Villous tumors of the duodenum.

Villous tumors of the duodenum are extremely rare, only 41 cases having been described in the world literature. Modes of presentation were: gastrointestinal bleeding (11 cases); obstructive jaundice (9 cases); duodenal obstruction (10 cases); vague abdominal discomfort (8 cases) and as an incidental finding on barium study of the upper gastrointestinal tract (2 cases) or at autopsy (1 case). Twelve of the 42 cases were associated with invasive adenocarcinoma. These were confined to patients over 50 years of age. Benign tumors should be treated with local excision while in those harboring adenocarcinoma pancreaticoduodenectomy is the treatment of choice. Endoscopy and biopsy should assume a major role in attempting to obtain an accurate preoperative diagnosis. Caution is advised in that the superficial portions of the tumor may appear benign while deeper portions may contain invasive adenocarcinoma. An additional case with a bizarre presentation is described and the literature reviewed.