Villous tumours of the duodenum. An analysis of the literature with emphasis on malignant transformation.
Until 1992, 192 patients with a villous tumour of the duodenum have been reported. The symptoms and signs of this tumour are mostly related to obstruction of the duodenal lumen or bile ducts. Radiological examination (e.g., hypotonic duodenography) may be of some help in diagnosing a villous tumour of the duodenum. In histological specimens, superficial parts of the tumour may appear benign while deeper parts may contain adenocarcinoma. Therefore, endoscopy with multiple biopsies or the use of electrocautery for removal of large fragments of the tumour should play a major role in obtaining an accurate preoperative diagnosis. Forty-two per cent of all reported villous tumours showed malignant changes at the time of presentation. Because of this great risk of malignant transformation, these tumours should always be resected. Unlike large bowel mucosa, small bowel mucosa contains lymphatics that course through the villi extending near the luminal surface, suggesting the possibility of early lymphatic spread before invading the muscularis mucosae. In 24 patients with intramucosal carcinoma, however, no metastases were found. For this reason, a mucosal resection of these tumours would appear to be an effective and safe treatment. Invasive carcinomas or recurrent villous tumours require more radical surgery. Depending on histological evaluation, location in the duodenum and intraoperative findings, segmental resection of the villous tumour or pancreaticoduodenectomy would seem to be an appropriate surgical procedure. A pedunculated villous tumour may be removed endoscopically. It is recommended that all patients who had their tumour resected locally, should be surveyed endoscopically.
Witteman
B J
BJ
Department of Gastroenterology and Hepatology, University Hospital Nijmegen, Netherlands.
Janssens
A R
AR
Griffioen
G
G
Lamers
C B
CB
D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology; D000236:Adenoma / Q000453:epidemiology / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004379:Duodenal Neoplasms / Q000453:epidemiology / Q000473:pathology*; D004384:Duodenoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged