1. History F/49 Present illness : 3 개월전 건강 검진 상 시행한 EGD 에서 duodenal polyp 발견됨

2. Endoscopic findings 3x2.2cm sized hyperemic protruding polypoid mass(YAMADA type 4) at junction of duodenal 1 st and 2 nd portion.

3. Cross section of a duodenal polyp (H&E, x1) Relatively well demarcated submucosal mass lesion Note the lobulated pattern and cystically dilated space

4. Proliferation of Brunner ’ s gland surrounded by muscle fiber and fibrous tissue. The cells of Brunner’s glands are eosinophilic with clear cytoplasm, and they typically contain basally oriented nuclei

5. Proliferation of Brunner ’ s gland intermixed with adipose tissue, smooth muscle fiber and lymphocyte. Note the cystically dilated gland.

6. Admixture of glandular, fatty element, lymphoid tissue and vascular structure. Note the cystically dilated Brunner ’ s gland

7. Brunner ’ s gland hamartoma - Solitary mass that contains a mixture of acini, ducts, smooth muscle, adipose tissue, and lymphoid tissue - Brunner’s gland hamartomas can occasionally contain heterotopic pancreatic acini and ducts - The lesion usually lie entirely beneath the muscularis mucosa - Dilatation of the glandular aicini or ducts show cystic appearance

8. c.f) Brunner’s gland hyperplasia : Multiple small polypoid or nodular lesions composed of excessive Brunner’s glands separated by fibrous septa

9. Brunner ’ s gland hamartoma -Mostly incidental finding (abdominal pain, duodenal abstruction, GI bleeding, intu, obx. Of CBD, pancreatic duct) -Incidence : fifth and sixth decades -No risk of malignancy -Rare complication : massive upper GI bleeding

10. Reference Gastrointestinal pathology Parakrama ’ Gastrointestinal pathology An atlas and text Brunner ’ s gland hyperplasia and hmartoma : imaging features with clinicopathologic correlation AJR 2006;187:751-722