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Villous Adenoma
Atif Zaheer, MD; Michael P. Federle, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Synonyms

              • Villous tumor
            • Definitions

              • Adenomatous polyp that contains predominantly villous ("shaggy" surface) elements

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Bains L et al: Giant villous adenoma of rectum- what is the malignant potential and what is the optimal treatment? A case and review of literature. World J Surg Oncol. 17(1):109, 2019
                                            2. Click B et al: Association of colonoscopy adenoma findings with long-term colorectal cancer incidence. JAMA. 319(19):2021-31, 2018
                                            3. Lubner MG et al: Villous gastrointestinal tumors: multimodality imaging with histopathologic correlation. Radiographics. 38(5):1370-84, 2018
                                            4. Turner KO et al: Lesions of all types exist in colon polyps of all sizes. Am J Gastroenterol. 113(2):303-6, 2018
                                            5. Jasperson KW et al: APC-associated polyposis conditions. In: GeneReviews® [Internet]. University of Washington, Seattle; 1993–2021
                                            6. Serra-Aracil X et al: Transanal endoscopic surgery with total wall excision is required with rectal adenomas due to the high frequency of adenocarcinoma. Dis Colon Rectum. 57(7):823-9, 2014
                                            7. Bozkurt N et al: Adenoma with rectal villous diarrhoea and severe hypokalaemia (McKittrick-Wheelock syndrome). Br J Hosp Med (Lond). 74(11):648-9, 2013
                                            8. Sanchez Garcia S et al: Hypersecretory villous adenoma as the primary cause of an intestinal intussusception and McKittrick-Wheelock syndrome. Can J Gastroenterol. 27(11):621-2, 2013
                                            9. Sosna J et al: Critical analysis of the performance of double-contrast barium enema for detecting colorectal polyps > or = 6 mm in the era of CT colonography. AJR Am J Roentgenol. 190(2):374-85, 2008
                                            10. Ferrucci JT: Double-contrast barium enema: use in practice and implications for CT colonography. AJR Am J Roentgenol. 187(1):170-3, 2006
                                            11. Taylor SA et al: Comparison of radiologists' confidence in excluding significant colorectal neoplasia with multidetector-row CT colonography compared with double contrast barium enema. Br J Radiol. 79(939):208-15, 2006
                                            12. Johnson CD et al: Comparison of the relative sensitivity of CT colonography and double-contrast barium enema for screen detection of colorectal polyps. Clin Gastroenterol Hepatol. 2(4):314-21, 2004
                                            13. Smith TR et al: CT appearance of some colonic villous tumors. AJR Am J Roentgenol. 177(1):91-3, 2001
                                            14. Chung JJ et al: Large villous adenoma in rectum mimicking cerebral hemispheres. AJR Am J Roentgenol. 175(5):1465-6, 2000
                                            15. Cunnane ME et al: Small flat umbilicated tumors of the colon: radiographic and pathologic findings. AJR Am J Roentgenol. 175(3):747-9, 2000
                                            16. Levine MS et al: Diagnosis of colorectal neoplasms at double-contrast barium enema examination. Radiology. 216(1):11-8, 2000
                                            17. Iida M et al: Endoscopic features of villous tumors of the colon: correlation with histological findings. Hepatogastroenterology. 37(3):342-4, 1990
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      TERMINOLOGY

                                                      • Synonyms

                                                        • Villous tumor
                                                      • Definitions

                                                        • Adenomatous polyp that contains predominantly villous ("shaggy" surface) elements

                                                      IMAGING

                                                      • General Features

                                                        • Radiographic Findings

                                                          • CT Findings

                                                            • MR Findings

                                                              • Ultrasonographic Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Bains L et al: Giant villous adenoma of rectum- what is the malignant potential and what is the optimal treatment? A case and review of literature. World J Surg Oncol. 17(1):109, 2019
                                                                                      2. Click B et al: Association of colonoscopy adenoma findings with long-term colorectal cancer incidence. JAMA. 319(19):2021-31, 2018
                                                                                      3. Lubner MG et al: Villous gastrointestinal tumors: multimodality imaging with histopathologic correlation. Radiographics. 38(5):1370-84, 2018
                                                                                      4. Turner KO et al: Lesions of all types exist in colon polyps of all sizes. Am J Gastroenterol. 113(2):303-6, 2018
                                                                                      5. Jasperson KW et al: APC-associated polyposis conditions. In: GeneReviews® [Internet]. University of Washington, Seattle; 1993–2021
                                                                                      6. Serra-Aracil X et al: Transanal endoscopic surgery with total wall excision is required with rectal adenomas due to the high frequency of adenocarcinoma. Dis Colon Rectum. 57(7):823-9, 2014
                                                                                      7. Bozkurt N et al: Adenoma with rectal villous diarrhoea and severe hypokalaemia (McKittrick-Wheelock syndrome). Br J Hosp Med (Lond). 74(11):648-9, 2013
                                                                                      8. Sanchez Garcia S et al: Hypersecretory villous adenoma as the primary cause of an intestinal intussusception and McKittrick-Wheelock syndrome. Can J Gastroenterol. 27(11):621-2, 2013
                                                                                      9. Sosna J et al: Critical analysis of the performance of double-contrast barium enema for detecting colorectal polyps > or = 6 mm in the era of CT colonography. AJR Am J Roentgenol. 190(2):374-85, 2008
                                                                                      10. Ferrucci JT: Double-contrast barium enema: use in practice and implications for CT colonography. AJR Am J Roentgenol. 187(1):170-3, 2006
                                                                                      11. Taylor SA et al: Comparison of radiologists' confidence in excluding significant colorectal neoplasia with multidetector-row CT colonography compared with double contrast barium enema. Br J Radiol. 79(939):208-15, 2006
                                                                                      12. Johnson CD et al: Comparison of the relative sensitivity of CT colonography and double-contrast barium enema for screen detection of colorectal polyps. Clin Gastroenterol Hepatol. 2(4):314-21, 2004
                                                                                      13. Smith TR et al: CT appearance of some colonic villous tumors. AJR Am J Roentgenol. 177(1):91-3, 2001
                                                                                      14. Chung JJ et al: Large villous adenoma in rectum mimicking cerebral hemispheres. AJR Am J Roentgenol. 175(5):1465-6, 2000
                                                                                      15. Cunnane ME et al: Small flat umbilicated tumors of the colon: radiographic and pathologic findings. AJR Am J Roentgenol. 175(3):747-9, 2000
                                                                                      16. Levine MS et al: Diagnosis of colorectal neoplasms at double-contrast barium enema examination. Radiology. 216(1):11-8, 2000
                                                                                      17. Iida M et al: Endoscopic features of villous tumors of the colon: correlation with histological findings. Hepatogastroenterology. 37(3):342-4, 1990