Adenoma viloso da ampola de Vater

Local excision of papillary adenoma in patients with high surgical risk for pancreaticoduodenectomy

“…And so, hardly enter the differential diagnosis of jaundice by periampullary diseases. Most patients remained asymptomatic and develops symptoms of biliary colic, gastrointestinal bleeding, or jaundice in accordance with tumor growth 2 , 3 , 5 .…”

“…The proper approach to the patient should be thoroughly discussed, it is known that there is a likelihood of malignancy of these tumors of approximately 30-40%. In this case, patients undergoing endoscopic treatment or surgical treatment with local resection should be rigorously followed in the clinic so that recurrences are detected early 2 , 3 , 5 .…”

“…Among these tumors adenomas, lipomas, hemangiomas, carcinoid and leiomyomas have been described. The villous adenoma remains the most frequent 2 , 5 . Necropsy studies have shown an incidence of around 0.04% to 0.12%, and for this rarely remembered in the periampullary lesions differential diagnosis 2 .…”

“…The adenoma of it affects more frequently women, an age group between 5 th and 7 th decades, and is often associated with colonic polyposis. Initially, the patient may be asymptomatic and clinical findings begin to emerge with the growth of the tumor 2 , 5 .…”

“…Some authors 2 , 3 , 5 believe in the existence of a pre-malignant lesions, where as malignant degeneration occurs in 30-40% of cases. Because of this potential for considerable degeneration, treatment is still controversial, with numerous discussions about the best approach, endoscopic, surgical with it transduodenal local excision or pancreaticoduodenectomy.…”