Pancreatoduodenectomy 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 is presented. His history included jaundice, pruritus, and weight loss. Physical examination was otherwise unremarkable. Laboratory data included anemia, guaiac-positive stool, hyperamylasemia, and abnormal liver 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 moderate dysplasia. Review of the literature reveals this to be a rare lesion (less than 1% of duodenal neoplasms). Local excision has been advocated 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.