Goblet cell adenocarcinoma
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| Goblet cell adenocarcinoma | |
|---|---|
| Diagnosis in short | |
 Crypt cell carcinoma. H&E stain. | |
|
| |
| LM | small clusters of cells with stippled chromatin and a goblet cell-like appearance |
| LM DDx | signet ring cell carcinoma, appendiceal neuroendocrine tumour, poorly differentiated adenocarcinoma |
| Stains | alcian blue +ve, PASD +ve, mucicarmine +ve |
| IHC | synaptophysin +ve, chromogranin +ve, S-100 +ve, CK20 +ve |
| Gross | usu. no mass apparent |
| Site | vermiform appendix, elsewhere in the GI tract |
|
| |
| Clinical history | "acute appendicitis" |
| Prevalence | rare |
| Prognosis | moderate |
| Clin. DDx | acute appendicitis, other appendiceal tumours, other abdominal pathology |
Crypt cell carcinoma, also known as goblet cell carcinoid[1][2] and neuroendocrine tumour with goblet cell differentiation, is a rare malignant tumour that is typically seen in the vermiform appendix.
General
- Rare appendiceal tumour that typically has an aggressive course vis-a-vis other appendiceal carcinoids.[1]
- Mixed (biphasic) tumour with endocrine and exocrine features.
- Usually presents as acute appendicitis.[2]
- Less common presentations: appendiceal mass, pain.
- Five year survival in one series: 60-85%.[2]
Gross
- Typically no mass is apparent at gross.[2]
Microscopic
Features:[2]
- Mixed neuroendocrine-nonneuroendocrine tumour;[3] features of both carcinoid and adenocarcinoma.[2]
- Archictecture: cells arranged in nests or clusters without a lumen.
- Location: deep to the intestinal crypts (crypts of Lieberkühn); usually do not involve the mucosa.
- Cytoplasm distended with mucin.
- DNA: crescentic nucleus (similar to in signet ring cells).
- +/-Multi-nucleation.
- +/-High mitotic rate.
- Usually minimal nuclear atypia.
DDx:
- Appendiceal neuroendocrine tumour.
- Signet ring cell carcinoma[4] - cells more detached, no neuroendocrine differentiation.
- Poorly differentiated adenocarcinoma - see colorectal carcinoma.
Images
CCC - low mag. (WC/Nephron)
CCC - intermed. mag. (WC/Nephron)
CCC - high mag. (WC/Nephron)
CCC - very high mag. (WC/Nephron)
CCC - intermed. mag. (WC/Nephron)
CCC - high mag. (WC/Nephron)
CCC - very high mag. (WC/Nephron)
Stains
- Mucin stains +ve:
IHC
- Classic neuroendocrine markers:
- Synaptophysin +ve.
- Chromogranin +ve.
- S-100 +ve.
- NSE +ve.
- Serotonin +ve.
Keratins:
- Usually CK20 +ve > CK7 +ve.
- CEA +ve (membrane).
Notes:
- Nice review of stains in Pahlavan and Kanthan.[2]
See also
References
- ↑ 1.0 1.1 van Eeden S, Offerhaus GJ, Hart AA, et al. (December 2007). "Goblet cell carcinoid of the appendix: a specific type of carcinoma". Histopathology 51 (6): 763–73. doi:10.1111/j.1365-2559.2007.02883.x. PMID 18042066.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Pahlavan, PS.; Kanthan, R. (Jun 2005). "Goblet cell carcinoid of the appendix.". World J Surg Oncol 3: 36. doi:10.1186/1477-7819-3-36. PMID 15967038. Cite error: Invalid
<ref>tag; name "pmid15967038" defined multiple times with different content Cite error: Invalid<ref>tag; name "pmid15967038" defined multiple times with different content - ↑ Volante M, Righi L, Asioli S, Bussolati G, Papotti M (August 2007). "Goblet cell carcinoids and other mixed neuroendocrine/nonneuroendocrine neoplasms". Virchows Arch. 451 Suppl 1: S61–9. doi:10.1007/s00428-007-0447-y. PMID 17684764.
- ↑ Pericleous, M.; Lumgair, H.; Baneke, A.; Morgan-Rowe, L.; E Caplin, M.; Luong, TV.; Thirlwell, C.; Gillmore, R. et al. (May 2012). "Appendiceal goblet cell carcinoid tumour: a case of unexpected lung metastasis.". Case Rep Oncol 5 (2): 332-8. doi:000339607. PMID 22933998.