Villous tumors of the duodenum

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. 27% of villous tumors of the duodenum are associated with adenocarcinoma. Invasive tumor is more common in patients over 50 yr 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.