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Extranodal Marginal Zone Lymphoma Presenting within the Meckel Diverticulum as Diverticulitis: A Case Report

A Nael1, M L Wu2, P Nagesh Rao3

  • 1Department of Pathology and Laboratory Medicine, University of California Irvine Medical Center, 101 The City Drive, Orange, CA 92868, USA.

Case Reports in Pathology
|May 29, 2014
PubMed

Insights

This case report details the first instance of extranodal marginal zone lymphoma within a Meckel diverticulum. This rare gastrointestinal lymphoma, also known as MALT lymphoma, was identified in a patient presenting with acute abdominal pain.

Area of Science:

  • Gastroenterology
  • Oncology
  • Pathology

Background:

  • Meckel diverticulum is the most common congenital gastrointestinal anomaly.
  • It can present asymptomatically or mimic other conditions like appendicitis.
  • Complications include bleeding, diverticulitis, obstruction, and rarely, neoplasia.

Purpose of the Study:

  • To report the first documented case of extranodal marginal zone lymphoma (EMZL) arising within a Meckel diverticulum.
  • To highlight the diagnostic features and implications of this rare presentation.

Main Methods:

  • A 44-year-old male presented with acute abdominal pain and signs of enteric obstruction.
  • Diagnostic laparoscopy revealed an intact Meckel diverticulum.
  • Microscopic examination, immunohistochemistry, and fluorescence in situ hybridization (FISH) were performed.

Main Results:

  • Microscopy revealed extensive infiltration by monocytoid B-cells in the submucosa and serosa of the Meckel diverticulum.
  • Immunohistochemistry showed positivity for CD20, BCL-2, and weak CD43, with negativity for other markers.
  • FISH confirmed the API2-MALT1 fusion, characteristic of t(11;18)(q21;q21), confirming EMZL (MALT lymphoma).

Conclusions:

  • Extranodal marginal zone lymphoma can occur within a Meckel diverticulum.
  • This diagnosis should be considered in patients with Meckel diverticulum and unexplained gastrointestinal symptoms.
  • The findings expand the known spectrum of MALT lymphoma manifestations.

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