Abstract Background Meckel's Diverticulum is the most commonly encountered congenital anomaly of the small intestine, occurring in approximately 2% of the population. Occasionally Meckel's diverticulum harbors neoplasms. Case presentation A 65 year old gentleman, presented with a pelvic mass. On exploratory laparotomy, it turned out to be gastrointestinal stromal tumour (GIST) arising from Meckel's diverticulum. Short history and review of literature are discussed. Conclusion Neoplasms occurring from Meckel's diverticulum, even though rare, should be considered as differential diagnosis of pelvic masses arising from bowel, wherever imaging modalities fail to give a definitive diagnosis.</p

AT Johnston

B Mijandrusic Sincic

CD Fletcher

Gopal Gurjar

H Kusumoto

HN Harkins

JJ Haber

K Chandramohan

Kiran C Kothari

LG Kindblom

M Hager

M Miettinen

M Yamaguchi

Mahesh H Patel

MJ Soltero

MT Mazur

Mudit Agarwal

P Roy

Preeti Trivedi

R Lorusso

Rohan C Gatti

RP DeMatteo

S Hirota

S Lattarulo

TS Emory

English

PubMed

Springer - Publisher Connector

BioMed Central
World Journal of Surgical Oncology
ssOpen AcceCase report
Gastrointestinal stromal tumour in Meckel's diverticulum
K Chandramohan*1,3, Mudit Agarwal1, Gopal Gurjar1, Rohan C Gatti1, 
Mahesh H Patel1, Preeti Trivedi2 and Kiran C Kothari1
Address: 1Department of Surgical Oncology, Gujarat Cancer and Research Centre, Ahmedabad, Gujarat, India, 2Department of Pathology, Gujarat 
Cancer and Research Centre, Ahmedabad, Gujarat, India and 3Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
Email: K Chandramohan* - drchandramohan@gmail.com; Mudit Agarwal - mudit1000@yahoo.com; 
Gopal Gurjar - drrohan1975@yahoo.co.in; Rohan C Gatti - gurjargopal@yahoo.co.in; Mahesh H Patel - cancerhospital@gmail.com; 
Preeti Trivedi - pinakintrivedi@hotmail.com; Kiran C Kothari - kckothari@gmail.com
* Corresponding author    
Abstract
Background: Meckel's Diverticulum is the most commonly encountered congenital anomaly of
the small intestine, occurring in approximately 2% of the population. Occasionally Meckel's
diverticulum harbors neoplasms.
Case presentation: A 65 year old gentleman, presented with a pelvic mass. On exploratory
laparotomy, it turned out to be gastrointestinal stromal tumour (GIST) arising from Meckel's
diverticulum. Short history and review of literature are discussed.
Conclusion: Neoplasms occurring from Meckel's diverticulum, even though rare, should be
considered as differential diagnosis of pelvic masses arising from bowel, wherever imaging
modalities fail to give a definitive diagnosis.
Background
Meckel's diverticulum, the most commonly encountered
congenital anomaly of the small intestine, affects 2% of
the population [1,2]. The vast majority of Meckel's diver-
ticulae are incidentally discovered during autopsy,
laparotomy, or barium studies [3]. Meckel's diverticulum
is surgically removed only when a complication arises or
a neoplasia develops. The tumors are infrequent and
observed only in 0.5–3.2% of the Meckel's diverticula. Of
these, 12% tumors are GIST. We are reporting one such
incidence, where we came across a Meckel's diverticulum
harboring GIST.
Case presentation
Sixty-five year old gentle man presented with constipation
for 4 months and bleeding per rectum for one month.
Physical examination was unremarkable. Ultrasonogra-
phy of the abdomen revealed 6 × 9 cms exophytic hypoe-
choic lesion in pelvis near sigmoid colon. Barium enema
study was normal. Colonoscopy showed colitis from anal
canal up to 20 cms. Rest of Colon was normal up to Cae-
cum. Contrast enhanced computerized tomography (CT)
scan showed lobulated mass lesion in pelvis posteriosupe-
rior to the urinary bladder compressing anterior wall of
sigmoid colon. CT scan picture was suggestive of soft tis-
sue tumour in close relation to sigmoid colon or sigmoid
mesentery (figure 1), a diagnosis of small bowel tumor
compressing sigmoid colon was made. An exploratory
laparotomy was done. On laparotomy, the lobulated
tumour seems to be arising from an ileal diverticulum,
which was very short in length and situated 50 cms from
ileocaecal valve. So diagnosis was soft tissue tumour aris-
Published: 12 May 2007
World Journal of Surgical Oncology 2007, 5:50 doi:10.1186/1477-7819-5-50
Received: 2 February 2007
Accepted: 12 May 2007
This article is available from: http://www.wjso.com/content/5/1/50
© 2007 Chandramohan et al; licensee BioMed Central Ltd. 
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), 
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Page 1 of 5
(page number not for citation purposes)
World Journal of Surgical Oncology 2007, 5:50 http://www.wjso.com/content/5/1/50ing from Meckel's diverticulum. The tumour was adherent
to sigmoid colon and part of wall of urinary bladder (fig-
ure 2, 3). There was no evidence of distant spread.
Tumour was excised with 3 cm of ileum on either side.
End to end anastomosis was done in two layers. Involved
area of anterior wall of sigmoid colon was also excised
and the defect was closed transversally. Adherent part of
the urinary bladder musculature was resected but the
bladder mucosa was intact. Postoperative period was une-
ventful. Postoperatively urinary catheter was retained for
10 days.
The pathology report was gastrointestinal stromal tumour
(GIST) arising from Meckel's diverticulum. The tumour
cells were pleomorphic and 2–3 mitosis were present in
50 high power fields (figure 4). All margins were negative.
Immuno-hisochemistry showed positive reaction for
vimentin and C kit (Figure 5). But desmin, actin, S100,
and CD 34 were negative.
Discussion
Meckel's diverticulum is the most commonly encountered
congenital anomaly of the small intestine, occurring in
approximately 2% of the population [1,2]. Meckel's diver-
ticulum is located on the antimesentric border of the
ileum approximately 45 to 60 cm proximal to the ileoce-
cal valve and results from incomplete closure of the
omphalomesentric, or viteline duct. An equal incidence is
found among men and women. Heterotopic mucosa is
present in Meckel's diverticulum, the most common of
which is gastric mucosa (present in 50% of all Meckel's
diverticula). Pancreatic mucosa is encountered in approx-
imately 5% of diverticula. Similarly these diverticula may
habour colonic mucosa.
The vast majority of Meckel's diverticula are incidentally
discovered during autopsy, laparotomy, or barium stud-
ies. The most common clinical presentations of the
Meckel's diverticulum are gastrointestinal bleeding (from
chronic acid-induced ulcer in the ileum adjacent to a
Meckel's diverticulum that contains gastric mucosa),
Preoperative CT scan showing pelvic mass; Contrast enhanced CT scan showing lobulated mass lesion in pelvis compressing anterio  wall of sigmoid colon and located posteriosuperior to the urinary bladderFigur  1
Preoperative CT scan showing pelvic mass; Contrast enhanced CT scan showing lobulated mass lesion in pelvis compressing 
anterior wall of sigmoid colon and located posteriosuperior to the urinary bladder.Page 2 of 5
(page number not for citation purposes)
World Journal of Surgical Oncology 2007, 5:50 http://www.wjso.com/content/5/1/50intestinal obstruction, and diverticulitis. Incidence of
tumours within the Meckel's diverticulm is 0.5 to 3.2% [4-
6]. Most of them are commonly benign tumours like leio-
myomas, angiomas, and lipomas. Malignant neoplasms
include adenocarcinoma (which commonly originate
from the gastric mucosa), sarcoma, carcinoid tumour and
GIST.
GISTs are rare neoplasms which account for 0.1–1% of
gastrointestinal malignancies. The term itself was first
used in 1983 by Mazur and Clark [7] to identify a hetero-
geneous group of tumours, all of them histologically char-
acterized by hyperplastic fused cells, not necessarily
leiomuscular ones, but even neural ones. Gastrointestinal
stromal tumours arise from the interstitial cells of Cajal,
pace maker cells of Gastrointestinal tract [8].
GIST occurs predominantly in adults at a median age of
58 years. The majority of GISTs (60% to 70%) have been
reported to arise in the stomach, whereas 20% to 30%
originate in the small intestine, and less than 10% in the
esophagus, colon and rectum. GISTs also occur in the
extra-intestinal abdominopelvic sites such as the omen-
tum, mesentery, or retroperitoneum [9-11]. GISTs arising
from Meckel's diverticulum are extremely rare [12-16].
For many patients, the detection of GIST may be an inci-
dental finding during evaluation of nonspecific symp-
toms. Symptoms tend to arise only when tumours reach a
large size or are in critical anatomic location. Most symp-
tomatic patients present with tumours larger than 5 cm in
maximal dimension. Symptoms at presentation may
include abdominal pain, abdominal mass, nausea, vomit-
ing, anorexia, and weight loss. The vast majority of meta-
Intraoperative picture showing tumour arising from Meckel's diverticulum; Tumour was located in Meckel's diverticulum and adherent to wall of urinary bladderFigu  2
Intraoperative picture showing tumour arising from Meckel's diverticulum; Tumour was located in Meckel's diverticulum and 
adherent to wall of urinary bladder.Page 3 of 5
(page number not for citation purposes)
World Journal of Surgical Oncology 2007, 5:50 http://www.wjso.com/content/5/1/50static GISTs are located intraabdominal, either in the liver,
in the omentum, or in the peritoneal cavity [9]. Metastatic
spread to lymph nodes and to other regions via lymphat-
ics is very rare.
CT is usually an adequate technology to diagnose
tumours arising from Meckel's diverticulum as long as
appropriate techniques for both noncontrast and intrave-
nous contrast administrations are used [13]. Histopatho-
logically, disease exhibits a wide variety of appearances
with characteristics of either epitheloid (approximately
70%) or spindle cell histology (remaining 30%). Nor-
mally, the KIT protein serves as a transmembrane RTK; the
CD117 antigen can be detected by immunohistochemical
staining as marker for the presence of the KIT protein.
With the use of sophiscated technology, it has become
clear that KIT mutations can be noted in more than 90%
of GIST cells.
CD34 expression is not specific for GIST, because it can
also be noted in desmoid tumours, and approximately
60% to 70% of GIST lesions are positive for CD34 [17-
19]. Expert analysis of the KIT and PDGFRA genotype may
be useful to define with certainty the group of rare patients
with CD117-negative GISTs in the future. GIST is consid-
ered to be potentially malignant tumours. [19].
Most reliable prognostic factors are the size of the primary
tumour and the mitotic index which measure proliferative
activity of the cells. Other prognostic factors are specific
histologic subtypes (epitheloid vs. spindle cell), the
degree of cellular pleomorphism and age of the patient.
Recurrence and survival rates have also been reported to
correlate with the location of the primary GIST lesion,
with small bowel tumours showing a somewhat worse
prognosis. The functional imaging in GISTs with FDG-PET
can give additional information that can assist clinicians
in the management of patients. Definitive surgery remains
the mainstay of treatment for patients with localized, pri-
mary GIST.
Histopathology slide after Immunostaining for C-Kit; Tumour cells show p sitivity f C-Kit staining, which suggests GISTFigure 5
Histopathology slide after Immunostaining for C-Kit; Tumour 
cells show positivity after C-Kit staining, which suggests 
GIST.
Intraoperative picture showing tumour and Meckel's divertic-ulum; Picture of Meckel's diverticulum with part of tumour, which was d livered outFigure 3
Intraoperative picture showing tumour and Meckel's divertic-
ulum; Picture of Meckel's diverticulum with part of tumour, 
which was delivered out.
High power view of the histopathology slide; Tumour cells were pleomorphic and 2–3 mitosis were present in 50 high power fieldsFi ure 4
High power view of the histopathology slide; Tumour cells 
were pleomorphic and 2–3 mitosis were present in 50 high 
power fields.Page 4 of 5
(page number not for citation purposes)
World Journal of Surgical Oncology 2007, 5:50 http://www.wjso.com/content/5/1/50Publish with BioMed Central   and  every 
scientist can read your work free of charge
"BioMed Central will be the most significant development for 
disseminating the results of biomedical research in our lifetime."
Sir Paul Nurse, Cancer Research UK
Your research papers will be:
available free of charge to the entire biomedical community
peer reviewed and published immediately upon acceptance
cited in PubMed and archived on PubMed Central 
yours — you keep the copyright
Submit your manuscript here:
http://www.biomedcentral.com/info/publishing_adv.asp
BioMedcentral
Conclusion
Neoplasms arising from Meckel's diverticulae are differen-
tial diagnoses in patients presenting with pelvic masses of
bowel origin, in which imaging modalities doesn't pin-
point a definitive diagnosis. Eventhough it is not so com-
mon, one should keep in mind this differential diagnosis
in pelvic masses of suspected bowel origin.
Competing interests
The author(s) declare that they have no competing inter-
ests.
Authors' contributions
CK: Drafted manuscript
MA: Helped in preparation of the manuscript.
RCG – Assisted surgery and did literature review.
GG – interpreted and correlated imaging data with text
narrative.
MH – Helped in drafting the manuscript
PT – Reported prepared pathology slides and photos.
KCK – Conceived idea, organized case reporting.
All authors read and approved the final manuscript.
Acknowledgements
Written consent was obtained from the patient for publication of this case 
report.
We acknowledge the help of Ms. Devimohan for preparing the manuscript.
References
1. Haber JJ: Meckel's diverticulum.  Am J Surg 1947, 73:468-485.
2. Harkins HN: Intussusception due to invaginated Meckel's
diverticulum.  Ann Surg 1933, 98:1070-1095.
3. Roy P, Lachaux A, Descos B, Chappuis JP, Bret P, Hermier M: Value
of barium transit of the small intestine in research on
Meckel's diverticulum.  Pediatrie 1990, 45:65-68.
4. Kusumoto H, Yoshida M, Takahashi I, Anai H, Maehara Y, Sugimachi
K: Complications and diagnosis of Meckel's diverticulum in
776 patients.  Am J Surg 1992, 164:382-383.
5. Yamaguchi M, Takeuchi S, Awazu S: Meckel's diverticulum. Inves-
tigation of 600 patients in Japanese literature.  Am J Surg 1978,
136:247-249.
6. Soltero MJ, Bill AH: The natural history of Meckel's diverticu-
lum and its relation to incidental removal. A study of 202
cases of diseased Meckel's diverticulum found in King
County, Washington, over a fifteen year period.  Am J Surg
1976, 132:168-173.
7. Mazur MT, Clark HB: Gastric stromal tumours. Reappraisal of
histogenesis.  Am J Surg Pathol 1983, 7:507-519.
8. Miettinen M, Sarlomo-Rikala M, Lasota J: Gastrointestinal stromal
tumors: recent advances in understanding of their biology.
Hum Pathol 1999, 30:1213-1220.
9. DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan
MF: Two hundred gastrointestinal stromal tumours: recur-
rence patterns and prognostic factors for survival.  Ann Surg
2000, 231:51-58.
10. Miettinen M, Lacosta J: Gastrointestinal stromal tumours defi-
nition, clinical, histological, immunohistochemical and
molecular genetic features and differential diagnosis.  Arch
Pathol Lab Med 2006, 130:1466-1478.
11. Emory TS, Sobin LH, Lukes L, Lee DH, O'Leary TJ: Prognosis of gas-
trointestinal smooth-muscle (stromal) tumors: dependence
on anatomic site.  Am J Surg Pathol 1999, 23:82-87.
12. Lattarulo S, Ugenti I, Ferrarese F, Fabiano G: Gastrointestinal stro-
mal tumors: current issues.  Chirurgia Italiana 2003, 55:219-226.
13. Johnston AT, Khan A, Bleakney R, Keenan RA: Stromal tumor
within a Meckel's diverticulum: CT and ultrasound findings.
Br J Radiol 2001, 74:1142-1144.
14. Mijandrusic Sincic B, Kovac D, Jasic M, Grbas H, Uravic M, Depolo A:
Crohn's disease and a gastrointestinal stromal tumor in an
81-year-old man-a rare coincidence.  Zentralbl Chir 2005,
130:597-599.
15. Hager M, Maier H, Eberwein M, Klingler P, Kolbitsch C, Tiefenthaler
W, Mikuz G, Moser PL: Perforated Meckel's diverticulum pre-
senting as a gastrointestinal stromal tumor:a case report.  J
Gastrointest Surg 2005, 9:809-811.
16. Lorusso R, Forte A, Urbano V, Soda G, D'Urso A, Bosco MR, Mancini
P, Bezzi M: Small bowel stromal tumors in a "meckelian" loca-
tion. About a clinical observation.  Ann Ital Chir 2003,
74:707-711.
17. Kindblom LG, Remotti HE, Aldenborg F, Meis-Kindblom JM: Gas-
trointestinal pacemaker cell tumour(GIPACT) :gastrointes-
tinal stromal tumours show phenotypic characteristics of
the interstitial cells of Cajal.  Am J Pathol 1998, 152:1259-1269.
18. Hirota S, Ohashi A, Nishida T, Isozaki K, Kinoshita K, Shinomura Y,
Kitamura Y: Gain-of-function mutations of c-kit in human gas-
trointestinal stromal tumours.  Science 1998, 279:577-580.
19. Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ,
Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin
LH, Weiss SW: Diagnosis of gastrointestinal stromal tumours:
a consensus approach.  Hum Pathol 2002, 33:459.Page 5 of 5
(page number not for citation purposes)


Gastrointestinal stromal tumour in Meckel's diverticulum

Crossref

Abstract Background Meckel's Diverticulum is the most commonly encountered congenital anomaly of the small intestine, occurring in approximately 2% of the population. Occasionally Meckel's diverticulum harbors neoplasms. Case presentation A 65 year old gentleman, presented with a pelvic mass. On exploratory laparotomy, it turned out to be gastrointestinal stromal tumour (GIST) arising from Meckel's diverticulum. Short history and review of literature are discussed. Conclusion Neoplasms occurring from Meckel's diverticulum, even though rare, should be considered as differential diagnosis of pelvic masses arising from bowel, wherever imaging modalities fail to give a definitive diagnosis.</p

Patel Mahesh H

Gatti Rohan C

Gurjar Gopal

Agarwal Mudit

Chandramohan K

Trivedi Preeti

Kothari Kiran C

Directory of Open Access Journals

World Journal of Surgical Oncology

AH: The natural history of Meckel's diverticulum and its relation to incidental removal. A study of 202 cases of diseased Meckel's diverticulum found in King County, Washington, over a fifteen year period.

Awazu S: Meckel's diverticulum. Investigation of 600 patients in Japanese literature.

Clark HB: Gastric stromal tumours. Reappraisal of histogenesis.

Depolo A: Crohn's disease and a gastrointestinal stromal tumor in an 81-year-old man-a rare coincidence. Zentralbl Chir

Fabiano G: Gastrointestinal stromal tumors: current issues. Chirurgia Italiana

Gain-of-function mutations of c-kit in human gastrointestinal stromal tumours. Science

Gastrointestinal stromal tumors: recent advances in understanding of their biology. Hum Pathol

Gastrointestinal stromal tumours definition, clinical, histological, immunohistochemical and molecular genetic features and differential diagnosis. Arch Pathol Lab Med

Hermier M: Value of barium transit of the small intestine in research on Meckel's diverticulum. Pediatrie

Intussusception due to invaginated Meckel's diverticulum. Ann Surg

Meckel's diverticulum.

Meis-Kindblom JM: Gastrointestinal pacemaker cell tumour(GIPACT) :gastrointestinal stromal tumours show phenotypic characteristics of the interstitial cells of Cajal.

MF: Two hundred gastrointestinal stromal tumours: recurrence patterns and prognostic factors for survival. Ann Surg

O'Leary TJ: Prognosis of gastrointestinal smooth-muscle (stromal) tumors: dependence on anatomic site.

PL: Perforated Meckel's diverticulum presenting as a gastrointestinal stromal tumor:a case report.

Small bowel stromal tumors in a &quot;meckelian&quot; location. About a clinical observation. Ann Ital Chir

Stromal tumor within a Meckel's diverticulum: CT and ultrasound findings.

Sugimachi K: Complications and diagnosis of Meckel's diverticulum in 776 patients.

Weiss SW: Diagnosis of gastrointestinal stromal tumours: a consensus approach. Hum Pathol

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1876459

Gastrointestinal stromal tumour in Meckel's diverticulum

Abstract

Similar works

Full text

Available Versions

Springer - Publisher Connector

Crossref

Directory of Open Access Journals