Skip to main content
Erschienen in: Journal of Gastrointestinal Surgery 1/2011

01.01.2011 | Original Article

Neuroendocrine Tumors of Meckel’s Diverticulum: Lessons from a Single Institution Study of Eight Cases

verfasst von: Gilles Poncet, MD, Valérie Hervieu, MD, Thomas Walter, MD, Florian Lépinasse, BSc, Laurence Chardon, MD, Frank Pilleul, MD, Catherine Lombard-Bohas, MD, Jean-Alain Chayvialle, MD, Christian Partensky, MD, Jean-Yves Scoazec, MD

Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 1/2011

Einloggen, um Zugang zu erhalten

Abstract

Introduction

Endocrine tumors of Meckel’s diverticulum are rare. Their clinical and pathological characteristics are not well known, making it difficult to assess the best strategy for therapeutic management.

Materials and Methods

Eight cases of endocrine tumors of Meckel’s diverticulum, submitted to surgical resection in our institution between 1977 and 2009, were studied. Clinical charts were reviewed; classification, grading, and staging were performed according to recent international recommendations. Five cases, including two associated with the carcinoid syndrome, were revealed by mesenteric mass or liver metastases; three cases were diagnosed incidentally at laparotomy or laparoscopy.

Results

All cases presented as typical well-differentiated midgut endocrine tumors. Five cases were associated with mesenteric lymph node metastases; three presented with liver metastases. Seven cases were classified as well-differentiated endocrine carcinomas, one as well-differentiated endocrine tumor of benign behavior.

Discussion

All tumors >1 cm, but one, had regional or distant disease. All patients had complete surgical resection of the primary. One patient deceased after 25 months; the others were alive after 12–101 months.

Conclusion

In conclusion, endocrine tumors of Meckel’s diverticulum are rarely symptomatic and often diagnosed at an advanced stage. All tumors measuring more than 1 cm in diameter must be resected according to oncological principles.
Literatur
1.
Zurück zum Zitat Stone PA, Hofeldt MJ, Campbell JE, Vedula G, DeLuca JA, Flaherty SK. Meckel diverticulum: ten-year experience in adults. South Med J 2004;97:1038–1041.PubMedCrossRef Stone PA, Hofeldt MJ, Campbell JE, Vedula G, DeLuca JA, Flaherty SK. Meckel diverticulum: ten-year experience in adults. South Med J 2004;97:1038–1041.PubMedCrossRef
2.
Zurück zum Zitat Ciardo LF, Agresta F, Bedin N. Meckel’s diverticulum: a neglected (or deliberately ignored) entity. Chir Ital 2004;56:689–692.PubMed Ciardo LF, Agresta F, Bedin N. Meckel’s diverticulum: a neglected (or deliberately ignored) entity. Chir Ital 2004;56:689–692.PubMed
3.
Zurück zum Zitat Modlin IM, Shapiro MD, Kidd M. An analysis of rare carcinoid tumors: clarifying these clinical conundrums. World J Surg 2005;29:92–101.PubMedCrossRef Modlin IM, Shapiro MD, Kidd M. An analysis of rare carcinoid tumors: clarifying these clinical conundrums. World J Surg 2005;29:92–101.PubMedCrossRef
4.
Zurück zum Zitat Solcia E, Klöppel G, Sobin L. Histological typing of endocrine tumours. 2nd edition. New York:Springer, 2000 Solcia E, Klöppel G, Sobin L. Histological typing of endocrine tumours. 2nd edition. New York:Springer, 2000
5.
Zurück zum Zitat Rindi G, Kloppel G, Alhman H, Caplin M, Couvelard A, de Herder WW, Erikssson B, Falchetti A, Falconi M, Komminoth P, Korner M, Lopes JM, McNicol AM, Nilsson O, Perren A, Scarpa A, Scoazec JY, Wiedenmann B. TNM staging of foregut (neuro)endocrine tumors: a consensus proposal including a grading system. Virchows Arch 2006;449:395–401.PubMedCrossRef Rindi G, Kloppel G, Alhman H, Caplin M, Couvelard A, de Herder WW, Erikssson B, Falchetti A, Falconi M, Komminoth P, Korner M, Lopes JM, McNicol AM, Nilsson O, Perren A, Scarpa A, Scoazec JY, Wiedenmann B. TNM staging of foregut (neuro)endocrine tumors: a consensus proposal including a grading system. Virchows Arch 2006;449:395–401.PubMedCrossRef
6.
Zurück zum Zitat Rindi G, Kloppel G, Couvelard A, Komminoth P, Korner M, Lopes JM, McNicol AM, Nilsson O, Perren A, Scarpa A, Scoazec JY, Wiedenmann B. TNM staging of midgut and hindgut (neuro) endocrine tumors: a consensus proposal including a grading system. Virchows Arch 2007;451:757–762.PubMedCrossRef Rindi G, Kloppel G, Couvelard A, Komminoth P, Korner M, Lopes JM, McNicol AM, Nilsson O, Perren A, Scarpa A, Scoazec JY, Wiedenmann B. TNM staging of midgut and hindgut (neuro) endocrine tumors: a consensus proposal including a grading system. Virchows Arch 2007;451:757–762.PubMedCrossRef
7.
Zurück zum Zitat Sobin LH, Gospodarowicz MK, Wittekind C. TNM Classification of Malignant Tumours, 7th Edition. New York: Wiley, 2009. Sobin LH, Gospodarowicz MK, Wittekind C. TNM Classification of Malignant Tumours, 7th Edition. New York: Wiley, 2009.
8.
Zurück zum Zitat Arnold C, Marjoniemi V. Islet of Langerhans heterotopia in Meckel’s diverticulum. Pathology 2006;38:452–454.PubMedCrossRef Arnold C, Marjoniemi V. Islet of Langerhans heterotopia in Meckel’s diverticulum. Pathology 2006;38:452–454.PubMedCrossRef
9.
Zurück zum Zitat Grossmann I, Akkersdijk GJ. Carcinoid tumor in a Meckel’s diverticulum: hypothesis on mutual embryological origin. Int Surg 2003;88:41–46.PubMed Grossmann I, Akkersdijk GJ. Carcinoid tumor in a Meckel’s diverticulum: hypothesis on mutual embryological origin. Int Surg 2003;88:41–46.PubMed
10.
Zurück zum Zitat Moyana TN. Carcinoid tumors arising from Meckel’s diverticulum. A clinical, morphologic, and immunohistochemical study. Am J Clin Pathol 1989;91:52–56.PubMed Moyana TN. Carcinoid tumors arising from Meckel’s diverticulum. A clinical, morphologic, and immunohistochemical study. Am J Clin Pathol 1989;91:52–56.PubMed
11.
Zurück zum Zitat Carpenter SS, Grillis ME. Meckel’s diverticulitis secondary to carcinoid tumor: an unusual presentation of the acute abdomen in an adult. Curr Surg 2003;60:301–303.PubMedCrossRef Carpenter SS, Grillis ME. Meckel’s diverticulitis secondary to carcinoid tumor: an unusual presentation of the acute abdomen in an adult. Curr Surg 2003;60:301–303.PubMedCrossRef
12.
Zurück zum Zitat Coyne JD, Dervan PA. Ileal intussuseptus containing a Meckel’s diverticulum showing florid localized mucosal angiogenesis and microcarcinoidosis. Histopathology 2003;43:608–609.PubMedCrossRef Coyne JD, Dervan PA. Ileal intussuseptus containing a Meckel’s diverticulum showing florid localized mucosal angiogenesis and microcarcinoidosis. Histopathology 2003;43:608–609.PubMedCrossRef
13.
Zurück zum Zitat Green M, Oratz R, Muggia FM. Carcinoid syndrome from a tumor of Meckel’s diverticulum. Am J Med 1987;12:184–186.CrossRef Green M, Oratz R, Muggia FM. Carcinoid syndrome from a tumor of Meckel’s diverticulum. Am J Med 1987;12:184–186.CrossRef
14.
Zurück zum Zitat Pyke CM, Lancaster BA, van Heerden JA, Kvols LK. Carcinoid syndrome secondary to a primary tumour in a Meckel’s diverticulum. Aust N Z J Surg 1993;63:732–734.PubMedCrossRef Pyke CM, Lancaster BA, van Heerden JA, Kvols LK. Carcinoid syndrome secondary to a primary tumour in a Meckel’s diverticulum. Aust N Z J Surg 1993;63:732–734.PubMedCrossRef
15.
Zurück zum Zitat La Rosa S, Rigoli E, Uccella S, Chiaravalli AM, Capella C. CDX2 as a marker of intestinal EC-cells and related well-differentiated endocrine tumors. Virchows Arch 2004;445:248–254.PubMedCrossRef La Rosa S, Rigoli E, Uccella S, Chiaravalli AM, Capella C. CDX2 as a marker of intestinal EC-cells and related well-differentiated endocrine tumors. Virchows Arch 2004;445:248–254.PubMedCrossRef
16.
Zurück zum Zitat Saqi A, Alexis D, Remotti F, Bhagat G. Usefulness of CDX2 and TTF-1 in differentiating gastrointestinal from pulmonary carcinoids. Am J Clin Pathol 2005;123:394–404.PubMedCrossRef Saqi A, Alexis D, Remotti F, Bhagat G. Usefulness of CDX2 and TTF-1 in differentiating gastrointestinal from pulmonary carcinoids. Am J Clin Pathol 2005;123:394–404.PubMedCrossRef
17.
Zurück zum Zitat Jaffee IM, Rahmani M, Singhal MG, Younes M. Expression of the intestinal transcription factor CDX2 in carcinoid tumors is a marker of midgut origin. Arch Pathol Lab Med 2006;130:1522–1526.PubMed Jaffee IM, Rahmani M, Singhal MG, Younes M. Expression of the intestinal transcription factor CDX2 in carcinoid tumors is a marker of midgut origin. Arch Pathol Lab Med 2006;130:1522–1526.PubMed
18.
Zurück zum Zitat Lundqvist M, Wilander E. Subepithelial neuroendocrine cells and carcinoid tumours of the human small intestine and appendix. A comparative immunohistochemical study with regard to serotonin, neuron-specific enolase and S-100 protein reactivity. J Pathol 1986;148:141–147.PubMedCrossRef Lundqvist M, Wilander E. Subepithelial neuroendocrine cells and carcinoid tumours of the human small intestine and appendix. A comparative immunohistochemical study with regard to serotonin, neuron-specific enolase and S-100 protein reactivity. J Pathol 1986;148:141–147.PubMedCrossRef
19.
Zurück zum Zitat Rasmussen OO, Rafiolsadat Z, Berg J. Carcinoid and pancreas tissue in a macroscopically normal Meckel’s diverticulum. Ugeskr Laeger 1987;83:2538. Rasmussen OO, Rafiolsadat Z, Berg J. Carcinoid and pancreas tissue in a macroscopically normal Meckel’s diverticulum. Ugeskr Laeger 1987;83:2538.
20.
Zurück zum Zitat Scognamiglio F, Panico L, Petrillo O, Fusco B, Terracciano LM, Ferrara G. Carcinoid associated with pancreatic heterotopia in Meckel’s diverticulum. The clinical, morphological and ultrastructural aspects of a case. Minerva Chir 1990;45:1043–1047.PubMed Scognamiglio F, Panico L, Petrillo O, Fusco B, Terracciano LM, Ferrara G. Carcinoid associated with pancreatic heterotopia in Meckel’s diverticulum. The clinical, morphological and ultrastructural aspects of a case. Minerva Chir 1990;45:1043–1047.PubMed
21.
Zurück zum Zitat Weber JD, McFadden DW. Carcinoid tumors in Meckel’s diverticula. J Clin Gastroenterol 1989;11:682–686.PubMedCrossRef Weber JD, McFadden DW. Carcinoid tumors in Meckel’s diverticula. J Clin Gastroenterol 1989;11:682–686.PubMedCrossRef
22.
Zurück zum Zitat Nies C, Zielke A, Hasse C, Ruschoff J, Rothmund M. Carcinoid tumors of Meckel’s diverticula. Report of two cases and review of the literature. Dis Colon Rectum 1992;35:589–596PubMedCrossRef Nies C, Zielke A, Hasse C, Ruschoff J, Rothmund M. Carcinoid tumors of Meckel’s diverticula. Report of two cases and review of the literature. Dis Colon Rectum 1992;35:589–596PubMedCrossRef
23.
Zurück zum Zitat Plockinger U, Couvelard A, Falconi M, Sundin A, Salazar R, Christ E, de Herder WW, Gross D, Knapp WH, Knigge UP, Kulke MH, Pape UF. Consensus guidelines for the management of patients with digestive neuroendocrine tumours: well-differentiated tumour/carcinoma of the appendix and goblet cell carcinoma. Neuroendocrinology 2008;87:20–30.PubMedCrossRef Plockinger U, Couvelard A, Falconi M, Sundin A, Salazar R, Christ E, de Herder WW, Gross D, Knapp WH, Knigge UP, Kulke MH, Pape UF. Consensus guidelines for the management of patients with digestive neuroendocrine tumours: well-differentiated tumour/carcinoma of the appendix and goblet cell carcinoma. Neuroendocrinology 2008;87:20–30.PubMedCrossRef
24.
Zurück zum Zitat Eriksson B, Kloppel G, Krenning E, Ahlman H, Plockinger U, Wiedenmann B, Arnold R, Auernhammer C, Korner M, Rindi G, Wildi S. Consensus guidelines for the management of patients with digestive neuroendocrine tumors-well-differentiated jejunal-ileal tumor/carcinoma. Neuroendocrinology 2008;87:8–19.PubMedCrossRef Eriksson B, Kloppel G, Krenning E, Ahlman H, Plockinger U, Wiedenmann B, Arnold R, Auernhammer C, Korner M, Rindi G, Wildi S. Consensus guidelines for the management of patients with digestive neuroendocrine tumors-well-differentiated jejunal-ileal tumor/carcinoma. Neuroendocrinology 2008;87:8–19.PubMedCrossRef
25.
Zurück zum Zitat Poncet G, Faucheron JL, Walter T. Recent trends in the treatment of well-differentiated endocrine carcinoma of the small bowel. World J Gastroenterol 2010;16:1696–1706.PubMedCrossRef Poncet G, Faucheron JL, Walter T. Recent trends in the treatment of well-differentiated endocrine carcinoma of the small bowel. World J Gastroenterol 2010;16:1696–1706.PubMedCrossRef
26.
Zurück zum Zitat Eriksson B, Kloppel G, Krenning E, Ahlman H, Plockinger U, Wiedenmann B, Arnold R, Auernhammer C, Korner M, Rindi G, Wildi S. Consensus guidelines for the management of patients with digestive neuroendocrine tumors—well-differentiated jejunal–ileal tumor/carcinoma. Neuroendocrinology 2008;87:8–19.PubMedCrossRef Eriksson B, Kloppel G, Krenning E, Ahlman H, Plockinger U, Wiedenmann B, Arnold R, Auernhammer C, Korner M, Rindi G, Wildi S. Consensus guidelines for the management of patients with digestive neuroendocrine tumors—well-differentiated jejunal–ileal tumor/carcinoma. Neuroendocrinology 2008;87:8–19.PubMedCrossRef
27.
Zurück zum Zitat Silk YN, Douglass HO Jr, Penetrante R. Carcinoid tumor in Meckel’s diverticulum. Am Surg 1988;83:664–667. Silk YN, Douglass HO Jr, Penetrante R. Carcinoid tumor in Meckel’s diverticulum. Am Surg 1988;83:664–667.
28.
Zurück zum Zitat Robijn J, Sebrechts E, Miserez M. Management of incidentally found Meckel’s diverticulum a new approach: resection based on a Risk Score. Acta Chir Belg 2006;106:467–470.PubMed Robijn J, Sebrechts E, Miserez M. Management of incidentally found Meckel’s diverticulum a new approach: resection based on a Risk Score. Acta Chir Belg 2006;106:467–470.PubMed
29.
Zurück zum Zitat Anderson DJ. Carcinoid tumor in Meckel’s diverticulum: laparoscopic treatment and review of the literature. J Am Osteopath Assoc 2000;100:432–434.PubMed Anderson DJ. Carcinoid tumor in Meckel’s diverticulum: laparoscopic treatment and review of the literature. J Am Osteopath Assoc 2000;100:432–434.PubMed
30.
Zurück zum Zitat Bona D, Schipani LS, Nencioni M, Rubino B, Bonavina L. Laparoscopic resection for incidentally detected Meckel diverticulum. World J Gastroenterol 2008;14:49614963.PubMedCrossRef Bona D, Schipani LS, Nencioni M, Rubino B, Bonavina L. Laparoscopic resection for incidentally detected Meckel diverticulum. World J Gastroenterol 2008;14:49614963.PubMedCrossRef
31.
Zurück zum Zitat Palanivelu C, Rangarajan M, Senthilkumar R, Madankumar MV, Kavalakat AJ. Laparoscopic management of symptomatic Meckel’s diverticula: a simple tangential stapler excision. JSLS 2008;12:66–70.PubMed Palanivelu C, Rangarajan M, Senthilkumar R, Madankumar MV, Kavalakat AJ. Laparoscopic management of symptomatic Meckel’s diverticula: a simple tangential stapler excision. JSLS 2008;12:66–70.PubMed
Metadaten
Titel
Neuroendocrine Tumors of Meckel’s Diverticulum: Lessons from a Single Institution Study of Eight Cases
verfasst von
Gilles Poncet, MD
Valérie Hervieu, MD
Thomas Walter, MD
Florian Lépinasse, BSc
Laurence Chardon, MD
Frank Pilleul, MD
Catherine Lombard-Bohas, MD
Jean-Alain Chayvialle, MD
Christian Partensky, MD
Jean-Yves Scoazec, MD
Publikationsdatum
01.01.2011
Verlag
Springer-Verlag
Erschienen in
Journal of Gastrointestinal Surgery / Ausgabe 1/2011
Print ISSN: 1091-255X
Elektronische ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-010-1312-x

Weitere Artikel der Ausgabe 1/2011

Journal of Gastrointestinal Surgery 1/2011 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.