위 유문륜에서 기시하여 심한 빈혈과 장중첩증을 동반한 거대 브루너선 선종 1예 = A Case of Giant Brunner's Gland Adenoma Originating from the Gastric Pylorus Associated with Severe Anemia and Intussusception

다국어 초록 (Multilingual Abstract)

Brunner's gland adenoma is characterized by benign proliferation of the normal Brunner's gland, and is a relatively rare disease that accounts for only 10% of benign duodenal tumors. It is usually found in the bulb and second portion of the duodenum, but is rarely found in the pylorus. The clinical manifestations vary from non-specific upper abdominal symptoms to obstruction, intussusception and gastrointestinal hemorrhage. It is a benign lesion but rarely undergoes malignant transformation. Management of Brunner's gland adenoma involves complete removal of the lesion. We experienced a 43-year-old man who had complained of melena and dyspnea on exertion. An esophagogastroduodenoscopy and computed tomography of the upper gastrointestinal tract demonstrated the presence of a 5.5 4.0 cm sized hyperemic and lobulated large mass with hemorrhage that originated from the pylorus and was intussuscepted into the duodenum. Resection of the tumor revealed that it was a Brunner's gland adenoma on a histological examination. (Korean J Gastrointest Endosc 2007;35:100-104)

국문 초록 (Abstract)

브루너선 선종은 십이지장에 정상적으로 존재하는 브루너선의 증식을 보이는 양성 종양이다. 이 종양의 발생 빈도는 비교적 드물며, 발생 부위는 주로 십이지장 구부이고 유문륜에서의 발생은 매우 드물다. 환자에서 흔히 나타나는 증상은 비특이적인 상부 위장관 증상이며 가끔 위장관 출혈을 동반하기도 하고 드물게는 장폐색, 장중첩증을 일으키기도 한다. 최근 브루너선의 악성화 소견이 보고되어 있으므로 반드시 제거해야 한다. 저자들은 흑색변과 운동 시 호흡곤란을 주소로 내원한 43세 남자에서 위내시경 검사 및 복부 전산화 단층 촬영을 시행하여 유문륜에서 기시하여 출혈로 인한 중증 빈혈소견과 십이지장 내로 장중첩증을 동반하고 있는 5.5×4.0 cm의 거대 종양을 관찰하여 수술로 제거하였으며, 조직검사에서 브루너선 선종으로 진단된 증례를 문헌 고찰과 함께 보고한다.

참고문헌 (Reference)

1 "a clinicopathologic analysis of six cases" koreanjgastrointestendosc1994;1419-23

2 "Two cases of Brunner's gland adenoma" 345-350, koreanjgastrointestendosc1990;10

3 "The safety and usefulness of endoscopic polypectomy for treatment of Brunner's gland adenomas" 43 : 299-303, 2004

4 "Relationship between disease of the pancreas and hyperplasia of Brunner's glands" 75-87,

5 "Nodular hyperplasia of Brunner's glands" 374-378, gastrointestendosc1985;31

6 "Large adenomatous polyp of Brunner's glangs" 438-443, amjclinpathol1961;36

7 "Intussusception of the duodenum report of a case due to Brunner's gland hyperplasia" 160-166,

8 "Four cases of Brunner's gland adenoma" 82-88, koreanjgastrointestendosc1994;14

9 "Endoscopic polypectomy in five cases of duodenal Brunner's gland adenoma" 283-288, koreanjgastroenterol1987;19

10 "Endoscopic injection and polypectomy for bleeing Brunner's gland hamartoma: case report and expanded literature review" 47 : 403-407, 1998

11 "Carcinoma of duodenum arising from Brunner's gland" 37 : 293-296, 2002

12 "Carcinoma of duodenal bulb arising from the Brunner's gland" itsu (itsu): 118-125, gastroenteroljpn1993;28

13 "Brunner's gland hamartoma with incipient ductal malignancy" 75-78, tumori1981;67

14 "Brunner's gland hamartoma causing gastric outlet obstruction treated by endoscopic resection" 54 : 114-117, 1998

15 "An unusual cause of jejunal intussusception: heterotopic and hyperplastic Brunner's gland pseudo-tumor" 29 : 1160-1163, 2005

16 "A case of huge duodenal Brunner's gland hyperplasia" 24 : 35-38, 2002

17 "A case of endoscopic polypectomy with a detachable snare in a huge duodenal Brunner's gland adenoma" 18 : 239-243, 1998

18 "A case of a giant Brunner's gland hamartoma originating from the pyloric ring" 27 : 531-535, 2003

19 "A case of Brunner's gland hamartoma with severe anemia and intussusception" 17 : 691-695, 1997