S6032 Benign Bumps, Big Impacts: Exploring Hamartomas in the Gastrointestinal Tract

Introduction: Hamartomas are benign lesions consistent of disorganized tissue native to the anatomical location. Though typically benign, they can undergo malignant transformation. Common sites of hamartomas include lungs, hypothalamus, and breast. They may cause morbidity by various mechanisms such as infection, infarction, pressure/obstruction, hemorrhage, and neoplastic transformation. Here, we highlight a rare case of Brunner’s gland hamartoma in the gastric antrum of the gastrointestinal tract. Case Description/Methods: A 43-year-old obese man with a past medical history of seasonal allergies and prior transverse duodenal mass presented for a follow-up. Three years prior, an endoscopy revealed a mass in the duodenal bulb covering a quarter of the circumference. Partial removal via cold forceps yielded inconclusive biopsies. A recent computed tomography abdomen and pelvis failed to detect the mass. Therefore, the patient underwent a repeat esophagogastroduodenoscopy which revealed a large multi-lobulated polyp with a smooth surface and a thick stalk arising from the edge of the pyloric channel. A solution of Everlift and epinephrine was injected to define the stalk and a 20 mm hot snare was used for a complete resection. Purastat solution was applied to the mucosal defect to aid in healing, and 1 Boston Scientific ultra-clip was placed to prevent bleeding. Pathology confirmed a Brunner’s gland hamartoma. Discussion: Brunner’s gland hamartomas are rare, benign duodenal tumors, compromising less than 1% of primary gastrointestinal tumors. Their clinical manifestations are often nonspecific, and the exact etiology remains unclear, but may be linked to high gastric acid section, H. pylori infection, chronic pancreatitis, inflammatory stimulation, and mucosal injury. Endoscopic biopsies are frequently negative, given that the mass is often covered by intact mucosa, and their submucosal location makes standard biopsies insufficient for accurate diagnosis. When biopsies are obtained, evaluation for malignant transformation through histology and immunochemistry is essential, especially if the lesion increases in size or exhibits morphological changes. This case highlights the importance of early detection and complete excision of gastrointestinal hamartomas. Addressing the underlying cause remains the cornerstone of effective management.