S6072 Two Cases of Brunner’s Gland Hamartomas: Incidental Findings or Symptomatic Lesions?

Introduction: Brunner’s gland hamartomas (BHG) are benign, rare tumors of the duodenum that comprise less than 1% of gastrointestinal tumors. They result from overgrowth of Brunner's glands, submucosal duodenal glands that secrete protective, alkaline mucus into the duodenal lumen. Because most BGH are asymptomatic, they are usually discovered incidentally on endoscopy or imaging. Symptomatic BHG present non-specifically, with bleeding, abdominal pain and/or signs of duodenal obstruction, such as nausea, vomiting and early postprandial satiety. This report details 2 patients with different presenting symptoms who were ultimately found to have Brunner’s gland hamartomas. Case Description/Methods: Case 1: A 48-year-old man with a past medical history of hypercholesterolemia, asthma and bipolar disorder presented to the emergency for 2 weeks of dark, tarry stools. He was found to have iron deficiency anemia and prescribed a proton pump inhibitor for suspected peptic ulcer disease. One year after his initial presentation, a third esophagogastroduodenoscopy demonstrated a ∼9 cm pedunculated polyp emerging from the duodenal bulb. The polyp was resected, and histopathology confirmed Brunner’s gland hamartoma. Case 2: A 32-year-old woman with a past medical history of polycystic ovarian disease, anxiety and depression presented to urgent care for 3 days of epigastric pain and persistent nausea and vomiting without exacerbating or alleviating factors. She was found to have normal vitals signs and laboratory values. She was referred to gastroenterology for evaluation of possible irritable bowel syndrome or H. Pylori infection. Esophagogastroduodenoscopy/colonoscopy revealed a ∼5 cm pedunculated polyp extended from the duodenal bulb. The polyp was resected, and histopathology confirmed Brunner’s gland hamartoma. Discussion: In both cases, duodenal bulb Brunner’s gland hamartomas were identified during endoscopic evaluation for gastrointestinal symptoms: melena and anemia in Case 1 and epigastric pain, nausea and vomiting in Case 2. No other abnormalities were identified on endoscopy or colonoscopy, raising the possibility that the hamartomas were the primary cause of the patient’s symptoms. Symptomatic BGH present variably and non-specifically, overlapping with the presentation of more common gastrointestinal conditions. Although rare, Brunner’s gland hamartomas should be considered in the differential diagnosis of nonspecific upper gastrointestinal symptoms—especially when suggestive lesions are identified.