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combined classical carcinoid and goblet cell carcinoid tumor

2010-09-06T14:18:51Z

Carcinoid tumors are the most common neoplasms of the appendix.

Histologically they have been categorized as classical, tubular, or goblet cell types.

Goblet cell carcinoid has been regarded as a distinctive tumor type, not related to classic carcinoids. Combinations of these 2 tumor types have rarely been described. (#20631606#)

The occurrence of both carcinoid types in the same appendices suggests a closer histogenetic relationship than previously believed, although the possibility that the 2 components represent separate, independent primaries ("collision tumors") can also be considered.

References

Combined classical carcinoid and goblet cell carcinoid tumor: a new morphologic variant of carcinoid tumor of the appendix. Chetty R, Klimstra DS, Henson DE, Albores-Saavedra J. Am J Surg Pathol. 2010 Aug;34(8):1163-7.PMID: #20631606#

appendiceal diverticula

2009-07-23T17:55:45Z

Appendiceal diverticula may rupture, resulting in mucin on the appendiceal serosa, which may raise concern for an underlying appendiceal mucinous neoplasm.

References

Ruptured Appendiceal Diverticula Mimicking Low-grade Appendiceal Mucinous Neoplasms. Hsu M, Young RH, Misdraji J. Am J Surg Pathol. 2009 Jul 20. PMID: #19623035#

adenoviral appendicitis

2008-03-05T20:01:28Z

See also

Adenovirus

adenoviral infections

Appendicitis

References

Grynspan D, Rabah R. Adenoviral appendicitis presenting clinically as acute appendicitis. Pediatr Dev Pathol. 2007 Jul 20;:1 PMID: #17990936#

appendiceal mucinous adenocarcinoma

2007-10-01T22:12:51Z

Low-grade appendiceal mucinous neoplasms may rupture and seed the peritoneum with bland neoplastic mucinous epithelium resulting, when grossly evident, in the well-known process pseudomyxoma peritonei.

Differential diagnosis

ruptured appendiceal diverticula (#19623035#)

References

Hristov AC, Young RH, Vang R, Yemelyanova AV, Seidman JD, Ronnett BM. Ovarian Metastases of Appendiceal Tumors With Goblet Cell Carcinoidlike and Signet Ring Cell Patterns: A Report of 30 Cases. Am J Surg Pathol. 2007 Oct;31(10):1502-1511. PMID: #17895750#

Yersinia appendicitis

2007-09-26T21:15:13Z

Synopsis

transmural epithelioid cell granulomas (EPGs)

predominantly nonsuppurative
surrounded by a lymphoid cuff composed of small lymphocytes.

suppurative granulomas

EPGs with suppuration of the centers of the granulomas (central microabscesses)

EPGs composed of numerous histiocytes with or without epithelioid cell features, along with scattered small T-lymphocytes and plasmacytoid monocytes.

None of the EPGs contain monocytoid B-cells.

Immunohistochemical study

EPGs usually surrounded by surface IgM/D+ small mantle zone lymphocytes.
CNA.42 immunostaining occasionally demonstrated residual follicular dendritic cells in the center of the EPGs.

Types

Yersinia enterocolitica appendicitis (#17189675#)

Differential diagnosis

cat scratch disease (numerous monocytoid B-cells)
lymphogranuloma venerum (numerous monocytoid B-cells)

References

Kojima M, Morita Y, Shimizu K, Yoshida T, Yamada I, Togo T, Johshita T. Immunohistological findings of suppurative granulomas of Yersinia enterocolitica appendicitis: a report of two cases. Pathol Res Pract. 2007;203(2):115-9. PMID: #17189675#

appendicectomy

2007-06-20T15:38:41Z

Videos

Laparoscopic appendicectomy

perforated acute appendicitis

2007-03-18T19:36:47Z

See also

Appendicitis

acute appendicitis

appendiceal carcinoid tumor

2007-02-02T03:03:51Z

Thought to arise from the subepithelial endocrine cells in the lamina propria and submucosa, appendiceal carcinoid tumors are the most common neoplasms affecting the appendix.

They are most often discovered during the fourth or fifth decade of life as an incidental finding during surgery performed for other reasons.

Most patients with appendiceal carcinoids are asymptomatic, likely because of the location of the neoplasm in relation to the appendiceal base; the vast majority (75%) are located in the distal third of the appendix, where the risk for obstruction is low, with the remainder located in the middle third, and <10% at the base.

In a series of 150 appendiceal carcinoids, Moertel et al. demonstrated that most appendiceal neoplasms were <1 cm in largest dimension, though larger tumors (>2 cm) appeared to be associated with a poorer prognosis and greater patient discomfort.

In fact, >50% of the patients who had large appendiceal carcinoids in one study presented with a clinical picture suggestive of acute appendicitis.

The prognosis for tumors <2 cm in size is quite favorable, because few of these neoplasms metastasize.

The 5-year survival rate overall is approximately 71% (94% for local disease, 85% for regional metastases, and 34% in the presence of distal disease).

Treatment

Tumor size has been shown to be the best predictor of prognosis in patients with appendiceal carcinoid tumors; as such, the surgical management of appendiceal carcinoids depends largely on the size and location of the primary tumor.

According to current guidelines, simple appendectomy is adequate for the treatment of small carcinoid tumors (

Indications for more extensive surgery than simple appendectomy have been shown to include tumor size >2 cm, lymphatic invasion, lymph node involvement, spread to the mesoappendix, tumor-positive resection margins, and cellular pleomorphism with a high mitotic index.

Given that approximately one third of patients with tumors >2 cm in diameter present with or develop nodal and distant metastases, most experts advocate a right hemicolectomy as the appropriate treatment option.

The management of tumors between 1 cm and 2 cm continues to be debated; however, a more aggressive treatment algorithm that includes right hemicolectomy is often employed, especially in younger patients.

Additional prognostic factors (gender and depth of penetration) may be used in choosing between appendectomy and hemicolectomy in these patients.

See also

carcinoid tumors

digestive carcinoid tumors

appendiceal tumors

appendiceal ulceration

2007-01-30T21:12:35Z

appendiceal ulcerations

- Appendix / Macroscopical images, Microscopical images, Tissular lesions

appendiceal lesions

2007-01-30T20:58:01Z

See also

Appendix

appendiceal diseases