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The histologic features of villous adenomas arising in the ampulla are similar to those seen in the colorectal region. They also show association with familial adenomatous polyposis and increased risk of malignant transformation. Ampullary adenomas are being detected with increased frequency these days given the greater use of imaging studies and endoscopic procedures. Previously, by the time these lesions manifested clinically, an invasive adenocarcinoma was usually present.