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[A pseudotumoral lesion revealing Meckel's diverticulum]
J Lemale1, S Boudjemaa2, B Parmentier3
1Service de nutrition et gastro-entérologie pédiatriques, hôpital Armand-Trousseau, AP-HP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France.
Introduction:
Meckel's diverticulum is a common malformation in children, usually asymptomatic, with complications in only 20% of cases. Exceptionally, a tumor can develop in Meckel's diverticulum in children, particularly Burkitt's lymphoma; in adults it can develop into a gastrointestinal stromal tumor, a leiomyosarcoma, or a neuroendocrine tumor such as a carcinoid tumor. The diagnosis of inflammatory pseudotumor following an insidious perforation is rare.
Observation:
We report the case of a 14-month-old boy who presented with fever, asthenia, food refusal, and digestive complaints such as vomiting and tender abdomen suggesting appendicitis. Computed tomography showed an ileal mass of 3cm in diameter, which led to the suspicion of Burkitt's lymphoma. Laparoscopy showed Meckel's diverticulum with a mass of 3×2.8×2cm. Histological examination confirmed the diagnosis of Meckel's diverticulum with gastric heterotopia and showed a proliferation of spindle cells in a myxoid background, with an inflammatory infiltrate made of lymphocytes and plasmocytes. Immunostaining ruled out a malignant tumor. The diagnosis of an inflammatory pseudotumor developing on a Meckel diverticulum with gastric heterotopias was made. The outcome was favorable after surgical resection.
Conclusion:
While perforation of a Meckel diverticulum with gastric heterotopia is a common finding, the discovery of an inflammatory pseudotumor following a perforation is rare; the differential diagnosis should include Burkitt's lymphoma.
Insights
A rare inflammatory pseudotumor developed in a child's Meckel's diverticulum with gastric heterotopia. This case highlights the importance of considering pseudotumors in Meckel's diverticulum diagnoses, even when suspecting malignancy.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Pathology
- Oncology
Background:
- Meckel's diverticulum is a common congenital anomaly in children, often asymptomatic.
- Malignant tumors like Burkitt's lymphoma can exceptionally arise in Meckel's diverticulum.
- Inflammatory pseudotumors are a rare complication of Meckel's diverticulum perforation.
Observation:
- A 14-month-old boy presented with symptoms suggestive of appendicitis, including fever and vomiting.
- Imaging revealed an ileal mass, initially suspected to be Burkitt's lymphoma.
- Laparoscopy confirmed Meckel's diverticulum with a mass, which histology revealed as an inflammatory pseudotumor with gastric heterotopia.
Findings:
- Histological examination ruled out malignancy, diagnosing an inflammatory pseudotumor.
- The pseudotumor was associated with gastric heterotopia within the Meckel's diverticulum.
- Surgical resection resulted in a favorable outcome for the patient.
Implications:
- This case underscores the rarity of inflammatory pseudotumors in Meckel's diverticulum.
- It emphasizes the need to include inflammatory pseudotumors in the differential diagnosis of pediatric Meckel's diverticulum masses, alongside malignancies like Burkitt's lymphoma.
- Early diagnosis and surgical intervention are crucial for favorable outcomes.
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