Malignant Stromal Tumor Consistent with Fibrosarcoma Arising from Meckel's Diverticulum. Clinicopathological Study of an Incidentally Discovered Tumor and Review of the Literature

Abstract

The authors report a case of a Meckel's diverticulum mesenchymal tumor incidentally discovered in a 69-year-old woman undergoing laparotomy for an ovarian cyst. Histological examination of the tumor revealed a fasciculated proliferation of spindle cells that proved to be immunoreactive to vimentin only; pleomorphism was mild, necrosis extensive and mitotic count high. Because these features were consistent with those of fibrosarcoma, the tumor was classified in the category of gastrointestinal stromal tumors; more specifically, it was considered malignant for the presence of spread beyond the primary site in the form of peritoneal nodules and for the high mitotic count. We have been able to find only one previously reported case of mesenchymal malignant tumor of Meckel's diverticulum classified as fibrosarcoma among the 199 malignant tumors described in the literature. Based on this personal experience and on the review of the literature concerning malignant tumors of Meckel's diverticulum, we discuss both the rarity of these tumors and the importance of removing Meckel's diverticulum every time it is found during laparotomy.

Gastrointestinal stromal tumours: a regular origin in the muscularis propria, but an extremely diverse gross presentation

“…A rare, but peculiar presentation seen especially in small intestinal GISTs is reflected by extramural growth exhibiting deep, fistula-like ulceration/necrosis, thus mimicking a diverticulum. This gross pattern seen in approximately 2% of all cases and in 8% of small intestinal GISTs in this study was almost always interpreted clinically as "tumour in Meckel's diverticulum" [39,40]. In our experience, no mucosal lining of the diverticular structure (tumour!)…”

“…In contrast to almost all other type of neoplasias, GISTs possess an extremely diverse clinical presentation that can (not rarely) mimic non-gastrointestinal neoplasia of diverse anatomic locations [29][30][31][32][33][34][35][36][37][38][39][40]. In many cases of apparent EGISTs, mild (filmy) adhesions with a surrounding bowel segment were observed [18].…”

Obscure Gastrointestinal Bleed from a Gastrointestinal Stromal Tumor in a Jejunal Diverticulum: A Rare Case Report

“…Bleed in a diverticulum is usually due to inflammatory involvement of the arcade vessel but may rarely occur due to a mass lesion (as in our case) or a vascular malformation [3]. Tumors within a Meckel's diverticulum are uncommon but recognized, with a reported incidence of 0.5-3.2% [4]. The case presented here is rare since it was a true diverticulum of the jejunum at the antimesenteric border and harbored a GIST.…”

Crohn's Disease and a Gastrointestinal Stromal Tumor in an 81-Year-Old Man - A Rare Coincidence

“…In our case the GIST was coincidentally, situated within Meckel's diverticulum, out of the inflamed area. Tumors within a Meckel's diverticulum are uncommon but well recognized, with a reported incidence of 0.5-3.2 % [2,7]. GIST comprise a significant proportion of these tumors and most of them are found incidentally during operation [7].…”