A duodenal villous adenoma associated with in situ carcinoma. A case report

Abstract

Villous adenomas of the duodenum behave in a manner similar to villous adenomas of the colon and rectum, having both a high rate of recurrence after local treatment and a high incidence of malignant transformation. Villous adenomas of the duodenum are the most common benign periampullary neoplasms. They are considered as premalignant lesions with a malignant transformation rate as high as 60%. Periampullary carcinomas arising from the villous adenomas of the duodenum are also the most frequent extracolonic cause of death in Familial Adenomatous Polyposis patients. Although the Whipple procedure remains the procedure of choice in treating adenomas containing invasive cancer, the selection of an appropriate procedure to treat benign villous adenomas of the duodenum, especially those with carcinoma in situ is controversial. Here we report a 63-year old woman who presented with epigastric pain secondary to a mass of the ampulla of Vater. An endoscopic biopsy revealed adenocarcinoma while pathological workup after curative pylorus preserving pancreaticoduodenectomy revealed villous adenoma of the duodenum associated with carcinoma in situ.

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