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Synchronous colorectal adenocarcinoma and gastrointestinal stromal tumor in Meckel's diverticulum; an unusual association.

Kosmidis C, Efthimiadis C, Levva S, Anthimidis G, Baka S, Grigoriou M, Tzeveleki I, Masmanidou M, Zaramboukas T, Basdanis G - World J Surg Oncol (2009)

Bottom Line: Coexistence of gastrointestinal stromal tumor with synchronous or metachronous colorectal cancer represents a phenomenon with increasing number of relative reports in the last 5 years.A 69 year old man, presented with abdominal distension and anal bleeding on defecation.Correct diagnosis of synchronous tumors of different origin is the cornerstone of treatment.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Interbalkan European Medical Center, Thessaloniki, Greece. dr.ckosmidis@gmail.com

ABSTRACT

Background: Coexistence of gastrointestinal stromal tumor with synchronous or metachronous colorectal cancer represents a phenomenon with increasing number of relative reports in the last 5 years. Synchronous occurence of GISTs with other gastrointestinal tumors of different histogenesis presents a special interest. We herein report a case of GIST in Meckel's diverticulum synchronous with colorectal adenocarcinoma.

Case presentation: A 69 year old man, presented with abdominal distension and anal bleeding on defecation. Colonoscopy revealed colorectal cancer and a low anterior resection was performed, during which a tumor in Meckel's diverticulum was discovered. Histologic examination revealed GIST in Meckel's diverticulum and a rectosigmoid adenocarcinoma.

Conclusion: Whenever GIST is encountered, the surgeon should be alert to recognize a possible coexistent tumor with different histological origin. Correct diagnosis of synchronous tumors of different origin is the cornerstone of treatment.

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Related in: MedlinePlus

A: The specimen of the GIST in Meckel's diverticulum. The arrow shows the diverticulum. B: Transverse section of the specimen of the GIST in Meckel's diverticulum and the proximal part of the ileum. The arrow shows the diverticulum.
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Figure 2: A: The specimen of the GIST in Meckel's diverticulum. The arrow shows the diverticulum. B: Transverse section of the specimen of the GIST in Meckel's diverticulum and the proximal part of the ileum. The arrow shows the diverticulum.

Mentions: Colonoscopy revealed intraluminal stenosis of the colorectal junction and biopsy specimens were obtained. Biopsy confirmed a well differentiated mucinous adenocarcinoma of the rectosigmoid colon. There was no evidence of metastasis, based on abdominal computed tomography (CT), chest X-ray and endorectal ultrasound (US) 3D. Carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9, and cancer antigen (CA) 50 were normal. Low anterior resection for colorectal carcinoma (CRC) with an end to end primary anastomosis was performed, while on exploration a mass in Meckel's diverticulum, 80 cm proximal to the ileocecal valve, was encountered (Figure 1). The mass was 7.5 cm in maximal diameter (Figure 2A, B), while the size of the Meckel's diverticulum was 3 cm. Thus, this case is classified as an "intermediate risk" GIST according to the risk assessment of aggressive behavior in GISTs proposed by Fletcher et al. (size: 7.5 cm, mitotic count: 0-1/50 HPF) [3]. No evidence of liver metastasis or intra-abdominal metastatic spread was found. The patient underwent resection of the tumor together with partial resection of the small bowel in order to avoid rupture and intra-abdominal spillage. Tumor was excised, together with 3 cm of ileum on either side, and a lateral to lateral anastomosis was performed with the use of staplers.


Synchronous colorectal adenocarcinoma and gastrointestinal stromal tumor in Meckel's diverticulum; an unusual association.

Kosmidis C, Efthimiadis C, Levva S, Anthimidis G, Baka S, Grigoriou M, Tzeveleki I, Masmanidou M, Zaramboukas T, Basdanis G - World J Surg Oncol (2009)

A: The specimen of the GIST in Meckel's diverticulum. The arrow shows the diverticulum. B: Transverse section of the specimen of the GIST in Meckel's diverticulum and the proximal part of the ileum. The arrow shows the diverticulum.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2664807&req=5

Figure 2: A: The specimen of the GIST in Meckel's diverticulum. The arrow shows the diverticulum. B: Transverse section of the specimen of the GIST in Meckel's diverticulum and the proximal part of the ileum. The arrow shows the diverticulum.
Mentions: Colonoscopy revealed intraluminal stenosis of the colorectal junction and biopsy specimens were obtained. Biopsy confirmed a well differentiated mucinous adenocarcinoma of the rectosigmoid colon. There was no evidence of metastasis, based on abdominal computed tomography (CT), chest X-ray and endorectal ultrasound (US) 3D. Carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9, and cancer antigen (CA) 50 were normal. Low anterior resection for colorectal carcinoma (CRC) with an end to end primary anastomosis was performed, while on exploration a mass in Meckel's diverticulum, 80 cm proximal to the ileocecal valve, was encountered (Figure 1). The mass was 7.5 cm in maximal diameter (Figure 2A, B), while the size of the Meckel's diverticulum was 3 cm. Thus, this case is classified as an "intermediate risk" GIST according to the risk assessment of aggressive behavior in GISTs proposed by Fletcher et al. (size: 7.5 cm, mitotic count: 0-1/50 HPF) [3]. No evidence of liver metastasis or intra-abdominal metastatic spread was found. The patient underwent resection of the tumor together with partial resection of the small bowel in order to avoid rupture and intra-abdominal spillage. Tumor was excised, together with 3 cm of ileum on either side, and a lateral to lateral anastomosis was performed with the use of staplers.

Bottom Line: Coexistence of gastrointestinal stromal tumor with synchronous or metachronous colorectal cancer represents a phenomenon with increasing number of relative reports in the last 5 years.A 69 year old man, presented with abdominal distension and anal bleeding on defecation.Correct diagnosis of synchronous tumors of different origin is the cornerstone of treatment.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Interbalkan European Medical Center, Thessaloniki, Greece. dr.ckosmidis@gmail.com

ABSTRACT

Background: Coexistence of gastrointestinal stromal tumor with synchronous or metachronous colorectal cancer represents a phenomenon with increasing number of relative reports in the last 5 years. Synchronous occurence of GISTs with other gastrointestinal tumors of different histogenesis presents a special interest. We herein report a case of GIST in Meckel's diverticulum synchronous with colorectal adenocarcinoma.

Case presentation: A 69 year old man, presented with abdominal distension and anal bleeding on defecation. Colonoscopy revealed colorectal cancer and a low anterior resection was performed, during which a tumor in Meckel's diverticulum was discovered. Histologic examination revealed GIST in Meckel's diverticulum and a rectosigmoid adenocarcinoma.

Conclusion: Whenever GIST is encountered, the surgeon should be alert to recognize a possible coexistent tumor with different histological origin. Correct diagnosis of synchronous tumors of different origin is the cornerstone of treatment.

Show MeSH
Related in: MedlinePlus