PANCREATICODUODENECTOMY FOR GIANT BENIGN VILLOUS ADENOMA OF THE AMPULLA OF VATER

The case of a 36-year-old man with a villous adenoma of the duodenum i s presented. His history included jaundice, pruritus, and weight loss. Physical examination was otherwise unremarkable. Laboratory data incl uded anemia, guaiac-positive stool, hyperamylasemia, and abnormal live r function tests. Biliary ductile dilation was seen on ultrasonography ; a filling defect in the duodenum was seen on CT scan, and endoscopic biopsy revealed villous adenoma with dysplasia. Pancreatoduodenectomy was performed and recovery was uneventful. Histopathology confirmed m oderate dysplasia. Review of the literature reveals this to be a rare lesion (less than 1% of duodenal neoplasms). Local excision has been a dvocated for small, histologically proven benign, lesions. Where doubt of benignity exists, however, and in the case of ''giant'' tumors (>3 .0 cm greatest dimension), pancreatoduodenectomy is indicated.