Familial Adenomatous Polyposis of the Colon (22 of 29)

Papilla of Vater. A small adenoma is observedin the same patient above. A carefully inspection of the papilla of Vater should be done removing any adenoma to avoid adenocarcinoma of the duodenum and the papilla of Vater, occurs in as many as 12% of patients. Patients with familial adenomatous polyposis (FAP) have a high prevalence of duodenal adenomas, and the region of the ampulla of Vater is the predilection site for duodenal adenocarcinomas. The average age at diagnosis of periampullary cancer in patients with polyposis is 46 years, compared with 39 years for the age of colon cancer diagnosis. fifty percent of patients with polyposis exhibit adenomatous histology of the papilla, although the polyps are often small and difficult to appreciate without a side- viewing endoscope. More than one third of the duodenal cancers reported occur at the papilla, and obstruction of the pancreatic duct has been observed from benign and malignant neoplasia of the papilla.