Villous Tumors of the Duodenum

Abstract

Villous tumors of the duodenum are rare, but treatment may be problematic because of their association with invasive adenocarcinoma. Two cases of villous tumor of the duodenum are described and 39 other reported cases are reviewed. Presenting symptoms were bleeding 27%; obstruction 24%; jaundice 22% and vague dyspepsia 20%. Diagnosis may be made by radiographic barium contrast evaluation of the duodenum, especially with the addition of air contrast hypotonic studies and by fibro-optic endoscopy. Twenty-seven per cent of villous tumors of the duodenum are associated with adenocarcinoma. Invasive tumor is more common in patients over 50 years old (35%), in tumors of the third and fourth portions of the duodenum (44%) and in tumors over 4 cm in diameter (30%). Local excision is the treatment of choice for benign lesions. Pancreatico-duodenectomy is recommended for tumors which include invasive carcinoma in patients without distal metastases.

Villous adenoma of the common bile duct

“…Invasive or in situ carcinoma has been reported in approximately 30% of villous tumors involving the periampullary region [4]. It is for this reason that many surgeons perform a pancreaticoduodenectomy which relieves the obstructive jaundice and avoids the possibility of later malignant transformation.…”

Non-vaterian duodenal adenomas: Report of 24 cases and review of the literature

“…As for nonvillous adenomas, 65.3% were treated by excision or mere resection, with one report of endoscopic resection [15]. The pancreatoduodenectomies performed in connection with villous adenomas were motivated by the lesion site or, more frequently, by suspected degeneration that was later confirmed [9,23,28] or excluded by examination of the specimen [4,32]. Duodenal adenomas thus constitute rare tumors, but emphasis should be placed on the frequency of degeneration of their villous form.…”

Adenocarcinoma of the Duodenum Arising in a Tubulo-Villous Adenoma

“…The most frequent symptoms are nausea, vomiting, weight loss, anorexia, as in our patient and also epigastric pain, jaundice, melena or fever. However, some patients are totally asymptomatic (1)(2)(3)(4)6). The examinations of choice are EGD, endoscopic retrograde cholangiopancreatography, UGI, abdominal CT and EUS.…”

“…Villous adenoma of the duodenum is a rare entity among small bowel neoplasms (1,2,4,6,7). Most of the time, this tumour is diagnosed late.…”

“…Most of the time, this tumour is diagnosed late. Symptoms are variable, from dyspepsia to obstruction or jaundice (1)(2)(3)(4)6). The main problem is the co-existence of malignancy, present in 21% to 47% of these tumours (3,6), which can be missed at the histological examination of biopsies by esophagogastroduodenoscopy (EGD) (3,4,8).…”