Villous Tumors of the Stomach and Duodenum

Abstract

Articles concerning villous tumors of A the large bowel have been rather frequent in the past few years (1–4). Much has been said regarding their incidence, morphology, and radiologic appearance in the colon, but reports of their existence in other sites are rare (5–7). In our recent experience three such lesions in the duodenum and stomach exhibited characteristic roentgenographic and histologic pictures. The rarity of these tumors in such locations plus the fact that malignant changes occurred in all three prompted this communication. Case Reports Case I: E. T., a 69-year-old Negro male, was admitted with a four-week history of nausea, occasional vomiting, anorexia, and weight loss. Two weeks prior to admission the patient noted scleral icterus, clay-colored stools, and dark urine. Four years previously he was also icteric and had been subjected to surgery for a benign duodenal tumor. On the present admission, positive physical findings were an elevated blood pressure, mild hypertensive retinopathy, slight gynecomastia, and a large ventral hernia. Positive laboratory studies included a cephalin flocculation of +2, SGOT (serum glutamic oxalacetic transaminase) of 108, and alkaline phosphatase of 23.6 units. An upper gastrointestinal series showed a filling defect in the second portion of the duodenum (Fig. 1). At laparotomy a soft mass was palpated in the area of the ampulla of Vater. On further exploration this proved to be a large villous-type tumor attached to the ampulla. It appeared to extend into the wall of the duodenum and the head of the pancreas. A Whipple procedure was undertaken. The patient sustained a stormy postoperative course, but was discharged in satisfactory condition. The final pathology report was recurrent low-grade villous adenocarcinoma of the duodenum. Review of slides from another hospital disclosed a similar histologic pattern but with a lower degree of anaplasia. Case II: M. R., a 60-year-old Negro male, was seen because of weakness and loss of appetite. One week prior to admission he noted darkening urine. Past History: The patient was hospitalized eight years previously for an active duodenal ulcer which had been treated medically. The following year a cholecystectomy was performed for cholelithiasis. A postoperative cholangiogram showed a common duct stone, but exploration, including a duodenotomy, did not confirm this finding. No calculi were noted, and he was discharged. One year ago he was readmitted for jaundice, and another common duct exploration yielded a number of small calculi. A second duodenotomy and biopsy revealed an adenoma of the duodenum with pseudopolyp formation. Physical examination on this admission revealed no abnormality other than the patient's icterus. Laboratory studies showed anemia (hemoglobin 9.2 g per 100 ml), total bilirubin 9.7, SGOT of 108, SGPT (serum glutamic pyruvic transaminase) of 250, and alkaline phosphatase of 26.4 units.