euro-gastro-2018-scientifictracks

15 / 25

6 t h A n n u a l E u r o p e a n C o n f e r e n c e o n
Gastroenterology
Euro Gastro 2018
J u n e 1 9 - 2 0 , 2 0 1 8
P a r i s , F r a n c e
Page 41
Journal of Clinical Gastroenterology and Hepatology
ISSN 2575-7733
Brunner gland (BG) nodule greater than 5 mm in diameter, a rare lesion,
is regarded as BG hyperplasia (BGH) regardless of coexistence of other
tissues. It is only the nodule whose epithelium is dysplastic that deserves the
term BG adenoma (BGA), which is still less common. Though two extremely
rare cases of cancerating BGA have been reported, which proved a definite
association of macroscopic transformation of the lesion with canceration,
we present a case, which casts doubt upon it. A spherical semi pedunculated
submucosal tumor with a small central depression was incidentally located
opposite the inferior duodenal angle of a 68-year-old Japanese diabetic
male with noncontributory past and family histories. Laboratory data were
unremarkable. He was followed up under the diagnosis of BGH by biopsy. The
tumor was found to have turned bowl-shaped with a wide central depression
occupying almost all the top of it 2 years later. The disrupted surface was
uneven, more reddened and lobulated by the groove-like excavations, in and
around which the mucosal pattern was obscured, and abnormal vessels were
observed. As the glandular epithelium showed dysplastic, it was interpreted as
BGA. An imminent risk of complicating cancer got it treated with endoscopic
mucosal resection, when the central depression more deepened and the
excavations coalesced into a wider deeper one. Measuring 17x12x10 mm,
it was proven to be composed of nothing but BGs with dysplastic, cystically
dilatated epithelium. It demonstrated papillary growth with the large round
nuclei having the larger nuclear-cytoplasmic ratio but no conspicuous nuclear
crowding with stratification. No fibrous septa existed separating the lobules.
Relatively larger proportion of the cells was Ki 67-positive in the superficial part
but only few p53-positive ones were strewn. Though diffusely immunolabeled
with MUC6 but not with MUC2, the lesion, in contrast to the normal BG, had
the foci positive for MUC5AC not only in the superficial but in the deeper
part, where no regenerative impact extended, reflecting the neoplastic trait.
Showing positivity for PAS but not for AB, pepsinogen1 or H+K+-ATPase, it
was differentiated from pyloric gland adenoma and diagnosed as BGA without
cancer. The present case explicitly proclaims that macroscopic transformation
of BGA in a natural history, though omens possible canceration through the
neoplastic features, does not necessarily herald such degeneration within.
Biography
Kenji Sasaki has completed his MD and as an Immunologist,
he completed his PhD at Tohoku University School of Medicine.
He was trained at Miyagi Cancer Center. He is a Board Certified
Fellow and Preceptor of Japan Gastroenterological Endoscopy
Society, Board Certified Gastroenterologist of Japanese Society
of Gastroenterology, Board Certified Member of the Japanese
Society of Internal Medicine and Editorial Board Member of
CRIM. He has published several papers on Gastroenterology
in international journals and served as a Reviewer for
Journal of Medical Microbiology, Journal of Pharmacology
& Pharmacotherapeutics and Journal of Gastrointestinal &
Digestive System.
A case of brunner gland adenoma, which exhibited dramatic
macroscopic metamorphosis in 2 years without canceration
Kenji Sasaki 1, Nobuo Takano 2, Noriyuki Iwama3 and Takayuki
Masuda4
1Midtown Medicare Clinic, Australia
2Shiogama City Hospital, Japan
3Tohoku Rosai Hospital, Japan
4Cancer Detection Center, Miyagi Cancer Society, Japan
Kenji Sasaki et al., J Clin Gastroenterol Hepatol 2018, Volume: 2
DOI: 10.21767/2575-7733-C1-002