Meckel’s Diverticulum (Gastrointestinal Stromal Tumors)-Two Rare Case Reports.

Introduction: Meckel’s Diverticulum is the most common congenital anomaly of the gastrointestinal tract (incidence: 0.6%-4%). Gastro Intestinal Stromal Tumors originate from multipotential stromal cells of Cajal (pacemaker cell of gastrointestinal tract). The GISTs of Meckel’s diverticulum are extremely rare,especially if you consider that only 2% of the population has this kind of diverticula confirmed by autopsy studies, with a percentage that varies between 0.4 and 4.5%. Case Reports: We report two cases, a 53 year old post menopausal lady and a 45 year old peri menopausal lady, both clinico radiologically diagnosed as ovarian masses, found to have a tumor arising from Meckel’s Diverticulum intraoperatively, that were histopathologically proven to be Gastro Intestinal Stromal Tumors. A thorough literature review was done and all the previously quoted case reports are listed. Our literature search revealed a total of 42 case reports of GIST of Meckel’s Diverticulum including ours. Perforation is the most common presentation of a Meckel’s GIST (13 case reports).Meckel’s GIST presenting as a pelvic mass mimicking an ovarian pathology has been reported in the literature (6 case reports). Conclusion: Meckel’s diverticular tumours, though rare, may mimic other pathologies of the abdomen, therefore should be taken into consideration during the differential diagnosis of abdominal and pelvic tumours, especially in cases where imaging modalities doesn’t pinpoint adefinitive diagnosis.

Immature teratoma of the ovary: A clinicopathological study of 28 cases.

Aim: Immature teratoma (IT) of the ovary represents 1% of all ovarian cancers and 20% of malignant ovarian germ cell tumors. This retrospective study of 28 such cases aims to look at its morphological spectrum and to study the correlation of the grade and stage of the tumor with prognosis. Materials and Methods: A retrospective study of 28 cases of IT of the ovary was done. Neuroepithelium was graded as grade I, II and III according to the standard criteria. The presence of immature mesenchyme was also looked for and similarly graded. Results: The median age for the cases was 19 years and abdominal pain was the commonest symptom. Neuroepithelium was seen in 26 cases (6 were grade I, 13 were grade II, and 7 were grade III); and two showed immature mesenchymal tissue (IM) only. IM was seen in all 28 cases, but no correlation with the grade of the IT of the ovary is found. The follow up is available in 23 cases ranging from 6 months to 78 months (median 33 months). Of these, 13 were stage I, 3 were stage II and 7 were stage III ITs. Out of 23 patients, 17 patients were alive without evidence of disease recurrence during the last follow up. Adverse events in the form of death and local recurrence occurred in 6 patients. One patient died of the disease at 7 months duration from the disease onset (stage III, grade II IT). Conclusion: Morphological spectrum of IT of ovary is varied. Immature mesenchyme was seen in all the cases of IT of ovary and its presence should prompt a careful search for immature neuroepithelium. Stage I IT of ovary has better prognosis. Combination of surgery and chemotherapy can give longer survival even in recurrent disease.

High-grade adenocarcinoma, (ductal type) arising in unilateral Warthin tumor of the parotid gland.

Warthin tumor is a well-recognized benign salivary gland neoplasm consisting of an epithelial as well as a lymphoid component. Malignant transformation in Warthin tumor is rare and its reported incidence is up to 1%. The more common types of carcinomas described in Warthin tumor are the squamous and mucoepidermoid types, with high-grade adenocarcinoma being extremely rare. A high-grade adenocarcinoma (ductal type) arising in the Warthin tumor in a 72-year-old man is presented for its rarity and diagnostic difficulties.