A rare incidence of only pancreatic endocrine tissue in Meckel’s diverticulum

Abstract

Background: A 49-year-old female presented with lower abdominal pain and vomiting. No significant history of any previous illness. CT scan showed acute Meckel’s diverticulitis. Small bowel was resected. Results: Microscopic examination showed ulcerated and necrotic Meckel’s with focal viable areas and clusters 0.3–0.8 mm in maximum dimension, of bland neuroendocrine cells in the muscularis propria and adjacent adventitial adipose tissue. These nests morphologically resembled islets of Langerhans with developed capillary network and stained with synaptophysin, chromogranin. Insulin stained insulin secreting cells towards the centre of the islets and Glucagon stained glucagon secreting cells located peripherally in the islets confirming similar morphology to pancreatic islets of Langerhans. Discussion: Ectopic endocrine pancreatic tissue is histologically present within 20% of Meckel’s diverticula. Only two cases of endocrine only ectopic pancreatic tissue have been reported, in the stomach and Meckel’s diverticulum respectively, both occurring in insulin-dependent diabetics.1 Primary or metastatic neuroendocrine (carcinoid) tumour is the main differential diagnosis. Extensive specimen sampling, examination, immunohistochemistry and awareness of the entity is required for differentiaton.1 It is usually asymptomatic and diagnosed only during examinations for other diseases.2 Definitive preoperative diagnosis is challenging.3 Due to the possible chance of malignant transformation, it should be excised.