BRUNNER GLAND HAMARTOMAS - CLINICAL PRESENTATION AND PATHOLOGICAL FEATURES OF 27 CASES

Objectives: The aim of this study was to characterize the clinical pre sentation, pathological features, and outcome of a series of patients with Brunner's gland hamartomas. Methods: We reviewed the clinical and pathological features of 27 patients who presented with Brunner's gla nd hamartomas, and we obtained follow-up information. Results: Patient s (12 men and 15 women) presented predominantly in the fifth and sixth decades of life either with gastrointestinal hemorrhage (n = 10) or o bstructive symptoms (n = 10); there were also patients whose tumors we re discovered as an incidental finding (n = 7). The tumors were genera lly pedunculated, were located in the first portion of the duodenum, a nd were in the range of diameter from 1 to 6 cm. Histologically, the h amartomas were characterized by the presence of nondysplastic, lobulat ed Brunner's glands with intervening bands of fibrous tissue and varia ble adipose and lymphoid tissue. Focal sclerosis was found in 93% of t he hamartomas, possibly mimicking an adenocarcinoma. Whether managed s urgically (24 patients) or endoscopically (three patients), the outcom e was uniformly favorable. After a median period of 7-yr-follow-up, no tumors recurred, and no additional morbidity was identified. Conclusi ons: Brunner's gland hamartomas are rare duodenal tumors occurring in middle age that present either with gastrointestinal hemorrhage, obstr uctive symptoms, or as an incidental finding. Surgical or endoscopic e xcision is uncomplicated, and the long-term outcome is favorable.