and reduced cost. In the present case, the large size of the lesion, coupled with its location in the thin-walled third portion of the duodenum, would have made endoscopic mucosal resection difficult and potentially dangerous; therefore, it was not attempted.

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