Summary and ConclusionsThe clinicopathologic study of 219 papilary (villous) adenomas in 215 patients is reported. The high incidence (58.6 per cent) of carcinomatous changes is again noted. The overall incidence of recurrence was 12 per cent. That papillary adenoma on the whole is relatively benign, with a favorable prognosis, is reflected in the 10‐year overall and determinate survival rates of 52 and 92 per cent, respectively.Contrary to previous observations that papillary adenoma is “generally solitary and unassociated with other colonic or rectal tumors,”29the present study reveals striking coincidences of associated malignant bowel lesions (16.2 per cent) and benign colonic polyps (48.8 per cent). Another 12 per cent had associated extracolonic malignant tumors.In contrast to the previous impression that the benign and/or atypical lesions have a strong propensity to become malignant, the present review uncovered only two patients in whom this acutally occurred. Both patients were long‐term survivors after initial conservative treatment and proper subsequent management. We therefore advocate a conservative approach in the surgical management of these tumors, unless the papillary adenoma contains invasive carcinoma, and provided strict follow‐up can be maintained.