2020 Volume 62 Issue 7 Pages 778-784
A 75-year-old man with a complaint of black stool and anemia was referred to our hospital. Endoscopic examination revealed a non-pedunculated polyp at the posterior aspect of the bulb with a small area of erosion and blood spot on the top, and we performed endoscopic hemostasis. Five weeks later, endoscopic ultrasound (EUS)-fine needle aspiration (FNA) revealed Brunnerʼs gland hyperplasia and the tissue from EUS-FNA was non-neoplastic. Four days after EUS-FNA, the patient developed black stool again, and we performed endoscopic hemostasis again. Because the lesion repeatedly hemorrhaged and because endoscopic resection of a non-pedunculated polyp at the posterior aspect of the bulb would be difficult, he underwent open duodenal submucosal dissection. The tumor was 25×25×10 mm, and histological analysis showed acinar cells, ducts and smooth muscles, leading to the diagnosis of Brunnerʼs gland hamartoma (BGH). In the past, according to the location of the lesion, pancreaticoduodenectomy was a choice for treatment when endoscopic resection of a hemorrhaging BGH would be difficult. Therefore, EUS-FNA is useful for preoperative diagnosis.
