case_images: PMC8214502_01
case_images: (a, b) Duodenoscopy showing a pedunculated (arrowheads in (a)), polypoid, 4 cm mass at the duodenal bulb. A secretory portion at the top of the tumor is visible (arrow in (b)) as well as an ulcerated lesion without bleeding (arrow in (a) and arrowheads in (b)).
case_images: CRIS2021-8861308.001.jpg
case_images: PMC8214502_01_CRIS2021-8861308.001.jpg
case_images: fig1
case_images: There was a secretory portion at the top of the tumor and an ulcerative lesion without bleeding (Figures 1(a) and 1(b)).
case_images: Abdominal CT showing a 7 cm mass extending from the bulb to the descending duodenum, with intussusception. The intrahepatic bile duct is not dilated.
case_images: CRIS2021-8861308.002.jpg
case_images: PMC8214502_01_CRIS2021-8861308.002.jpg
case_images: fig2
case_images: The common bile duct was not dilated (Figure 2).
case_images: Magnetic resonance imaging (MRI) showing high- and low-signal intensities in the tumor on T2WI (a, b) and no enhancement during the arterial phase (c). The surface of the mass gradually enhanced during the delayed phase (d).
case_images: CRIS2021-8861308.003.jpg
case_images: PMC8214502_01_CRIS2021-8861308.003.jpg
case_images: fig3
case_images: T2-weighted image (T2WI). The tumor was not enhanced during the arterial phase; however, the tumor surface was gradually enhanced during the delayed phase (Figures 3(a)-3(d)).
case_images: (a, b) The tumor stalk is located at the anterior wall of the bulb (a), and the ampulla is not involved. We opened the anterior duodenal wall (white arrows in (b)) and identified the tumor (black arrows in (b)). We resected the tumor with part of the wall of the duodenal bulb.
case_images: CRIS2021-8861308.004.jpg
case_images: PMC8214502_01_CRIS2021-8861308.004.jpg
case_images: fig4
case_images: We resected the tumor with the wall of the duodenal bulb (Figures 4(a) and 4(b)).
case_images: The resected tumor measured 7 x 4 x 2.3 cm. The surface epithelium consisted of normal duodenal mucosa with areas of focal ulceration and a secretory portion at the top.
case_images: CRIS2021-8861308.005.jpg
case_images: PMC8214502_01_CRIS2021-8861308.005.jpg
case_images: fig5
case_images: Macroscopically, the size of the resected tumor was 7 x 4 x 2.3 cm, the surface was smooth, and there were cystic lesions inside the mass (Figure 5).
case_images: (a, b) The mass consists mostly of lobules of Brunner's glands showing no cellular atypia, with a small cluster of eosinophilic cells in the fibrotic lesion. Immunohistochemically, hyperplastic lobules of Brunner's glands were positive for Muc 6 (B).
case_images: CRIS2021-8861308.006.jpg
case_images: PMC8214502_01_CRIS2021-8861308.006.jpg
case_images: fig6
case_images: The histological diagnosis was Brunner's gland hyperplasia (BGH) without malignancy (Figures 6(a) and 6(b)).