Peritoneal metastases from malignant degeneration of ectopic gastric epithelium in Meckel's diverticulum: A case report.

BACKGROUND: Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, resulting from incomplete obliteration of the omphalomesenteric duct in early fetal development. The diverticulum frequently contains ectopic gastrointestinal epithelial tissue, most commonly gastric or pancreatic. Adenocarcinoma can arise from either of these epithelia but is extremely rare, with less than 50 cases reported in the world literature. METHODS: In a patient with peritoneal metastases from ectopic gastric mucosae in a Meckel's diverticulum a multidisciplinary treatment plan was initiated. RESULTS: Diagnosis was evident from study of the resected specimen of small bowel in a patient with acute abdominal pain. A multiagent chemotherapy regimen using oxaliplatin, mitomycin C, doxorubicin, and capecitabine (O-Max) resulted in a clinical and radiologic response. A second surgery with extensive sampling of tissues from the abdomen and pelvis confirmed a complete response to systemic chemotherapy. At four years from onset of disease the patient has no evidence of recurrence. CONCLUSIONS: Peritoneal metastases from malignant degeneration of ectopic gastric epithelium in a Meckel's diverticulum was reported. Multidisciplinary treatments were beneficial.

Vertical sleeve gastrectomy specimens have a high prevalence of unexpected histopathologic findings requiring additional clinical management.

BACKGROUND: Laparoscopic vertical sleeve gastrectomy is used with increasing frequency as a therapeutic option for morbid obesity. Before the procedure, patients undergo a rigorous preoperative evaluation including double contrast upper gastrointestinal radiographic series at our institution. Patients undergoing sleeve gastrectomy are presumed to have no significant gastric pathology. OBJECTIVES: To investigate the prevalence of histopathologic findings requiring clinical follow-up in sleeve gastrectomy specimens. SETTING: University Hospital, United States. METHODS: Retrospective review was conducted of all primary vertical sleeve gastrectomy specimens performed for morbid obesity at our institution from July 2008 until August 2012 (N = 248). RESULTS: Unanticipated findings warranting clinical follow-up were identified in 8.4% of cases and included cases of H. pylori gastritis, autoimmune gastritis with microcarcinoid formation, necrotizing vasculitis, and intestinal metaplasia. H. pylori was identified in 5.2% of all cases and in 33.3% of cases of gastritis. Neoplasms were identified at laparoscopy in 2 additional cases (0.8%). CONCLUSIONS: Surgeons and pathologists should be aware of the high prevalence of diagnoses requiring clinical follow-up in vertical sleeve gastrectomy specimens.

Fatal gastrointestinal hemorrhage in a paraplegic man with undiagnosed AA (secondary) amyloidosis.

We report a case of a 41-year-old African-American male paraplegic for more than 20 years, who had recurrent infections, renal failure with total urine protein of 840 mg/dL on urine protein electrophoresis and adrenal cortical insufficiency. He died suddenly of massive gastrointestinal (GI) hemorrhage. Autopsy showed clinically undiagnosed systemic amyloidosis involving the kidneys, adrenal cortices, spleen and small blood vessels of most organs and tissues, including those of the gastrointestinal tract. The history and autopsy findings indicated secondary or amyloid A (AA) amyloidosis. Paraplegia was one of the most common causes of secondary amyloidosis decades ago, but has now become unusual in patients with AA amyloidosis. Extensive involvement of GI small vessels was the most likely cause of fatal bleeding. GI amyloid previously has been shown to cause hemorrhage, but a fatal case has not yet been described.