Cytochemical and immunocytochemical characteristics of Meckel's diverticulum with heterotopic rests of pancreatic tissue

Abstract

Background. Meckel?s diverticulum (MD) is a congenital anomaly of the small intestine. It results from incomplete obliteration and resorption of the proximal omphaloenteric duct connecting yolk sac with primitive gut in the fetal period. Case report. A case of 20-year old female with ectopic pancreatic rests in a MD was reported. She was hospitalized with clinical signs of acute appendicitis. During surgery an inflamated Meckel?s diverticulum was found and a clinoid resection of the diverticulum was performed. Histologic examination revealed pancreatic tissue in the removed diverticulum. Endocrine cells (EC) were detected with Masson staining and aberrant pancreatic tissue with immunocytochemical LSAB2 method using pan cytokeratin as epithelial marker. Conclusion. Most of MD are asymptomatic and accessory finding during laparothomias for different causes, but complications of undiagnozed MD can be serious (diverticulitis, perforation with peritonitis or intestinal obstruction caused by invagination). In unclear cases, additional cytochemical and immunocytochemical diagnostics could be done.Uvod. Mekelov divertikulum (MD) je kongenitalna anomalija tankog creva. Nastaje zbog nepotpune obliteracije i resorpcije proksimalnog dela omfaloentericnog kanala koji povezuje zumancanu kesu sa primitivnim crevom u fetalnom periodu. Prikaz bolesnika. Prikazana je dvadesetogodisnja devojka sa ektopicnim tkivom pankreasa u MD. Hospitalizovana je sa klinickim znacima akutnog apendicitisa. Tokom operacije nadjen je inflamirani MD i uradjena je klinasta resekcija divertikuluma. Patohistoloski nalaz otkrio je pankreasno tkivo u uklonjenom divertikulumu. Endokrine celije (EC) dokazane su Massonovim bojenjem, a aberantno pankreasno tkivo imunocitohemijskom metodom LSAB2, uz upotrebu epitelnog markera pan citokeratina. Zakljucak. Vecina MD je asimtomatska i otkriva se pri laparotomiji zbog drugih razloga, ali komplikacije nedijagnistkovanog MD mogu biti ozbiljne (divertikulitis, perforacija sa peritonitisom ili intestinalna opstrukcija zbog invaginacije). U nejasnim slucajevima, dijagnostika se moze sprovesti koriscenjem dodatnih citohemijskih ili imunohistohemijskih metoda.