Argentaffin-cell tumour of Meckel's diverticulum a report of 2 cases and review of the literature

Abstract

Two patients with argentaffin carcinoma (carcinoid tumour) of Meckel's diverticulum are described and the literature is reviewed. Only 45 previous cases have been reported. In both patients the primary tumour had metastasized by the time the diagnosis was made. The first patient developed the carcinoid syndrome 3 months after removal of the tumour but he is alive and well over 5 years later. The findings in these 2 patients add further support to the view that a carcinoid in a Meckel's diverticulum behaves like that in the small bowel rather than that in the appendix, with an appreciable (21 per cent) incidence of metastasis. The recommended treatment, therefore, should be similar to that of small intestinal carcinoid, namely, wide excision of intestine with a wedge of mesentery. Furthermore, prophylactic resection of Meckel's diverticulum is recommended whenever possible to eliminate the possibility of subsequent development of this tumour.

Carcinoid tumour arising in a Meckel's diverticulum

“…Metastases, which have been reported in onefifth of cases, involve the regional lymph nodes and liver. Of those patients with liver metastases 50% later develop the carcinoid syndrome (Jones et al, 1972). Dissemination is seen in oneto two-thirds of patients with other small intestinal carcinoids (Moertel et al, 1961;Godwin, 1975) compared with less than 5% of patients with carcinoid tumours arising in the vermiform appendix (Godwin, 1975).…”

“…The majority of carcinoid tumours arising in Meckel's diverticulum are incidental findings at either postmortem examination or laparotomy for other conditions (Jones et al, 1972). Similarly, appendiceal carcinoids are usually discovered following incidental appendicectomy or appendicectomy for acute appendicitis (Dawes et al, 1984).…”

“…In contrast almost half of all jejuno-ileal carcinoids present with small intestinal obstruction (Dawes et al, 1984). The mean age at which carcinoid tumours in Meckel's diverticulum are found is 55 years (Jones et al, 1972) compared with 60 years for other small intestinal carcinoids and 29 years for those in the appendix (Dawes et al, 1984). The fact that appendiceal carcinoids are seen at a much earlier age is partly explained by their common presentation as an incidental pathological finding following appendicectomy.…”

“…Carcinoid tumours within a Meckel's diverticulum are seen four times more commonly in men than women (Weitzner, 1969;Jones et al, 1972). This sex distribution probably reflects the higher incidence of both Meckel's diverticulum (Yamaguchi et al, 1978) and small intestinal carcinoids (Godwin, 1975) …”

“…This compares with rates of 30-50% for small intestinal carcinoids (Brookes et al, 1968;Welch & Malt, 1977). Information on the limited number of patients with carcinoid tumours in a Meckel's diverticulum is insufficient to predict accurately the prognosis of this tumour, only three patients having been followed up for more than 5 years since diagnosis (Jones et al, 1972).…”