MALIGNANT CHANGE IN A DUODENAL ADENOMA IN FAMILIAL ADENOMATOUS POLYPOSIS - REPORT OF A CASE

Patients with FAP (familial adenomatous polyposis) are known to be at high risk for duodenal cancer. Although the adenoma-carcinoma sequence is thought to exist in the duodenum, clinical observation of the deve lopment of duodenal adenoma to cancer has rarely been reported. We out line a 44-yr-old postcolectomy man with FAP who underwent regular gast roduodenoscopy annually or biannually and was found to be harboring du odenal ampullary cancer 5 yr after colectomy. Endoscopic and pathologi cal examination of the ampullary lesion during these 5 yr revealed pro gression of pathology from adenoma to carcinoma. Pathology of the surg ical specimen confirmed ampullary cancer. This in vivo demonstration o f the adenoma-carcinoma sequence highlights the current limitations of duodenal surveillance in FAP. (Am J Gastroenterol 1998;93:1566-1568, (C) 1998 by Am. Coll. of Gastroenterology).