BACKGROUND Duodenal Brunner's gland hyperplasia(BGH)is a therapeutic target when complications such as bleeding or gastrointestinal obstruction occur or when malignancy cannot be ruled out.Herein,we present a case...BACKGROUND Duodenal Brunner's gland hyperplasia(BGH)is a therapeutic target when complications such as bleeding or gastrointestinal obstruction occur or when malignancy cannot be ruled out.Herein,we present a case of large BGH treated with endoscopic mucosal resection(EMR).CASE SUMMARY An 83-year-old woman presented at our hospital with dizziness.Blood tests revealed severe anemia,esophagogastroduodenoscopy showed a 6.5 cm lesion protruding from the anterior wall of the duodenal bulb,and biopsy revealed the presence of glandular epithelium.Endoscopic ultrasonography(EUS)demonstr-ated relatively high echogenicity with a cystic component.The muscularis propria was slightly elevated at the base of the lesion.EMR was performed without complications.The formalin-fixed lesion size was 6 cm×3.5 cm×3 cm,showing nodular proliferation of non-dysplastic Brunner's glands compartmentalized by fibrous septa,confirming the diagnosis of BGH.Reports of EMR or hot snare polypectomy are rare for duodenal BGH>6 cm.In this case,the choice of EMR was made by obtaining information on the base of the lesion as well as on the internal characteristics through EUS.CONCLUSION Large duodenal lesions with good endoscopic maneuverability and no evident muscular layer involvement on EUS may be resectable via EMR.展开更多
AIM: To examine the molecular mechanism of exocytosis in the Brunner’s gland acinar cell. METHODS: We used a submucosal preparation of guinea pig duodenal Brunner’s gland acini to visualize the dilation of the ducta...AIM: To examine the molecular mechanism of exocytosis in the Brunner’s gland acinar cell. METHODS: We used a submucosal preparation of guinea pig duodenal Brunner’s gland acini to visualize the dilation of the ductal lumen in response to cholinergic stimulus. We correlated this to electron microscopy to determine the extent of exocytosis of the mucin-filled vesicles. We then examined the behavior of SNARE and interacting Munc18 proteins by confocal microscopy. RESULTS: One and 6 μmol/L carbachol evoked a dose- dependent dilation of Brunner’s gland acini lumen, which correlated to the massive exocytosis of mucin. Munc18c and its cognate SNARE proteins Syntaxin-4 and SNAP-23 were localized to the apical plasma membrane, and upon cholinergic stimulation, Munc18c was displaced into the cytosol leaving Syntaxin-4 and SNAP-23 intact. CONCLUSION: Physiologic cholinergic stimulation induces Munc18c displacement from the Brunner’s gland acinar apical plasma membrane, which enables apical membrane Syntaxin-4 and SNAP-23 to form a SNARE complex with mucin-filled vesicle SNARE proteins to affect exocytosis.展开更多
BACKGROUND Brunner’s gland hyperplasia(BGH)is a rare benign lesion of the duodenum.Lipomatous pseudohypertrophy(LiPH)of the pancreas is an extremely rare disease.Because each condition is rare,the probability of pure...BACKGROUND Brunner’s gland hyperplasia(BGH)is a rare benign lesion of the duodenum.Lipomatous pseudohypertrophy(LiPH)of the pancreas is an extremely rare disease.Because each condition is rare,the probability of purely coincidental coexistence of both conditions is extremely low.CASE SUMMARY We report a 26-year-old man presenting to our hospital with symptoms of recurrent upper gastrointestinal bleeding.Upper gastrointestinal endoscopy showed a huge pedunculated polypoid lesion in the duodenum with bleeding at the base of the lesion.Histopathological examination of the duodenal biopsy specimens showed BGH.Besides,abdominal computed tomography and magnetic resonance imaging revealed marked fat replacement over the entire pancreas,confirmed by histopathological evaluation on percutaneous pancreatic biopsies.Based on the radiological and histological findings,LiPH of the pancreas and BGH were diagnosed.The patient refused any surgical intervention.Therefore,he was managed with supportive treatment.The patient’s symptoms improved and there was no further bleeding.CONCLUSION This is the first well-documented case showing the coexistence of LiPH of the pancreas and BGH.展开更多
Brunner’s gland adenoma is a rare tumour of the duodenum,which is usually benign.A 71-year-old woman presenting with epigastric pain,upper gastro-intestinal haemorrhage and melaena was reported in this paper.Upper ga...Brunner’s gland adenoma is a rare tumour of the duodenum,which is usually benign.A 71-year-old woman presenting with epigastric pain,upper gastro-intestinal haemorrhage and melaena was reported in this paper.Upper gastro-intestinal(GI)endoscopy revealed a large pedunculated tumour on the superior part of the duodenal bulb.Endoscopic polypectomy was successfully performed by clipping and nylon thread without any com-plications.Histological examination revealed a Brunner’s gland adenoma.展开更多
文摘BACKGROUND Duodenal Brunner's gland hyperplasia(BGH)is a therapeutic target when complications such as bleeding or gastrointestinal obstruction occur or when malignancy cannot be ruled out.Herein,we present a case of large BGH treated with endoscopic mucosal resection(EMR).CASE SUMMARY An 83-year-old woman presented at our hospital with dizziness.Blood tests revealed severe anemia,esophagogastroduodenoscopy showed a 6.5 cm lesion protruding from the anterior wall of the duodenal bulb,and biopsy revealed the presence of glandular epithelium.Endoscopic ultrasonography(EUS)demonstr-ated relatively high echogenicity with a cystic component.The muscularis propria was slightly elevated at the base of the lesion.EMR was performed without complications.The formalin-fixed lesion size was 6 cm×3.5 cm×3 cm,showing nodular proliferation of non-dysplastic Brunner's glands compartmentalized by fibrous septa,confirming the diagnosis of BGH.Reports of EMR or hot snare polypectomy are rare for duodenal BGH>6 cm.In this case,the choice of EMR was made by obtaining information on the base of the lesion as well as on the internal characteristics through EUS.CONCLUSION Large duodenal lesions with good endoscopic maneuverability and no evident muscular layer involvement on EUS may be resectable via EMR.
基金Grants to H.Y.G. from the U.S. National Institute of Health, R21 AA015579-01A1 and to S.V. form the Canadian Institute of Health Research
文摘AIM: To examine the molecular mechanism of exocytosis in the Brunner’s gland acinar cell. METHODS: We used a submucosal preparation of guinea pig duodenal Brunner’s gland acini to visualize the dilation of the ductal lumen in response to cholinergic stimulus. We correlated this to electron microscopy to determine the extent of exocytosis of the mucin-filled vesicles. We then examined the behavior of SNARE and interacting Munc18 proteins by confocal microscopy. RESULTS: One and 6 μmol/L carbachol evoked a dose- dependent dilation of Brunner’s gland acini lumen, which correlated to the massive exocytosis of mucin. Munc18c and its cognate SNARE proteins Syntaxin-4 and SNAP-23 were localized to the apical plasma membrane, and upon cholinergic stimulation, Munc18c was displaced into the cytosol leaving Syntaxin-4 and SNAP-23 intact. CONCLUSION: Physiologic cholinergic stimulation induces Munc18c displacement from the Brunner’s gland acinar apical plasma membrane, which enables apical membrane Syntaxin-4 and SNAP-23 to form a SNARE complex with mucin-filled vesicle SNARE proteins to affect exocytosis.
基金Supported by School of Medicine and Pharmacy,Vietnam National University Hanoi,Hanoi,Viet Nam,No.QGSP.2021.06.
文摘BACKGROUND Brunner’s gland hyperplasia(BGH)is a rare benign lesion of the duodenum.Lipomatous pseudohypertrophy(LiPH)of the pancreas is an extremely rare disease.Because each condition is rare,the probability of purely coincidental coexistence of both conditions is extremely low.CASE SUMMARY We report a 26-year-old man presenting to our hospital with symptoms of recurrent upper gastrointestinal bleeding.Upper gastrointestinal endoscopy showed a huge pedunculated polypoid lesion in the duodenum with bleeding at the base of the lesion.Histopathological examination of the duodenal biopsy specimens showed BGH.Besides,abdominal computed tomography and magnetic resonance imaging revealed marked fat replacement over the entire pancreas,confirmed by histopathological evaluation on percutaneous pancreatic biopsies.Based on the radiological and histological findings,LiPH of the pancreas and BGH were diagnosed.The patient refused any surgical intervention.Therefore,he was managed with supportive treatment.The patient’s symptoms improved and there was no further bleeding.CONCLUSION This is the first well-documented case showing the coexistence of LiPH of the pancreas and BGH.
文摘Brunner’s gland adenoma is a rare tumour of the duodenum,which is usually benign.A 71-year-old woman presenting with epigastric pain,upper gastro-intestinal haemorrhage and melaena was reported in this paper.Upper gastro-intestinal(GI)endoscopy revealed a large pedunculated tumour on the superior part of the duodenal bulb.Endoscopic polypectomy was successfully performed by clipping and nylon thread without any com-plications.Histological examination revealed a Brunner’s gland adenoma.
