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ACG Case Reports Journal Jun 2023Malignant neoplasms arising from the Brunner gland are exceedingly rare. A 62-year-old man with a history of surgical resection of Brunner gland adenocarcinoma presented...
Malignant neoplasms arising from the Brunner gland are exceedingly rare. A 62-year-old man with a history of surgical resection of Brunner gland adenocarcinoma presented with upper extremity cellulitis. Hospital course was complicated by atrial fibrillation and hematochezia. Bidirectional endoscopy was negative; however, small bowel enteroscopy revealed recurrence of Brunner gland adenocarcinoma 6 years after surgical resection. To our knowledge, this is the first reported case of recurrent Brunner gland adenocarcinoma after curative resection.
PubMed: 37305801
DOI: 10.14309/crj.0000000000001060 -
Journal of Translational Internal... Sep 2023The surface of the small bowel mucosa is covered more than any other section of the digestive canal; however, the overall prevalence of small bowel tumors of the whole...
The surface of the small bowel mucosa is covered more than any other section of the digestive canal; however, the overall prevalence of small bowel tumors of the whole gastrointestinal tract is evidently low. Owing to the improvement in endoscopic techniques, the prevalence of small bowel tumors has increased across multiple countries, which is mainly due to an increase in duodenal tumors. Superficial non-ampullary duodenal epithelial tumors (SNADETs) are defined as tumors originating from the non-ampullary region in the duodenum that share similarities and discrepancies with their gastric and colorectal counterparts in the pathogenesis and clinicopathologic characteristics. To date, white light endoscopy (WLE) remains the cornerstone of endoscopic diagnosis for SNADETs. Besides, narrow-band imaging (NBI) techniques and magnifying endoscopy (ME) have been widely used in the clinic and endorsed by multiple guidelines and consensuses for SNADETs' evaluation. Confocal laser endomicroscopy (CLE), endocytoscopy (ECS), and artificial intelligence (AI) are also up-and-coming methods, showing an exceptional value in the diagnosis of SNADETs. Similar to the endoscopic treatment for colorectal polyps, the choices for SNADETs mainly include cold snare polypectomy (CSP), endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and laparoscopic endoscopic cooperative surgery (LECS). However, owing to the narrow lumen, rich vascularity, weak muscle layer, abundant Brunner's gland, and the hardship of endoscope control, the duodenum ranks as one of the most dangerous operating areas in the digestive tract. Therefore, endoscopists must anticipate the difficulties in endoscopic maneuverability, remain aware of the increased risk of complications, and then select the appropriate treatment according to the advantages and disadvantages of each method.
PubMed: 37662895
DOI: 10.2478/jtim-2023-0102 -
NPJ Regenerative Medicine Aug 2023A network of co-hepato/pancreatic stem/progenitors exists in pigs and humans in Brunner's Glands in the submucosa of the duodenum, in peribiliary glands (PBGs) of...
A network of co-hepato/pancreatic stem/progenitors exists in pigs and humans in Brunner's Glands in the submucosa of the duodenum, in peribiliary glands (PBGs) of intrahepatic and extrahepatic biliary trees, and in pancreatic duct glands (PDGs) of intrapancreatic biliary trees, collectively supporting hepatic and pancreatic regeneration postnatally. The network is found in humans postnatally throughout life and, so far, has been demonstrated in pigs postnatally at least through to young adulthood. These stem/progenitors in vivo in pigs are in highest numbers in Brunner's Glands and in PDGs nearest the duodenum, and in humans are in Brunner's Glands and in PBGs in the hepato/pancreatic common duct, a duct missing postnatally in pigs. Elsewhere in PDGs in pigs and in all PDGs in humans are only committed unipotent or bipotent progenitors. Stem/progenitors have genetic signatures in liver/pancreas-related RNA-seq data based on correlation, hierarchical clustering, differential gene expression and principal component analyses (PCA). Gene expression includes representative traits of pluripotency genes (SOX2, OCT4), endodermal transcription factors (e.g. SOX9, SOX17, PDX1), other stem cell traits (e.g. NCAM, CD44, sodium iodide symporter or NIS), and proliferation biomarkers (Ki67). Hepato/pancreatic multipotentiality was demonstrated by the stem/progenitors' responses under distinct ex vivo conditions or in vivo when patch grafted as organoids onto the liver versus the pancreas. Therefore, pigs are logical hosts for translational/preclinical studies for cell therapies with these stem/progenitors for hepatic and pancreatic dysfunctions.
PubMed: 37528116
DOI: 10.1038/s41536-023-00303-5 -
Endoscopy Dec 2023
Topics: Humans; Gastric Bypass; Brunner Glands; Hyperplasia; Duodenal Diseases; Stomach Diseases
PubMed: 37604435
DOI: 10.1055/a-2134-9501 -
Cureus Jul 2023Brunner's gland hyperplasia is an uncommon pathology from the duodenum and is believed to be associated with infection with . Patients commonly present with...
Brunner's gland hyperplasia is an uncommon pathology from the duodenum and is believed to be associated with infection with . Patients commonly present with gastrointestinal bleeding, nausea, or abdominal pain. However, obstruction is an unusual clinical finding. A 47-year-old male presented to the emergency department with complaints of recurrent emesis, epigastric pain, and cramping for three days. Medical history was significant for duodenitis and diverticulitis, but there had been no prior abdominal surgeries. Epigastric tenderness to palpation without rebound tenderness was present on physical examination, stool antigen was positive on admission, and treatment with triple therapy was initiated. Progressively the patient developed increasing emesis, with an associated cessation in flatus and bowel movements. On endoscopy, it was reported that the endoscope could not advance past the second portion of the duodenum. A nasogastric tube was placed for gastric decompression. Small bowel follow-through showed obstruction at the distal second duodenal segment. Bismuth quadruple therapy was initiated on day three. Push enteroscopy showed luminal narrowing and a transition point at the second duodenal segment with no identifiable mass or significant ulceration. Biopsy reports indicated Brunner's gland hyperplasia. By day seven, the patient reported increased bowel movements and flatus, with a resolution of his nausea and emesis, and the nasogastric tube was removed. The patient was discharged on day eight with outpatient prescriptions for quadruple therapy for six days. He was also instructed to follow up with the general surgery and gastroenterology teams for outpatient colonoscopy six weeks post-discharge and with his primary care physician (PCP) four weeks after completing quadruple therapy to ensure eradication. Studies have shown that were detected in most patients with Brunner's gland hyperplasia and may induce proliferation in Brunner's glands. Brunner's gland hyperplasia has a low incidence, with minimal cases reported. There is malignant potential but a low risk of progression into adenocarcinoma. Our case reinforces the idea that Brunner's gland hyperplasia should be included in the work-up, alongside testing for infection with in assessing patients with gastric obstruction.
PubMed: 37408935
DOI: 10.7759/cureus.41351 -
Scientific Reports Dec 2023Pyloric gland adenoma (PGA) is a duodenal neoplasm expressing MUC6 and is often associated with high-grade dysplasia and adenocarcinoma. MUC6 secreted from the pyloric...
Pyloric gland adenoma (PGA) is a duodenal neoplasm expressing MUC6 and is often associated with high-grade dysplasia and adenocarcinoma. MUC6 secreted from the pyloric gland cells carries unique O-glycans exhibiting terminal α1,4-linked N-acetylglucosamine residues (αGlcNAc). The small peptide trefoil factor 2 (TFF2) is also secreted from pyloric gland cells and binds to αGlcNAc. We recently demonstrated that αGlcNAc serves as a tumor suppressor for gastric neoplasm including PGA, but the significance of TFF2 expression remains unknown. We examined 20 lesions representing low- and high-grade PGA in 22 cases by immunohistochemistry for αGlcNAc, TFF2, MUC6, MUC5AC, MUC2 and p53. αGlcNAc, TFF2 and MUC6 were co-expressed on the cell surface and a dot-like pattern in the cytosol in low-grade PGA lesions. High-grade PGA also expressed MUC6, but reduced αGlcNAc and TFF2 expression. The ratios of αGlcNAc or TFF2 to MUC6 score in high-grade PGA were significantly lower than low-grade PGA (P < 0.001). Co-expression of αGlcNAc-glycosylated MUC6 and TFF2 in PGA suggests the existence of αGlcNAc/TFF2 form complex in PGA cells, a finding consistent with our observations in non-neoplastic Brunner's gland cells. The decreased αGlcNAc and TFF2 expression are associated with high grade atypical cells, indicative of the malignant potential of PGA.
Topics: Humans; Glycosylation; Mucin-6; Trefoil Factor-2; Biomarkers, Tumor; Duodenum; Gastric Mucosa; Adenoma
PubMed: 38062108
DOI: 10.1038/s41598-023-49040-1 -
Revista Espanola de Enfermedades... Nov 2023Brunner's gland hyperplasia constitutes 10.6% of benign tumors of the duodenum, with an incidence of 0.008%. It is usually an incidental finding during endoscopy or...
Brunner's gland hyperplasia constitutes 10.6% of benign tumors of the duodenum, with an incidence of 0.008%. It is usually an incidental finding during endoscopy or imaging tests as they are small and asymptomatic. In the case of symptomatic tumors, resection of the lesion is indicated. In lesions ≤2 cm, endoscopic resection can be chosen, reserving surgery for larger lesions or endoscopically inaccessible ones. We present the case of a patient with a history of vomiting and hyporexia of months of evolution who presented peptic ulcer perforation and underwent surgery. During follow-up, she presented intestinal obstruction due to pyloric stenosis. Given the impossibility of ruling out a neoplastic process with certainty in diagnostic tests, surgical resection (antrectomy) was decided with an anatomopathological finding of Brunner's gland hyperplasia.
Topics: Female; Humans; Hyperplasia; Brunner Glands; Duodenal Diseases; Intestinal Obstruction; Duodenum
PubMed: 36896921
DOI: 10.17235/reed.2023.9538/2023 -
Cells Aug 2023Aquaporins (AQPs), transmembrane proteins permeable to water, are involved in gastrointestinal secretion. The secretory products of the glands are delivered either to... (Review)
Review
Aquaporins (AQPs), transmembrane proteins permeable to water, are involved in gastrointestinal secretion. The secretory products of the glands are delivered either to some organ cavities for exocrine glands or to the bloodstream for endocrine glands. The main secretory glands being part of the gastrointestinal system are salivary glands, gastric glands, duodenal Brunner's gland, liver, bile ducts, gallbladder, intestinal goblet cells, exocrine and endocrine pancreas. Due to their expression in gastrointestinal exocrine and endocrine glands, AQPs fulfill important roles in the secretion of various fluids involved in food handling. This review summarizes the contribution of AQPs in physiological and pathophysiological stages related to gastrointestinal secretion.
Topics: Intestinal Absorption; Gastrointestinal Absorption; Gastrointestinal Tract; Body Fluids; Aquaporins
PubMed: 37681902
DOI: 10.3390/cells12172170 -
Minerva Gastroenterology Sep 2023
PubMed: 37712943
DOI: 10.23736/S2724-5985.23.03524-6 -
International Journal of Molecular... Aug 2023Tff1 is a typical gastric peptide secreted together with the mucin, Muc5ac. -deficient () mice are well known for their prominent gastric phenotype and represent a...
Tff1 is a typical gastric peptide secreted together with the mucin, Muc5ac. -deficient () mice are well known for their prominent gastric phenotype and represent a recognized model for antral tumorigenesis. Notably, intestinal abnormalities have also been reported in the past in these animals. Here, we have compared the expression of selected genes in mice and their corresponding wild-type littermates (RT-PCR analyses), focusing on different mucosal protection systems along the murine intestine. As hallmarks, genes were identified with maximum expression in the proximal colon and/or the duodenum: , //, , , , , /, . This is indicative of different protection systems such as Tff2/Muc6, Tff1-Fcgbp, gastrokines, fucosylation, and reactive oxygen species (ROS) in the proximal colon and/or duodenum. Few significant transcriptional changes were observed in the intestine of mice when compared with wild-type littermates, (), , , , . We also analyzed the expression of , , and in the pancreas, liver, and lung of and wild-type animals, indicating a cross-regulation of gene expression. Furthermore, on the protein level, heteromeric Tff1-Fcgbp and various monomeric Tff1 forms were identified in the duodenum and a high-molecular-mass Tff2/Muc6 complex was identified in the proximal colon (FPLC, proteomics).
Topics: Animals; Mice; Intestines; Duodenum; Colon; Animals, Wild; Biological Transport; Trefoil Factor-1
PubMed: 37628863
DOI: 10.3390/ijms241612684