Schulten M F, Oyasu R, Beal J M
Am J Surg. 1976 Jul;132(1):90-6. doi: 10.1016/0002-9610(76)90297-x.
A case of villous adenoma of the duodenum, with focal in situ carcinomatous changes, has been described with a review of forty-two other case reports from the world literature. Occult bleeding, resulting in anemia, and vague obstructive symptoms appear to be the most common presenting findings. The average age was 56.4 years, which was seven years younger than the average age for villous tumors of the colon. Adequate radiologic studies should establish the diagnosis preoperatively. These tumors obtain relatively large size before causing significant symptoms. Approximately one third showed carcinomatous changes, and approximately one half of these were in situ changes. Local segmental resection for duodenal villous tumors is desirable when possible. However, in areas where this is not feasible, local mucosal excision is acceptable for benign tumors and for those with in situ carcinoma. If invasive carcinoma is found in the excised specimen, pancreatoduodenectomy is recommended. Insufficient evidence is available to adequately evaluate survival for malignant villous tumors of the duodenum, but the available data suggest that the survival after treatment of malignant villous tumors is comparable to other malignant lesions originating in the duodenum.
本文报告了一例十二指肠绒毛状腺瘤伴局灶原位癌改变的病例，并对世界文献中的其他42例病例报告进行了综述。隐匿性出血导致贫血和模糊的梗阻症状似乎是最常见的临床表现。平均年龄为56.4岁，比结肠绒毛状肿瘤的平均年龄小7岁。充分的放射学检查应在术前确立诊断。这些肿瘤在引起明显症状之前会长得相对较大。大约三分之一的病例显示有癌变，其中约一半为原位癌改变。十二指肠绒毛状肿瘤尽可能行局部节段性切除。然而，在无法进行局部节段性切除的情况下，对于良性肿瘤和原位癌患者，局部黏膜切除是可以接受的。如果在切除标本中发现浸润性癌，建议行胰十二指肠切除术。目前尚无足够证据充分评估十二指肠恶性绒毛状肿瘤的生存率，但现有数据表明，恶性绒毛状肿瘤治疗后的生存率与十二指肠起源的其他恶性病变相当。
