Brunner’s glands, first described in 1688, are submucosal mucin-secreting glands predominantly localized in the duodenum. They secrete alkaline fluid containing mucin to protect the duodenal epithelium from the acidic chyme of the stomach. Proliferation of these glands is common and this is known as Brunner’s gland hyperplasia. Brunner’s gland hamartomas (BGH) are another form of proliferation of these glands along with the presence of adipose tissue, smooth muscle bundles, and lymphoid tissue, and they are usually solitary lesions [1]. Though rare and uncommon, these Brunner’s gland hamartomas can be detected incidentally or present with major complications such as overt GI bleeding and even malignant transformation. Here, we present two cases of large BGH, first presenting with chronic iron deficiency anemia and was found to have high grade dysplasia and the second with overt gastrointestinal bleeding requiring hospitalization.

A 76-year-old female was seen for evaluation of iron deficiency anemia. Her only symptom was chronic constipation with no other major gastrointestinal complaints. Her medical history included osteoporosis, hypertension, and dyslipidemia. Upper endoscopy was notable for a large polyp with a long pedicle arising from the duodenal bulb and migrating to the distal duodenum (Fig. 1A). A prophylactic hemoclip was placed at the stalk and the polyp was removed by hot snare polypectomy (Fig. 1B) and retrieved with a Roth net (US Endoscopy, USA). The gross endoscopic resection specimen showed a lesion measuring 3 × 2 × 2 cm. Histologic evaluation of the polyp was consistent with a Brunner gland hamartoma with foci of high-grade dysplasia in the surface epithelium with negative margins (Fig. 2). Gastric biopsies with modified Giemsa stain were negative for Helicobacter pylori organisms.

A 45-year-old male presented with 2-day history of dizziness, fatigue, and melena. His past medical history was significant for hypertension and celiac artery thrombosis treated with vascular stent placement and dual antiplatelet therapy (aspirin and clopidogrel). The patient reported use of non-steroidal anti-inflammatory drugs (NSAID) and intermittent use of proton pump inhibitors (PPI). Physical examination was negative except for melena on digital rectal examination. Laboratory studies showed anemia with a hemoglobin of 9.1 g/dL (normal range, 13.0–18.0 g/dL). Upper endoscopy revealed a large pedunculated polyp in the distal duodenum with an ulcer on the stalk. An Endoloop (Olympus Medical systems, Tokyo, Japan) was placed at the stalk below the ulcer, followed by hot snare polypectomy (Fig. 3). The polyp was retrieved by a Roth net (US Endoscopy, USA) in one piece. The gross endoscopic resection specimen measured 2 × 1.5 × 1 cm. Histologic evaluation of the polyp was consistent with a Brunner gland hamartoma (Fig. 4). Gastric biopsies with modified Giemsa stain were negative for Helicobacter pylori organisms. There was no recurrence of bleeding and the patient’s hemoglobin rose to 11.8 g/dL at a 3-week follow up visit.