1986 Volume 47 Issue 4 Pages 470-476
Duodenal adenoma of the papilla of Vater is a rare and clinically interesting disease as a borderline between benignity and malignancy. Thus, selection of surgical operative method is difficult. In this case, a tumor located at a site of the papilla of Vater appeared to be an adenoma, but we performed pancreaticoduodenectomy because of the possibility of its being well differentiated adenocarcinoma (malignancy). Postoperative pathohistological examination showed that it was a wide-based tubulovillous adenoma, 2.2×1.0×1.0 cm in size.
We divided 21 cases so far reported in Japan into two groups, one consisting of adenomas with malignant change and the other adenomas without malignant change. There was no significant difference in tumor size between the two groups but the average age in the former (66.2 years old) was 10 years more than in the latter.
Moreover, all cases combined malignant change showed the villous pattern histologically. Accordingly, when a patient is more than 60 years old and histological examination at biopsy shows a villous pattern, pan-creaticoduodenectomy as a radical operation should be performed for this disease.
