MYOEPITHELIAL HAMARTOMA OF THE STOMACH COMPLICATED BY GASTRIC OBSTRUCTION

Itis about a patient 52 yearold,presents to the emergency room for incoercible vomiting and state of dehydration. The investigations show hydroelectrolityicdisorderswith a pyloricstenosis on the imagery. after urgent conditioning of the patient heunderwent partial gastrectomysurgerywithgastrojejunalanastomosis. Anatomopathology of the operativespecimen shows a stenosingpyloricBrunerichamartoma; the post-operativeconsequences are satisfactory gastrectomywithgastrojejunostomy. Histopathologicalexamination of the resectedspecimenconfirmedit to beBrunner’s gland hyperplasia. Post-operativehospitalstaywasuneventful.

Itis about a patient 52 yearold,presents to the emergency room for incoercible vomiting and state of dehydration. The investigations show hydroelectrolityicdisorderswith a pyloricstenosis on the imagery. after urgent conditioning of the patient heunderwent partial gastrectomysurgerywithgastrojejunalanastomosis. Anatomopathology of the operativespecimen shows a stenosingpyloricBrunerichamartoma; the post-operativeconsequences are satisfactory Copy Right, IJAR, 2021,. All rights reserved.

Introduction:-
With the exception of leiomyomas, submucosaltumors of the stomach are extremely rare. brunner's glands are branchedacinotubular glands normallyfound in the deepmucosal or submucosallayers of the proximal duodenum and secretealkalinebased mucus to protect the duodenalliningfrom the gastricacid andmostlyasymptomaticBrunner's gland hyperplasia canpresent as gastrointestinal (GI) bleeding, obstruction, and abdominal pain in symptomatic cases 1. Histologically, thistumorpresentshypertrophicsmooth muscle bands surrounding diverse epithelialelementsthatcanbearranged in differentways: as a simple glandular structure, Brunner's gland, pancreaticducts, and occasionallypancreatic acinus 2.
We report an unusual case of Brunner's gland hyperplasia in the pylorusleading to severegastricoutlet obstruction requiringsurgical intervention

Case report
A 52-year-male patient presented to the emergency room for uncontrollablevomiting, hissymptoms go back a yearwith the installation of post prandial vomiting first to solidsthen to liquidswithouthematemesis or melena, clinicalexamination on admission, hemodynamically and respiratory stable patient; supple abdomen, His vital signs objective hisbloodparametershemoglobin13.2 g/dl (13.8-17.7), total leukocyte count 5000 cells/cumm (4000-11000), potassium 1 ,8 g/dl serumalkaline phosphatase 96 U/L (50-130), and serum).the patient benefited in the emergency departmentfrom a 2-way venousoutlet for rehydrationwith potassium refillthenfrom a gastricfibroscopyobjectifyingpre-pyloriculcer and impassable stenosisHistologicalfindings on biopsysamples of the lesion and itsbordersrevealedhypertrophicendothelia and granulation tissue, leiomuscular bands infltrated by lymphocytes, plasma cells, granulocytes and rare distorted gland architecture and varying degrees of epithelialdysplasia. He was positive for Helicobacterpylori(HP) the abdominal scanner revealedpy loricstenos is with stas is stomach The patient underwentlaparoscopic distal gastrectomywithgastrojejunostomy. Histopathologicalexamination of the specimenconfirmedBrunner's gland hyperplasia. No postoperative complications occurred and ourpatient'sgeneral conditions were optimal atdischarge 7 daysaftersurgery. Twomonthspostoperativelyhisgeneralhealth conditions are still good Corresponding Author:-Radouane Chouiba

Discussion:-
Brunner's gland issubmucosalmucin-secretingacinar glands of the duodenumwhichsecretes mucus, pepsinogen, and urogastrone as a response to stimulation by gastricacid, to protect the duodenalmucosa 3.Myoepithelialhamartoma of the stomachis a rare tumorand isalsoreferred to as myoglandularhamartoma, adenomyomatoushamartoma, gastricadenomyoma, adenomyosis and heterotopia 4,5. Histologically, they are branchedacinotubular glands coveredwithcuboidalcells in the ducts and cuboidal to columnarcells in the gland 6.Suchlesions have been observed in the gastric antrum(85%) and in the pylorus (15%); theypresentnonspecificsymptomssuch as intermittent gastric pain, nausea and vomiting, and in some patients cause intermittent pyloricobstruction 7our case presented a pyloric obstruction withvomiting Most of the cases reported in the literaturewerediagnosed by conventional X-rays of the upper digestive tract using a bariummeal, while the other cases weredetectedincidentallyduringsurgery or autopsy 7. Hamartomasoftenappear as a roundish or ovalshapedmass in the submucosal tissue simulating a lipoma, a neurofibroma or a polypoid formation 2. Our case detectedduringsurgery. Conservative treatmentwith protonpumpinhibitor and antacids are sufficient for treatment of Brunner's gland hyperplasia whenthe patient isasymptomatic 8. If the patient issymptomatic, endoscopicresection, laparoscopic, or laparotomymayberequired 9. If the lesionispedunculated and <5 cm in size, thenendoscopicresectionisdone. In case of lesions, >5 cm laparoscopic or open surgical excision ispreferred 10. In our case, weplanned for surgical intervention.
Radical surgeryisalsojustified in cases of a definitediagnosis of hamartoma as the lesionisvery rare and may not bebenign, and the risk of cancerizationisstill an open question 11. Generallyspeaking, gastricpolyps are considered to have alowrisk of cancerization, yet the risk of neoplasticdegenerationishigher for hyperplasticadenomatouspolyps and fundicglandularpolyps directly correlated with HP infection. Cancer has been detectedin 2.1% of hyperplasticgastricpolyps 12,13 an in 1.6% of gastrichamartous polyps14,15 alsomakesour case distinct.
Another possible relationshipbetweenpepticulcer and Brunner's gland hyperplasia isthatboth have an association withH. pylori16. The patient, in this case, tested positive for H. pylori. Presence of Brunner's gland hyperplasia in the region of the antropylorusleading to severegastricoutlet obstruction.The patient underwentlaparoscopic distal gastrectomywithgastrojejunostomy. Histopathologicalexamination of the resectedspecimenconfirmedit to beBrunner's gland hyperplasia. Post-operativehospitalstaywasuneventful.