Rare case of gastrointestinal stromal tumour from Meckel's diverticulum

Abstract

A 60-year-old man presented with abdominal pain for 3 months. Clinical examination revealed a well-defined intra-abdominal mass lesion measuring about 5 ¥ 6 cm, which was located in the left of umbilical region and extending into the left lumbar quadrant. The mass was mobile, non-tender and had firm consistency. The rest of the clinical examination and routine investigations were normal. The patient was evaluated with ultrasound of the abdomen, which showed 7 ¥ 8 ¥ 7 cm 3 hypo-echoic and solid nature mass underneath the parietal wall, with no intervening bowel coils. Contrastenhanced computed tomography scan confirmed ultrasound findings; in addition, it showed mass in close proximity to loop of small bowel and its mesentery (Fig. 1a). The patient underwent exploratory laparotomy, and intraoperative mass was seen arising from anti-mesenteric border of the ileum about 50 cm proximal to ileocaecal junction (Fig. 1b). The mass was resected en-bloc with adjacent ileum and end-to-end anastomosis was performed. Resected specimen showed (Fig. 2) that the mass is arising from diverticulum of small bowel, that is, Meckel's diverticulum. Post-operative period was uneventful. Histopathology revealed both spindle and epitheloid-shaped tumour cells with marked nuclear atypia, suggestive of malignant gastrointestinal stromal tumour (GIST). Immunohistochemistry revealed tumour cells positive for CD 117(C-KIT). The patient was followed up after two years and showed no recurrence/metastasis.Meckel's diverticulum is the most commonly encountered congenital anomaly of the small intestine, occurring in approximately 2% of the population. 1 It is located on the anti-mesenteric border of the ileum, approximately 4560 cm proximal to ileo-caecal valve and results from incomplete closure of omphalo-mesenteric duct. An equal incidence is found among men and women. Meckel's diverticulum has lining mucosa similar to that of the adjacent bowel but may contain heterotopic mucosa, the most common of which is gastric mucosa in 50%, pancreatic mucosa in 5% and may also harbour colonic mucosa. The majority of Meckel's diverticula are incidentally discovered during autopsy, laparotomy or barium studies. The most common clinical presentations of Meckel's diverticulum are gastrointestinal bleeding (from chronic ulcer in ileum adjacent to Meckel's diverticulum containing gastric mucosa), intestinal obstruction and diverticulitis. Incidence of tumours within Meckel's diverticulum is 0.53.2%, most of them are benign tumours like leiomyomata, angiomas, lipomas and villous adenomas. Malignant neoplasms include adenocarcinoma, sarcoma, carcinoid tumour, melanoma, lymphoma and GIST. 2,3 GISTs are rare neoplasms that account for 0.1-1% of gastrointestinal malignancies. Described in 1983 by Mazur and Clark, 4 GISTs arise from interstitial cells of Cajal, the pacemaker cells of the gastrointestinal tract. 5 GIST occurs in adults at a median age of 58 years and most commonly arise from stomach (60%), small intestine (30%) and less than 10% in the oesophagus, c...

A rare presentation of gastrointestinal stromal tumor arising from a meckel’s diverticulum: A case report

“…The gastric mucosa is the most prevalent, followed by pancreatic mucosa. [ 1 2 ] We found gastric mucosa as heterotrophic mucosa in our case.…”

“…[ 1 4 ] Among them, most are benign like leiomyoma, lipoma, adenoma, angioma, and malignant including adenocarcinoma, sarcoma, carcinoid tumor, lymphoma, and GIST. [ 2 5 ] In our case, the patient came with a complaint of melena.…”

“…[ 3 ] Meckel diverticula are usually seen on the small bowel’s antimesenteric border around 70 to 100 cms from the ileocecal valve. [ 2 ] Heterotopic mucosa such as gastric, duodenal, ileal, colonic, pancreatic, Brunner’s gland, and hepatobiliary system line Meckel diverticula. The gastric mucosa is the most prevalent, followed by pancreatic mucosa.…”

“…GISTs are very rare and account for 0.1% to 1% of gastrointestinal tumors. [ 2 ] GISTs are described as pleomorphic mesenchymal tumors of the gastrointestinal tract that exhibit the tyrosine kinase receptor (KIT) proteins CD 117 and CD 34 on immunohistochemistry. [ 6 ] GISTs originate from the Cajal’s interstitial cells, which are the digestive tract’s pacemakers.…”

“…[ 1 ] Majority of it remains asymptomatic. [ 2 ] Surgical removal indicated only on complication or malignant conversion. Malignant tumors developing from Meckel’s diverticulum are extremely uncommon, accounting for about 0.5% to 3.2% of all Meckel diverticula.…”