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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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A) Invasion of submucosa of small intestine from GIST (HE×200). B) Histologically, the GIST was composed of sheets of spindle cell with moderate to slight interstitial collagen (HE×200).
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Figure 4: A) Invasion of submucosa of small intestine from GIST (HE×200). B) Histologically, the GIST was composed of sheets of spindle cell with moderate to slight interstitial collagen (HE×200).

Mentions: The lesion in the colorectal junction was a stage C2 (Astler-Coller) tumour, 8 × 6 cm in size (Figure 3), located in the rectosigmoid colon. Microscopic examination showed a well-differentiated adenocarcinoma, penetrating the bowel wall, without nerve and vascular invasion. However, one of the 23 resected lymph nodes was positive for metastasis. According to the TNM (tumor, lymph nodes, metastasis) classification, the disease was stage IIIb. Histopathological examination of the resected Meckel's diverticulum tumor revealed a stromal cell neoplasm with a few necrotic and hemorrhagic areas and a low index of mitotic count (0–1 mitoses/50 HPF) (Figure 4A, B). Immunohistochemical analysis revealed expression of C-kit (strongly positive), moderately positive stain for SMA, while markers for focal S-100 and CD 34 were negative (Figure 5).


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) Invasion of submucosa of small intestine from GIST (HE×200). B) Histologically, the GIST was composed of sheets of spindle cell with moderate to slight interstitial collagen (HE×200).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: A) Invasion of submucosa of small intestine from GIST (HE×200). B) Histologically, the GIST was composed of sheets of spindle cell with moderate to slight interstitial collagen (HE×200).
Mentions: The lesion in the colorectal junction was a stage C2 (Astler-Coller) tumour, 8 × 6 cm in size (Figure 3), located in the rectosigmoid colon. Microscopic examination showed a well-differentiated adenocarcinoma, penetrating the bowel wall, without nerve and vascular invasion. However, one of the 23 resected lymph nodes was positive for metastasis. According to the TNM (tumor, lymph nodes, metastasis) classification, the disease was stage IIIb. Histopathological examination of the resected Meckel's diverticulum tumor revealed a stromal cell neoplasm with a few necrotic and hemorrhagic areas and a low index of mitotic count (0–1 mitoses/50 HPF) (Figure 4A, B). Immunohistochemical analysis revealed expression of C-kit (strongly positive), moderately positive stain for SMA, while markers for focal S-100 and CD 34 were negative (Figure 5).

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