With regard to benign neoplasms of the small intestine, which of the following are true statements?

a. Many are asymptomatic and only found as incidental findings

b. Leiomyomas are the most common symptomatic benign neoplasm and may present with gastrointestinal bleeding

c. Villous adenomas carry a distinct malignant potential and occur most commonly in the periampullary duodenum

The most common benign small intestinal neoplasms are adenomas, leiomyomas, and lipomas. Hamartomas, fibromas, angiomas, and neurofibromas may also occur at a lesser frequency. Three types of adenomas occur, simple tubular adenomas, villous adenomas, and Brunner gland adenomas. Tubular adenomas have a very low malignant potential whereas villous adenomas carry a distinct malignant potential similar to that of colonic villous adenomas. These adenomas occur most commonly in the duodenum and especially in the periampullary region. Brunner gland adenomas represent hyperplasia of the exocrine glands within the proximal duodenal mucosa and have little risk of malignant change. The smooth muscle tumor, leiomyoma, are the most common symptomatic benign neoplasms. Most leiomyomas enlarge with an extraluminal orientation and, may reach considerable size. The tumors eventually may outgrow their blood supply leading to central necrosis, ulceration and intraluminal bleeding. Rupture of the tumor may also occur with intraperitoneal bleeding. Differentiation of larger leiomyomas from their malignant counterpart, leiomyosarcoma, may be difficult on pathologic review. Peutz-Jegher Syndrome is an inherited syndrome associated with multiple gastrointestinal polyps throughout the jejunum and ileum. Histologically these polyps are hamartomas and not adenomas and therefore offer little risk of malignant transformation.