Giant Duodenal Brunneroma: Report of a Rare Case and Review of the Literature.

Abstract

BACKGROUND Brunneromas are among the rarest benign tumors of the upper gastrointestinal tract. They arise from the Brunner's glands and patients have a good prognosis if treated timely and radically. Because symptoms are rare, their diagnosis can be challenging, especially regarding the smaller ones. The symptoms reflect a vast spectrum, from asymptomatic to severe obstructive symptoms and bleeding. Given the elevated clinical suspicion, it is imperative to accurately diagnose these tumors. CASE REPORT We present a case of a 39-year-old male patient with a giant Brunneroma in the second segment of the duodenum. He was admitted to the hospital due to melena, epigastric pain, and persisting anemia during the last 2 months preceding his admission. A computed tomography (CT) scan revealed a tumor in the second pars of the duodenum. Following an endoscopic examination and biopsy of the tumor, the case was presented to the multidisciplinary team (MDT) at our hospital. In accordance with the recommendation of the MDT, the patient underwent laparotomy and duodenum-preserving radical tumor excision, without any adverse incidents. The final histopathological reports and preoperative biopsies established the diagnosis of Brunneroma. CONCLUSIONS Because of their rarity and benign character, Brunneromas are often unsuspected and may not have surveillance protocols and proper treatment. This case report presents our experience and perspective regarding the most advisable approach, the differential diagnosis, treatment, and management of these tumors.