The distinction between Brunner gland hyperplastic nodules/polyps and Brunner gland hamartomas is arbitrary and has been traditionally based mainly on size.
In the past, the terms Brunner gland hyperplasia, Brunner gland hamartoma, and Brunner gland adenoma have been used interchangeably causing some confusion in the pathologic classification of these lesions.
DISCUSSION: Brunner gland hyperplasia accounts for 10.6% of all benign duodenal tumors.
In 1934 Feyrter classified brunner gland hyperplasia into 3 types (1) diffuse nodular hyperplasia (2) circumscribed nodular hyperplasia (3) adenomatous hyperplasia/ glandular adenoma.
The key histologic criteria include (1) dilated ducts and pseudocystic changes in the duodenal wall, (2) duodenal submucosal fibrosis extending to the adjacent soft tissue in the groove area and pancreas, and (3) variable Brunner gland hyperplasia forming a thick layer with surrounding smooth muscle and myofibroblastic proliferation.
Characteristics of Groove Pancreatitis Patient population Men > women 40-50 y Alcohol consumption Clinical presentation Severe abdominal pain, mostly epigastric Obstructive symptoms: nausea, vomiting, weight loss Jaundice: rare Imaging: computed tomography Thickened duodenal wall with luminal stenosis Hypodense mass between pancreas and duodenum Cysts Pancreatic duct may be uninvolved Cytology Spindled epithelioid cells with oval nuclei, small nucleoli Background granular/necrotic debris Bland epithelial cells with foamy cytoplasm Histology Fibrosis/scarring Myofibroblastic proliferation Brunner gland hyperplasia Treatment of choice Pancreaticoduodenectomy
By further impairing the discharge, the cysts, Brunner gland hyperplasia, and the reactive spindle cell proliferation may cause the extension of the intraduodenal pancreatitis to the groove region, to the dorsocranial pancreas with compression of the duct of Wirsung, thus adding an obstructive component to the damaging effect of alcohol for the development of the paraduodenal pancreatitis.
The pseudotumoral presentation is the product of a fibroinflammatory process within the intraduodenal pancreatic parenchyma associated with cystic transformation, myoid stromal proliferation, and Brunner gland hyperplasia.
Despite the presence of prominent mature adipose tissue, our lesion can be distinguished from a duodenal lipoma by the presence of ectopic Brunner gland
and dilated ducts.