[Villous adenomas of the major duodenal papilla: apropos a case]

Proceeding from a review of the literature and the personal observation of a case of tubulovillous adenoma of the large duodenal papilla, which had undergone malignant degeneration, the authors outline the diagnostic problems in this pathology. Since its clinical manifestations are not specific enough, it comes into consideration only after the possible more common diseases in the region of the right subcostal space have been ruled out. Preoperative diagnosis can be established mainly with fiber duodenoscopy. The demand from the pathologist is not only to give a histologic diagnosis, but to define the biologic nature of the tumor formation, since this predetermines the operative approach. It is sometimes difficult to give answer to the latter requirement even through and intraoperative express biopsy specimen examination.