거대 Brunner 종양 국내보고 39예의 임상적 고찰

강지훈,임윤정,한석재,최종순,고문수,이진호 대한소화기내시경학회 2010 Clinical Endoscopy Vol.40 No.5

Background/Aims: Brunner's gland tumor is a common benign tumor noted in duodenum and might be designated as Brunner's gland hamartoma, adenoma or hyperplasia. But, a large duodenal polyp (over 1 cm in diameter) pathologically proven as a tumor of Brunner's gland origin is rare. Methods: We analyzed a total of 39 cases including our direct experience of two cases and reports of 37 cases to clarify the clinical features of large Brunner's gland tumors. Results: This tumor tends to present predominantly after the fourth decade: Median age is 52.6 years. Neither gender showed predominance. The size of the tumor ranged from 1 to 8 cm and the mean diameter was 2.9 cm. The most common location was the bulb. A pedunculated polyp was the common appearance. Epigastric pain was the most common symptom. Brunner's gland tumor can cause gastrointestinal hemorrhage or obstruction. Most of the polyps had non-diagnostic pathologic yield at pinch biopsy and only one case was diagnosed as focal adenocarcinoma. Endoscopic or surgical removal was undertaken for treatment. Most cases had no recurrence after removal. Snare polypectomy or submucosal dissection very safe and useful treatment modalities. Conclusions: Large Brunner's gland tumors are mostly found during a check up or epigastric pain. Anemia, melena and obstruction often develop. Endoscopic polypectomy is recommended as a first line treatment. 목적: Brunner 종양은 흔한 양성 종양으로 십이지장에 존재하며 Brunner 과오종, 선종, 과증식으로도 부른다. 그러나, 직경 1 cm 이상의 Brunner 과오종, 선종, 과증식은 드물다. 대상 및 방법: 국내 학술지에 보고된 37예와 저자들이 경험한 2예를 토대로 1 cm 이상의 Brunner 종양의 임상적 특징을 알아보았다. 결과: 평균 나이는 52.6세였으며 40세 이후 뚜렷한 증가 추세가 관찰되었고 성별에 따른 차이는 없었다. 크기는 1 cm에서 8 cm으로 나타났고 평균 직경 2.9 cm이었으며 모양은 주로 유경성 용종으로 나타났다. 가장 흔한 위치는 구부였으며, 심와부 통증이 가장 흔한 증상이었다. Brunner 종양은 위장관 출혈 및 폐색 등 합병증으로 발견된다. 대부분의 용종은 점막 조직검사에서 비 진단적인 병리학적 소견을 보이고 한 예에서만이 Brunner 종양에서 악성 변화를 관찰할 수 있었다. 치료로 대부분 내시경적 용종절제술 또는 점막하박리술이 안전하게 이루어졌으며 일부에서 수술적 제거로 이루어졌다. 제거 후에는 국소적 재발은 없었다. 결론: Brunner 종양은 심와부 동통이나 검진 목적으로 상부위장관 내시경에서 대부분 우연히 발견되나 빈혈, 위장관 출혈, 폐색 등 합병증이 동반된다. 정확한 조직학적 진단과 치료를 위해 일차적으로 내시경적 용종절제술을 권고한다.

낭종내 도립형 증식을 동반한 낭성 Brunner선 과증식

홍석인,김진일,이호상,김건민,박진민,정대영,박수헌,김재광 대한소화기내시경학회 2009 Clinical Endoscopy Vol.39 No.4

Cystic Brunner’s gland hyperplasia is a benign lesion of the duodenum that may not be familiar to gastroenterologists because of its rarity. Moreover, cystic Brunner’s gland hyperplasia with intacystic inverted growth is more uncommon lesion. Here, we report a case of cystic Brunner’s gland hyperplasia in a 34-year-old man. An endoscopy of the upper digestive tract revealed the presence of a 1.2 cm sized polypoid mass of the duodenal second portion. Endoscopic submucosal dissection was performed to remove the mass. Microscopically, a cystic lesion was seen in the submucosa underneath the normal surface duodenal mucosa. Hyperplastic Brunner’s glands were seen close by the cyst. The cyst was lined by a layer of columnar epithelium similar to that of Brunner’s gland ducts with no cytologic atypia. Also, a part of the cyst lining was inverted into the cyst lumen with fibrovascular core. Therefore, The final diagnosis was a cystic Brunner’s gland hyperplasia with intracystic inverted growth. 낭성 Brunner선 과증식은 십이지장에서 발생하는 드문 양성 병변이며 이는 소화기내과 의사에 익숙하지 않은 질환이다. 더욱이 낭종내 도립형 증식을 동반한 낭성 Brunner선 과증식은 매우 드문 질환이다. 저자들은 낭종내 도립형 증식을 동반한 낭성 Brunner선 과증식으로 진단된 34세 남자 환자를 경험하였다. 상부위장관 내시경 결과에서 십이지장 제2부의 1.2 cm 크기의 용종성 종괴가 관찰되어 내시경 점막하 박리술을 시행하였다. 조직검사 소견에서 종괴는 정상 십이지장 점막을 갖춘 병변이었고 점막하에 Brunner선 정열을 갖춘 낭성 병변과 그 주변으로 Brunner선 과증식이 관찰되어 낭성 Brunner선 과증식으로 진단할 수 있었다. 또한, 낭성 병변 정열의 일부가 낭성 병변 내강으로 도립되었고 낭성 병변 정열을 이루는 상피에서 이형성 소견이 관찰되지 않아, 낭종내 도립형 증식을 동반한 낭성 Brunner선 과증식으로 최종 진단할 수 있었다.

증례 : 소화기 ; 형성이상을 동반한 Brunner 샘 과다형성 1예

김민성 ( Min Seong Kim ),박정민 ( Jung Min Park ),이창석 ( Chang Seog Lee ),김철영 ( Chul Young Kim ),임영배 ( Young Bae Lim ),이용규 ( Yong Gyu Lee ),이동현 ( Dong Hyun Lee ) 대한내과학회 2012 대한내과학회지 Vol.82 No.3

Brunner`s gland hyperplasia, also known as Brunner`s gland adenoma, polypoid hamartoma, or Brunneroma, is a rare proliferative lesion arising from the Brunner`s glands of the duodenum. These lesions have been described previously as benign, with no malignant potential. We report a case of Brunner`s gland hyperplasia in the duodenum that was discovered incidentally during the endoscopic evaluation of anal bleeding. Histopathological examination of this Brunner`s gland hyperplasia revealed well-marked, low-grade dysplasia. This case suggests a dysplastic stage with malignant potential in the natural history of Brunner`s gland hyperplasia. (Korean J Med 2012;82:321-325)

세파계 항생제가 흰쥐 Brunner's gland에 미치는 영향

이법이 건국대학교 의과학연구소 2000 건국의과학학술지 Vol.10 No.-

This study was performed in male Sprague-Dawley rats to investigate effects of ceftezole sodium(CTZ) on Brunner's gland. Rats were treated intraperitoneally with CTZ at 1000mg/kg/day for 7 consecutive days. 1)Alcian blue(pH 2.5)-P.A.S stain: In Brunner's gland of the treated group, there was a decrease in red and blue color reactivity. This means that weakly sulfated acid mucin and neutral mucin especially decreased. 2)EM study: In acinus of Brunner's gland of the treated group, wide and irregular intercellular spaces and small sized secretory vesicles were observed. But any other distinct changes in the cytoplasmic organelles were not detectable. Consequently, it was suggested that CTZ influences the mucopolysaccharides synthesis in Brunner's gland.

내시경으로 절제한 거대 십이지장 Brunner선 선종

강병국 ( Byung Kook Kang ),박남선 ( Nam Seon Park ),진대호 ( Dae Ho Jin ),안태홍 ( Tae Hong Ahn ),박민범 ( Min Bom Park ),이기조 ( Key Jo Lee ),한윤주 ( Yoon Ju Han ),박효진 ( Hyo Jin Park ) 대한소화기학회 2008 대한소화기학회지 Vol.52 No.2

Brunner`s gland adenoma is a rare tumor of duodenum. Patients are usually aymptomatic and most are discovered incidentally during the upper gastrointestinal (GI) series or esophagogastroduodenoscopy. These lesions are most commonly located in the duodenal bulb and clinical manifestations are variable. In symptomatic patients, the most common manifestations are GI hemorrhage and duodenal obstruction. On histologic examination, Brunner`s gland adenoma that causes clinical symptoms is composed of hyperplastic Brunner`s glands and contains mostly an admixture of glandular, adipose, and muscular tissues. We report a case of large Brunner`s gland adenoma causing upper gastrointestinal hemorrhage in a 47-year-old woman which was successfully removed by endoscopic resection without complications such as bleeding or perforation. Microscopically, it was entirely composed of variable Brunner`s glands. (Korean J Gastroenterol 2008;52:106-109)

잠복성 위장관 출혈을 일으킨 Brunner선 과오종

박창환 ( Park Chang Hwan ),이수정 ( Lee Su Jeong ),박정호 ( Park Jeong Ho ),박재홍 ( Park Jae Hong ),이완식 ( Lee Wan Sig ),주영은 ( Ju Yeong Eun ),김현수 ( Kim Hyeon Su ),최성규 ( Choe Seong Gyu ),유종선 ( Yu Jong Seon ),유성협 ( 대한소화기학회 2004 대한소화기학회지 Vol.43 No.3

Brunner`s gland hamartomas are rare tumors of duodenum, they are often discovered incidentally during esophagogastroduodenoscopy or upper gastrointestinal series. These tumors arise mainly in the duodenal bulb and can present with gastrointestinal hemorrhage and intestinal obstruction. Most of Brunner`s gland hamartomas are located within the range of the standard esophagogastroduodenoscope. However, they are rarely located below the third portion of duodenum. As well known, the small intestine, including the 4th portion of duodenum, jejunum, and ileum, is relatively inaccessible with routine endoscopy. Thus, the diagnosis of Brunner`s gland hamartoma in these area can be delayed up to several months after onset of symptoms. We report a case of Brunner`s gland hamartoma which was located in the fourth portion of the duodenum and presented as obscure gastrointestinal hemorrhage. Radiologic, surgical, and pathologic appearances are presented. (Korean J Gastroenterol 2004; 43:211-214)

내시경적 절제술로 치료한 급성 출혈을 동반한 거대 브루너샘 샘종 1예

박평강,정우조,이경용,이성학,장재정,서승철 고신대학교(의대) 고신대학교 의과대학 학술지 2015 고신대학교 의과대학 학술지 Vol.30 No.2

Brunner’s gland adenoma is a rare benign small bowel neoplasm and it represents 10% of small bowel benign tumor. Most of adenoma manifest as polypoidal, multiple and size does not exceed 1 cm and mostly asymptomatic, but the lesion larger than 1 ㎝ is solitary and can cause bleeding, obstruction, intussusception and there are some reports of showing malignant transformation. Until the present, there are two cases of over 8㎝ huge Brunner’s gland adenoma in Korea and each of their chief complaint was abdominal discomfort and melena, but there is no case report of over 8 ㎝ Brunner’s gland adenoma accompanied with acute bleeding as seen in this case. We diagnosed an 8 ㎝ sized, huge duodenal Brunner’s gland adenoma which accompanied with acute bleeding and treated it by endoscopic resection using an IT-knife, successfully.

브루너샘의 낭종 위에 발생한 십이지장 선종

남윤정 ( Yun Jung Nam ),김병욱 ( Byung-wook Kim ),김준성 ( Joon Sung Kim ),김기준 ( Gi Jun Kim ) 대한소화기학회 2017 대한소화기학회지 Vol.70 No.3

Sporadic non-ampullary duodenal adenoma is uncommon and found incidentally during endoscopic examinations. Brunner`s gland hyperplasia is commonly encountered during endoscopic examinations. Adenomas arising from Brunner`s gland hyperplasia originate from the glandular cells, and the surface epithelia are usually intact. Little has been reported on adenomas originating from the surface epithelium that overrides Brunner`s gland hyperplasia. Here, we report a case of a sporadic non-ampullary duodenal adenoma overriding the cystic dilatation of Brunner`s gland hyperplasia. (Korean J Gastroenterol 2017;70:141-144)

Brunner선 선종 치료에 있어서 내시경 용종절제술의 안전성과 유용성에 대한 검토

박재홍 ( Jae Hong Park ),박창환 ( Chang Hwan Park ),박정호 ( Jeong Ho Park ),이수정 ( Soo Jung Lee ),이완식 ( Wan Sik Lee ),주영은 ( Young Eun Joo ),김현수 ( Hyun Soo Kim ),최성규 ( Sung Kyu Choi ),유종선 ( Jong Sun Rew ),김세종 ( 대한소화기학회 2004 대한소화기학회지 Vol.43 No.5

Background/Aims: Brunner`s gland adenoma is a rare benign tumor of the duodenum. Although several cases of successful endoscopic polypectomy have been reported, the studies on the safety and usefulness of endoscopic polypectomy are extremely rare. Therefore, we report the results of 10 cases of Brunner`s gland adenoma treated by endoscopic polypectomy. Methods: Between November 1998 and January 2003, 10 cases of Brunner`s gland adenoma were diagnosed. The mean age of the cases (6 male, 4 female) was 60.4 years. They were located in the bulb (9) and the second portion (1) of the duodenum. All cases were diagnosed and removed by endoscopic polypectomy. Results: The size of the tumor ranged from 1.0 to 3.5 cm in diameter. Pedunculated polyps were found in three cases. In other seven cases, semipedunculated polyps were observed and, three of them were presented as submucosal tumor. All cases had no malignant foci. There was no complication such as bleeding, perforation, and pancreatitis after endoscopic polypectomy. During follow-up period (range 1~39 months) after endoscopic polypectomy, there was no complication and recurrence of the lesions. Conclusions: Endoscopic polypectomy was a safe and useful method for the treatment of duodenal Brunner`s gland adenoma without complication and recurrence.(Korean J Gastroenterol 2004;43:299-303)

샘근육종 과증식을 동반한 십이지장 구부 거대 Brunner선 과증식

정주원 ( Joo Won Chung ),서주희 ( Joo Hee Seo ),박승우 ( Seung Woo Park ),송시영 ( Si Young Song ),정재복 ( Jae Bock Chung ),김상겸 ( Sang Kyum Kim ),김호근 ( Ho Keun Kim ),방승민 ( Seung Min Bang ) 대한소화기학회 2008 대한소화기학회지 Vol.52 No.6

Brunner`s gland hyperplasia is a rare tumor of the duodenum and might also be an unusual cause of gastrointestinal bleeding. In symptomatic patients, treatment requires either surgical resection or endoscopic polypectomy. We report a case of upper gastrointestinal bleeding from a pedunculated Brunner`s gland hyperplasia in the duodenal bulb. Endoscopic resection using the detachable snare and hemoclipping was instituted to remove a large pedunculated polyp. The pathologic diagnosis was Brunner`s gland hyperplasia with adenomyomatous hyperplasia.