A Rare Duodenal Mass, Brunneroma: Case Report

Abstract

A 65 years old female patient referred to our clinic was diagnosed with ileus following laparoscopic cholecystectomy. Contrast-enhanced abdominal tomography (CT) had earlier been applied to determine the underlying cause of ileus. A hypodense 52 × 32 mm sized mass was incidentally detected in the first and second sections of duodenum. In upper gastric endoscopy, submucosal located mass was observed in the first section of the duodenum at the posterior wall, which was not blocking the passage of endoscope. Positron emission tomography (PET) CT examination with a standardized uptake value (SUVmax) of 6 showed a potential malignancy. As the patient’s clinical condition worsened, exploratory surgery was planned. Small bowel adhesions and strangulation were detected. Transduodenal biopsy was taken. Pathological examination revealed hyperplastic Brunner’s glands, which was considered to be Brunner’s Gland Adenoma. Patient was discharged at postoperative day 12 with cure. For diagnosis of BGA, endoscopic ultrasonography and contrasted tomography can be used. In symptomatic cases, transduodenal resection can be performed. In the case of non-symptomatic and incidentally detected duodenal masses, however, PET-CT would be useful. A SUVmax lower than 2.3 suggests a benign mass and a higher value over 5 in PET-CT have a high risk of malignancy. As in this case, gastrointestinal system tumors with a SUVmax greater than 5 is not always related with malignancy. In conclusion, for regular bordered mass images, which are detected at this localization, BGA should be kept in mind for differential diagnosis. Patients with BGA should be followed-up for malignancy and recurrence.