title: [Villous duodenal adenoma with II and III grade dysplasia and carcinoma in situ treated with cephalic duodenopancreatectomy].
abstract: BACKGROUND
  Villous duodenal adenomas are rare, tend to malignant alteration and recurrency if surgical procedures are not sufficiently radical. They are mostly localized in the second portion of the duodenum and close to a papilla and are prone to malignant alteration.
  
  
  METHODS
  In this paper we presented a 79-year-old female patient already operated on twice elsewhere due to obstructive jaundice caused by villous duodenal adenoma, using, firstly, cholecystectomy and T-tube drainage of the choledoclus, and, then, an unsuccessful attempt of radical surgery--duodenopancreatectomy. The patient was some time wearing a T-tube drainage, and, then, submitted to endoscopic papillotomy, endoscopic stenting, and, finally to the insertion of a self-expandable metallic stent which got clogged three months later causing chalangitis. Three years following the first surgery, the patient presented to our institution and submitted to cephalic duodenopancreatectomy. Histology confirmed villous duodenal adenomas with II and III grade dysplasia and carcinoma in situ. The limph nodes were tumour-free. The postoperative recovery was somewhat prolonged due to cardiologic difficulties and a mild infection of the wound.
  
  
  CONCLUSIONS
  Villous duodenal adenoma is curable if treated correctly and in a proper time. Radical treatment delay increases the risk for malignant alteration which was the case with our patient who was submitted to it three years after the histologic confirmation of the diagnosis.
authors.affiliation: Klinicki centar Srbije, Prva hiruska klinika, Institut za bolesti digistivnog sistema, Beograd.
authors.forename: Radoje
authors.initials: R
authors.lastname: Colović
authors.forename: Nikica
authors.initials: N
authors.lastname: Grubor
authors.forename: Marijan
authors.initials: M
authors.lastname: Micev
authors.forename: Milenko
authors.initials: M
authors.lastname: Ugljesić
authors.forename: Stojan
authors.initials: S
authors.lastname: Latincić
mesh_terms: D018253:Adenoma, Villous / Q000473:pathology* / Q000601:surgery; D000368:Aged; D002278:Carcinoma in Situ / Q000473:pathology* / Q000601:surgery; D004379:Duodenal Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D009378:Neoplasms, Multiple Primary / Q000473:pathology* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D012086:Reoperation