[Villous adenoma of Vater's papilla. Problems in diagnosis and therapy]

Adenomas of the ampulla of Vater are rare tumors which cause the same diagnostic problems as adenomas of the colon and rectum. From 1984 to 1991 we treated 5 patients with adenomas of the ampulla of Vater verified by endoscopy and biopsy. All 5 patients underwent transduodenal papillectomy and reimplantation of the common bile duct and pancreatic duct with intraoperative frozen section examination of the specimen. In 2 out of the 5 cases, the definitive diagnosis was invasive carcinoma undetected by frozen section examination. Both patients subsequently underwent partial duodenopancreatectomy with preservation of the pylorus. In one of our patients villous adenoma was detected six years after the insertion of a biliary endoprosthesis for alveolar echinococcus infiltrating the bifurcation of the hepatic ducts, a finding which raises the question as to an etiologic role of long-time biliary duct stenting. We discuss the diagnostic problems of the adenoma-carcinoma sequence and the therapeutic options.