Eighteen years after a Billroth II procedure for a duodenal ulcer, a 65-year-old man presented with a large epigastric mass which was clinically interpreted as a pancreatic carcinoma. Fourteen months later, reevaluation of the enlarging mass led to a diagnosis of a villous tumor of the afferent limb of the gastroenterostomy. Laparotomy revealed an advanced villous adenocarcinoma. We could find only one other similar case in a 50-year literature review.