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Zheng M, Li T, Li Y, Zhang T, Zhang L, Ma W, Zhou L. Survival Profile and Prognostic Factors for Appendiceal Mixed Neuroendocrine Non-neuroendocrine Neoplasms: A SEER Population-Based Study. Front Oncol 2020; 10:1660. [PMID: 32903647 PMCID: PMC7438709 DOI: 10.3389/fonc.2020.01660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/28/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction Mixed neuroendocrine non-neuroendocrine neoplasm (MiNEN) is a rare form of neuroendocrine neoplasms (NENs). The purpose of this study was to investigate the characteristics and survival profile of appendiceal MiNENs, with a view of providing robust clinical features of this rare disease. Methods Patients were selected from the Surveillance, Epidemiology, and End Results database (2004–2016). The prognosis of MiNEN (n = 315) was compared with other histological subtypes including neuroendocrine tumor (NETs) (n = 1734), neuroendocrine carcinoma (NECs) (n = 375), goblet cell carcinoid (GCC) (n = 968), signet ring cell carcinoma (n = 463), mucinous adenocarcinoma (MAC) (n = 2355), and non-mucinous adenocarcinoma (NMAC) (n = 1187) in the appendix. Age-adjusted incidence was calculated using Joinpoint regression. The Cox proportional hazards model and the Fine–Gray competing risk model were used to perform overall survival (OS) and cancer-specific mortality (CSM) analyses, respectively. Results The age-adjusted incidence of MiNENs increased from 0.01/100,000 person-years in 2004 to 0.07/100,000 person-years in 2016. The 3-, 5-, and 10-year OS rates for MiNENs were 69.5, 57.4, and 43.7%, respectively, and the corresponding CSM rates were 23.1, 36.4, and 45.1%, respectively. Multivariate analysis revealed that the prognosis of MiNENs was worse than that of NETs, NECs, GCC, and MAC but better than that of NMAC and signet ring cell carcinoma. Tumor extension was the only independent factor influencing the prognosis of MiNENs, but tumor size, grade, and surgical approaches were not. Moreover, when compared with local excision or appendectomy, extensive surgery such as hemicolectomy or colectomy did not prolong the survival of individuals with MiNENs. Conclusion MiNEN is a rare but aggressive tumor with a poor prognosis differing from NENs, GCC and adenocarcinomas. To improve the prognosis of the disease, early diagnosis and comprehensive evaluation are necessary.
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Affiliation(s)
- Mengzhen Zheng
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tong Li
- Genetic and Prenatal Diagnosis Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Li
- Xinxiang Medical University, Xinxiang, China
| | - Tengfei Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lianfeng Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wang Ma
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lin Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Kubo K, Kimura N, Suzuoki M, Matsuda S, Tsuda M, Ohara M, Kato M. Perforated Goblet Cell Carcinoid of the Appendix. Case Rep Gastroenterol 2020; 14:354-360. [PMID: 32884510 PMCID: PMC7443672 DOI: 10.1159/000508427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/30/2020] [Indexed: 11/21/2022] Open
Abstract
Goblet cell carcinoid (GCC) of the perforated appendix is rare, and its pathological features and prognosis remain poorly described. A 71-year-old woman was admitted to our hospital for right lower abdominal pain, vomiting, and high-grade fever. She was diagnosed with acute appendicitis and underwent emergency laparoscopic appendectomy. Intraoperative examination revealed an enlarged and perforated appendix. Histopathological examination revealed GCC of the appendix with subserosal invasion. She underwent laparoscopic ileocecal resection with lymph node dissection (D3) following appendectomy. Histopathological findings showed no residual tumor or lymph node metastases. To the best of our knowledge, this report is a valuable addition to the GCC literature, describing a case of GCC of the appendix presenting as perforated appendix.
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Affiliation(s)
- Kimitoshi Kubo
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Noriko Kimura
- Department of Pathology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Masato Suzuoki
- Department of Surgery, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Soichiro Matsuda
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Momoko Tsuda
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Masanori Ohara
- Department of Surgery, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Mototsugu Kato
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
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Inoue Y, Horie H, Homma Y, Sadatomo A, Tahara M, Koinuma K, Yamaguchi H, Mimura T, Kihara A, Lefor AK, Sata N. Goblet cell carcinoid of the rectum: a case report. Surg Case Rep 2020; 6:174. [PMID: 32683504 PMCID: PMC7368876 DOI: 10.1186/s40792-020-00937-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/10/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Goblet cell carcinoid (GCC) is a neuroendocrine tumor usually found in the appendix. GCCs exhibit characteristic findings with mixed endocrine-exocrine features such as staining positive for neuroendocrine markers and producing mucin. The primary GCC of the rectum is exceedingly rare. CASE PRESENTATION A 77-year-old Japanese male presented with hematochezia. Anal tenderness and a hard mass in the anal canal were found on the digital rectal examination, and colonoscopy was performed. Colonoscopy showed an irregularly shaped mass in the anal canal. Biopsy showed mixed features including adenocarcinoma in situ, well-differentiated adenocarcinoma, and mucinous carcinoma with invasive proliferation. No metastatic lesions were found on the computed tomography scan. Pelvic magnetic resonance imaging scan showed extramural growth of a tumor on the ventral side of the rectum without invasion to the prostate. Laparoscopic abdominoperineal resection was performed. The final diagnosis was well-differentiated adenocarcinoma in the mucosa and goblet cell carcinoid from the submucosa to the adventitia of the rectum. The patient was discharged from the hospital on postoperative day 16. Six months after resection, a computed tomography scan revealed multiple metastatic lesions in the liver. Several chemotherapy regimens were given, and the patient has stable disease 27 months after surgery. CONCLUSION We present a patient with rectal GCC with metachronous liver metastases. Since GCC grows intramurally and is biologically aggressive compared to typical carcinoid lesions, the disease is usually diagnosed at an advanced stage. The development of optimal adjuvant chemotherapy is needed for those patients.
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Affiliation(s)
- Yoshiyuki Inoue
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji Shimotsuke, Tochigi, 329-0498, Japan.
| | - Hisanaga Horie
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji Shimotsuke, Tochigi, 329-0498, Japan
| | - Yuko Homma
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji Shimotsuke, Tochigi, 329-0498, Japan
| | - Ai Sadatomo
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji Shimotsuke, Tochigi, 329-0498, Japan
| | - Makiko Tahara
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji Shimotsuke, Tochigi, 329-0498, Japan
| | - Koji Koinuma
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji Shimotsuke, Tochigi, 329-0498, Japan
| | - Hironori Yamaguchi
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji Shimotsuke, Tochigi, 329-0498, Japan
| | - Toshiki Mimura
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji Shimotsuke, Tochigi, 329-0498, Japan
| | - Atsushi Kihara
- Department of Pathology, Jichi Medical University, 3311-1 Yakushiji Shimotsuke, Tochigi, 329-0498, Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji Shimotsuke, Tochigi, 329-0498, Japan
| | - Naohiro Sata
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji Shimotsuke, Tochigi, 329-0498, Japan
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Stewart JH, Blazer DG, Calderon MJG, Carter TM, Eckhoff A, Al Efishat MA, Fernando DG, Foster JM, Hayes-Jordan A, Johnston FM, Lautz TB, Levine EA, Maduekwe UN, Mangieri CW, Moaven O, Mogal H, Shen P, Votanopoulos KI. The Evolving Management of Peritoneal Surface Malignancies. Curr Probl Surg 2020; 58:100860. [PMID: 33832580 DOI: 10.1016/j.cpsurg.2020.100860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/04/2020] [Indexed: 02/07/2023]
Affiliation(s)
| | - Dan G Blazer
- Division of Surgical Oncology, Duke University Medical Center, Durham, NC
| | | | | | | | | | | | - Jason M Foster
- Fred and Pamela Buffet Cancer Center, University of Nebraska, Omaha, NE
| | | | - Fabian M Johnston
- Complex General Surgical Oncology Program, Johns Hopkins University, Baltimore, MD
| | - Timothy B Lautz
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Ugwuji N Maduekwe
- Division of Surgical Oncology and Endocrine Surgery, University of North Carolina, Chapel Hill, NC
| | | | | | | | - Perry Shen
- Wake Forest University School of Medicine, Winston-Salem, NC
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Abstract
Mucinous appendiceal tumors include low-grade appendiceal mucinous neoplasm, high-grade appendiceal mucinous neoplasm, and mucinous adenocarcinoma. Nonmucinous adenocarcinomas are less frequent. Recent consensus guidelines and the latest edition of the World Health Organization classification will allow consistent use of agreed nomenclature. Accurate diagnosis is important not only for patient management but also to allow comparison of results between centers and tumor registries. Serrated polyps are the most common benign polyp in the appendix. They need to be distinguished from low-grade appendiceal mucinous neoplasm, which can also mimic other benign conditions. Goblet cell adenocarcinomas are a distinctive type of appendiceal neoplasm.
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Affiliation(s)
- Norman J Carr
- Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Aldermaston Road, Basingstoke RG24 9NA, UK.
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56
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Abstract
Neuroendocrine neoplasms (NENs) of the gastrointestinal (GI) tract and pancreas are a rare and heterogeneous group of neoplasms characterized by common cellular features as well as unique site-specific traits. GI and pancreatic NENs are much rarer than the more common adenocarcinomas arising at these sites. However, the incidences of GI and pancreatic NENs have increased significantly, particularly in the stomach and common site, followed by rectum, appendix, colon, and stomach. Pancreatic NENs are also uncommon, with fewer than 1 per 100,000, accounting for 1% to 2% of all pancreatic neoplasms.
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Imam R, Imam A, Atlan K, Mintz Y, Khoury T, Grozinsky-Galsberg S, Oleinikov K, Pikarsky AJ, Khalaileh A. Gastric goblet cell carcinoma concurrent with a neuroendocrine tumor. Pathol Res Pract 2020; 216:153092. [PMID: 32825959 DOI: 10.1016/j.prp.2020.153092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/13/2020] [Accepted: 06/26/2020] [Indexed: 10/24/2022]
Abstract
Goblet cell carcinoma, a tumor that is assumed to originate from crypt base stem cells, is a distinct type of tumor, that occurs typically in the appendix, however, extra-appendiceal locations were also described in few cases. We herein present a unique case of a 48-year-old male with a diagnosis of primary gastric Goblet cell carcinoma that was initially discovered at the time of an endoscopy performed to evaluate an unremitting abdominal pain that was accompanied by remarkable weight loss; four polypoid fragments of the gastric mucosa were sent for histopathologic examination which showed a moderately differentiated goblet cell carcinoma in addition to classical neuroendocrine tumor. Later, laparoscopic D2 total gastrectomy with appendectomy were performed and confirmed the previously mentioned findings along with a normal histopathology of the appendix.
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Affiliation(s)
- Riham Imam
- Department of General Surgery, Hadassah Medical Center and Hebrew University, Jerusalem, Israel
| | - Ashraf Imam
- Department of General Surgery, Hadassah Medical Center and Hebrew University, Jerusalem, Israel.
| | - Karin Atlan
- Department of Pathology, Hadassah-Hebrew University Medical Center, Ein Kerem Campus, Jerusalem, Israel
| | - Yoav Mintz
- Department of General Surgery, Hadassah Medical Center and Hebrew University, Jerusalem, Israel
| | - Tawfik Khoury
- Gastroenterology Unit, Hadassah-Hebrew University Medical Center, Ein Kerem Campus, Jerusalem, Israel
| | - Simona Grozinsky-Galsberg
- Department of Endocrinology, Hadassah-Hebrew University Medical Center, Ein Kerem Campus, Jerusalem, Israel
| | - Kira Oleinikov
- Neuroendocrine Tumor Unit, Endocrinology Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Alon J Pikarsky
- Department of General Surgery, Hadassah Medical Center and Hebrew University, Jerusalem, Israel
| | - Abed Khalaileh
- Department of General Surgery, Hadassah Medical Center and Hebrew University, Jerusalem, Israel
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58
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Goblet Cell Carcinoid (GCC) of the Appendix presenting as a Small Bowel Obstruction. Radiol Case Rep 2020; 15:1339-1343. [PMID: 32617127 PMCID: PMC7322488 DOI: 10.1016/j.radcr.2020.05.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 11/28/2022] Open
Abstract
A 68 year old male presented to our Emergency Department with a one-day history of right sided abdominal pain, distention and vomiting on a background of no previous abdominal surgery. Abdominal CT demonstrated a high grade, closed loop small bowel obstruction involving the terminal segment of the ileum. Also of significance was alow-density appendiceal nodule. A subsequent laparoscopy revealed the tip of the appendix adherent to the mesosigmoid colon, forming a tight band and consequent mechanical bowel obstruction. Furthermore, the meso-appendix was embedded with crystal deposits and extruding mucin. The decision was made to convert to laparotomy and perform a caecectomy. Immunohistochemistry demonstrated reactivity to synaptophysin, chromogranin A and CD56, confirming the diagnosis of Goblet Cell Carcinoid. A staging CT after this initial surgery revealed no metastasis. After discussion at our oncology MDT, the patient went on to receive a completion right hemicolectomy which revealed no further malignancy on histology. The patient otherwise progressed well, and made a good post-operative recovery.
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59
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Appendiceal neoplasms and histological involvement of the mesoappendix: A case series. Ann Med Surg (Lond) 2020; 56:64-67. [PMID: 32577233 PMCID: PMC7305355 DOI: 10.1016/j.amsu.2020.05.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction Acute appendicitis is a common presentation to surgical departments, typically resulting in appendicectomy. Appendiceal tumours may not be visible intraoperatively, and are present in roughly 0.5–1% of specimens. Routine resection of the mesoappendix is not universally practiced, despite the mesoappendix being commonly involved in appendiceal tumours. This is a case series of the histological findings of 21 patients with appendiceal tumours, with consideration to tumour within the resected mesoappendix. Methods We reviewed the histology of 1344 patients undergoing laparoscopic appendicectomy over a 6-year period assessing for the presence of appendiceal tumours and resected mesoappendix. Results Twenty-one patients were found to have appendiceal tumours, with a mean maximum tumour dimension of 7.2 mm. Sixteen of these patients had simultaneous mesoappendix resection, of whom six (38%) were found to have direct or indirect tumour tissue within the mesoappendix. Conclusion Further evidence for routine removal of the mesoappendix, and the need for larger prospective studies to investigate for any survival benefit. We note the worrying trend of conservative management of acute appendicitis. The mesoappendix is a key site of appendiceal tumour spread, directly & indirectly. Routine mesoappendix resection may reduce the need for reoperation. Conservative management of appendicitis may delay diagnosis of appendiceal tumours.
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A 30-Year Long-Term Experience in Appendix Neuroendocrine Neoplasms-Granting a Positive Outcome. Cancers (Basel) 2020; 12:cancers12061357. [PMID: 32466539 PMCID: PMC7353034 DOI: 10.3390/cancers12061357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/19/2020] [Accepted: 05/23/2020] [Indexed: 11/21/2022] Open
Abstract
Neuroendocrine neoplasms (NENs) are the most common tumor of the appendix and have an excellent prognosis. Appendiceal tumors diagnosed between 1989 and 2019 were reviewed, and clinical data were collected from patient files. Part of the series was immuno-profiled for markers related to cell cycle proliferation and/or senescence-type, apoptotic, and metastatic potential. Appendix NENs were detected in 74 patients, with 0.47% of incidence per appendectomy. The median age of the patients was 21.5 years, with two age peaks of incidence at 17.0 and 55.2 years. The median tumors size was 5.8 mm, and most were smaller than 10 mm. Lymphovascular and perineural invasion, as well as necrosis, was associated with larger tumor size. G1 tumors composed 96.0% of the cohort. The presence of moderate/strong p16 and the absent/low Bcl-2 expression was frequently observed and associated with a smaller size. This study represents one of the largest cohorts and with a long follow-up. For tumors smaller than 10 mm appendicectomy was sufficient as a curative procedure, as revealed by the good outcome. This series presented a 100% disease-free survival. The indolent phenotype of appendix NENs is supported by the expression of markers that point towards a strong inhibition of cell replication and growth inhibition.
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Das S, Shi C, Du L, Idrees K, Berlin J. Adenocarcinoma Ex-Goblet Cell: a Retrospective Experience. J Gastrointest Cancer 2020; 50:709-715. [PMID: 29974346 DOI: 10.1007/s12029-018-0131-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Adenocarcinoma ex-goblet cell carcinoids (AGCCs) are rare appendiceal tumors with mixed neuroendocrine and glandular features. They tend to behave more aggressively than typical carcinoid tumors, affect younger patients, and have a greater predilection for spreading to the peritoneum. Outcomes of AGCC patients treated with chemotherapy, extrapolated from colon cancer regimens, in the adjuvant or metastatic setting have not been explicitly reported. We sought to explore outcomes of AGCC patients with either local disease treated with adjuvant FOLFOX or metastatic disease treated with FOLFOX/FOLFIRI post-cytoreductive debulking (or CRS plus HIPEC in the peritoneal-limited setting). METHODS We performed a single-institution retrospective analysis of 23 pathologically identified AGCC patients from Vanderbilt University Medical Center treated with chemotherapy in either the adjuvant or metastatic settings. Each patient's tumor was categorized as group B or group C based on the criteria from Tang et al. Median progression-free survival (PFS) or disease-free survival (DFS) (in the curative setting) and overall survival (OS) were determined for each patient and specified patient subgroup. RESULTS AND CONCLUSION AGCC patients who were treated with FOLFOX chemotherapy in the adjuvant setting or FOLFOX/FOLFIRI in the metastatic setting experienced prolonged PFS, DFS, and OS. Five patients with peritoneal-limited disease treated with CRS plus HIPEC have not yet reached median PFS or OS. While small sample size, patient selection, and retrospective nature limit the generalizability of findings from our analysis, the efficacy signals we observed suggest prospective evaluation with chemotherapy and CRS plus HIPEC is warranted in AGCC patients.
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Affiliation(s)
- Satya Das
- Division of Hematology Oncology, Department of Medicine, Vanderbilt University Medical Center, 2220 Pierce Avenue, 777 Preston Research Building, Nashville, TN, 37232, USA.
| | - Chanjuan Shi
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Liping Du
- Department of Biostatistics, Vanderbilt Center for Quantitative Sciences, Nashville, TN, USA
| | - Kamran Idrees
- Division of Hematology Oncology, Department of Medicine, Vanderbilt University Medical Center, 2220 Pierce Avenue, 777 Preston Research Building, Nashville, TN, 37232, USA
| | - Jordan Berlin
- Division of Hematology Oncology, Department of Medicine, Vanderbilt University Medical Center, 2220 Pierce Avenue, 777 Preston Research Building, Nashville, TN, 37232, USA
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The Chicago Consensus on peritoneal surface malignancies: Management of appendiceal neoplasms. Cancer 2020; 126:2525-2533. [PMID: 32282073 DOI: 10.1002/cncr.32881] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 08/14/2019] [Indexed: 12/13/2022]
Abstract
The Chicago Consensus Working Group provides multidisciplinary recommendations for the management of appendiceal neoplasms specifically related to the management of peritoneal surface malignancies. These guidelines are developed with input from leading experts, including surgical oncologists, medical oncologists, pathologists, radiologists, palliative care physicians, and pharmacists. These guidelines recognize and address the emerging need for increased awareness in the appropriate management of peritoneal surface disease. They are not intended to replace the quest for higher levels of evidence.
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Affiliation(s)
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- Chicago Consensus Working Group, Chicago, Illinois
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The Chicago Consensus on Peritoneal Surface Malignancies: Management of Appendiceal Neoplasms. Ann Surg Oncol 2020; 27:1753-1760. [PMID: 32285275 DOI: 10.1245/s10434-020-08316-w] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Indexed: 11/18/2022]
Abstract
The Chicago Consensus Working Group provides multidisciplinary recommendations for the management of appendiceal neoplasms specifically related to the management of peritoneal surface malignancies. These guidelines are developed with input from leading experts including surgical oncologists, medical oncologists, pathologists, radiologists, palliative care physicians, and pharmacists. These guidelines recognize and address the emerging need for increased awareness in the appropriate management of peritoneal surface disease. They are not intended to replace the quest for higher levels of evidence.
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64
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Rozenblum L, Mokrane FZ, Yeh R, Sinigaglia M, Besson FL, Seban RD, Zadro C, Dierickx L, Chougnet CN, Partouche E, Revel-Mouroz P, Zhao B, Otal P, Schwartz LH, Dercle L. Imaging-guided precision medicine in non-resectable gastro-entero-pancreatic neuroendocrine tumors: A step-by-step approach. Eur J Radiol 2020; 122:108743. [DOI: 10.1016/j.ejrad.2019.108743] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/11/2019] [Indexed: 12/11/2022]
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65
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ΔNp73 status in peritoneal and ovarian dissemination of appendicular adenocarcinoids (goblet cells). Clin Transl Oncol 2019; 21:1432-1439. [PMID: 31025168 DOI: 10.1007/s12094-019-02091-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Goblet cell carcinoma (GCC) is an appendicular neoplasia representing less than 5% of all appendicular tumors, found in 0.3-0.9% of the appendectomies, 35-58% of all appendicular neoplasms, and less than 14% of malign appendix tumors. The most frequent clinical presentation is abdominal pain associated with a picture of acute appendicitis. MATERIALS AND METHODS We present 3 clinical cases of appendix GCC, 2 subjected to cytoreductory surgery plus intraperitoneal hyperthermic chemotherapy and a third, who is currently receiving neoadjuvant treatment with a good response to chemotherapy and who will be offered the same treatment as the first two patients. Given the unpredictable behavior of these tumors, the use of molecular markers could help us to predict their behavior and prognosis. In this context, the TP73 gene would make an interesting putative marker. ∆Np73 has been described as overexpressed in a great variety of tumor types including colon cancer and this up-regulation is associated with a poor prognosis. To evidence its role in this malignancy, we evaluate here the status of ∆Np73 in the primary tumor and normal counterpart tissues, in the metastatic implants and in healthy areas of the peritoneum from the appendicular GCC patients. In addition, we checked the expression levels of this p73 variant in the tumor and normal tissue of 26 patients with colon cancer. RESULTS Remarkably, 2 patients showed significant ∆Np73 down-regulation in both the primary tumor and the implants. Case 1 presented a fourfold decrease of levels in the primary tumor and 20-fold decrease in the implants. Case 2 showed a seven- and fourfold down-regulation in the primary tumor and implants, respectively. However, Case 3 showed an up-regulation of 53- and threefold in the primary tumor and implants, respectively. CONCLUSION Goblet cell carcinoma of the appendix is very rate. It tends to seed throughout the peritoneum, making aggressive surgical cytoreduction and chemotherapy viable treatment options. Investigation into the molecular basis of these tumors may improve the diagnosis, prognosis and therapeutic decisions regarding these patients. ∆Np73 seems a good candidate for further analysis in longer series.
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66
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Clyde JW, Katz AW. Hypofractionated Stereotactic Radiation Therapy for Metastatic Adenocarcinoma ex Goblet Cell Carcinoid of the Appendix: Case Report and Literature Review. Case Rep Oncol 2019; 12:807-813. [PMID: 31762753 PMCID: PMC6872988 DOI: 10.1159/000503879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 11/19/2022] Open
Abstract
Adenocarcinoma ex-goblet carcinoid (ADA ex-GCC) is a rare and aggressive subtype of goblet cell carcinoid, a distinct tumor of the appendix characterized by both neuroendocrine and glandular differentiation. Patients often present with chronic abdominal pain or symptoms of acute appendicitis. Right hemicolectomy is the primary mode of treatment, and prophylactic salpingo-oophorectomy and hysterectomy is recommended in post-menopausal women due to the tumor's propensity of transcoelemic spread, especially to the ovaries. In this case report, we describe a patient with ADA ex-GCC who was found to have oligometastic disease in the pelvis and treated with hypofractionated stereotactic body radiation therapy (HSRT). She initially underwent a right hemicolectomy followed by adjuvant capecitabine four years prior when her tumor was incidentally discovered on colonoscopy. She subsequently had a salpingo-oophorectomy for gynecologic tract metastatic disease and declined further chemotherapy. The patient was again discovered to have oligometastatic disease in the right pelvis adjacent to the rectum on a Gallium-68 dotatate PET/MRI, and was subsequently treated with HSRT to 39 Gy in 6.5 Gy daily fractions. The patient tolerated her radiation course without notable radiation-related toxicity, and she remains without disease progression nine months later.
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Affiliation(s)
- Joseph W Clyde
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York, USA
| | - Alan W Katz
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York, USA
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Mehmood A, Connelly TM, Healy D, Zeeshan S, Cooke F. Do get suspicious: diagnosing appendicular goblet cell carcinoid. ANZ J Surg 2019; 89:1524. [PMID: 31760700 DOI: 10.1111/ans.15437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/18/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Abeera Mehmood
- Department of Surgery, University Hospital Waterford, Waterford, Ireland
| | - Tara M Connelly
- Department of Surgery, University Hospital Waterford, Waterford, Ireland
| | - Donagh Healy
- Department of Surgery, University Hospital Waterford, Waterford, Ireland
| | - Saqib Zeeshan
- Department of Surgery, University Hospital Waterford, Waterford, Ireland
| | - Fiachra Cooke
- Department of Surgery, University Hospital Waterford, Waterford, Ireland
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68
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Huang D, Ren F, Ni S, Tan C, Weng W, Zhang M, Xu M, Wang L, Xu Q, Sheng W. Amphicrine carcinoma of the stomach and intestine: a clinicopathologic and pan-cancer transcriptome analysis of a distinct entity. Cancer Cell Int 2019; 19:310. [PMID: 31832022 PMCID: PMC6873408 DOI: 10.1186/s12935-019-1031-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 11/11/2019] [Indexed: 12/28/2022] Open
Abstract
Background and aim Amphicrine carcinoma, in which endocrine and epithelial cell constituents are present within the same cell, is very rare. This study characterized the clinicopathologic and survival analysis of this tumor, further compared the genetic diversities among amphicrine carcinoma and other tumors. Materials and methods The clinicopathologic characteristics and survival outcomes of amphicrine carcinoma in this study were analyzed. The pan-cancer transcriptome assay was utilized to compare the genetic expression profile of this entity with that of conventional adenocarcinoma or neuroendocrine tumors. Results Ten cases (all in male patients) were identified in the stomach or intestine, with a median patient age of 62 years. There were characteristic patterns in the tumors: tubular, fusion or single-file growth of goblet- or signet ring-like cells. Four tumors were classified as low-grade and 6 as high-grade according to the histologic architecture. All cases were positive for neuroendocrine markers (synaptophysin and chromogranin A) and showed intracellular mucin in the amphicrine components. Four cases exhibited mRNA expression patterns showing transcriptional homogeneity with conventional adenocarcinomas and genetic diversity from neuroendocrine tumors. During the follow-up period, 3 patients died of disease, all of whom had high-grade tumors. Patients with high-grade amphicrine carcinoma had worse outcomes than those with low-grade tumors. Conclusions This study confirms the morphological, immunostaining and transcriptome alterations in amphicrine carcinoma distinct from those in conventional adenocarcinomas and neuroendocrine tumors, but additional studies are warranted to determine the biological behavior and therapeutic response.
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Affiliation(s)
- Dan Huang
- 1Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032 People's Republic of China.,2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,3Institute of Pathology, Fudan University, Shanghai, People's Republic of China
| | - Fei Ren
- 1Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032 People's Republic of China.,2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,3Institute of Pathology, Fudan University, Shanghai, People's Republic of China
| | - Shujuan Ni
- 1Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032 People's Republic of China.,2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,3Institute of Pathology, Fudan University, Shanghai, People's Republic of China
| | - Cong Tan
- 1Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032 People's Republic of China.,2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,3Institute of Pathology, Fudan University, Shanghai, People's Republic of China
| | - Weiwei Weng
- 1Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032 People's Republic of China.,2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,3Institute of Pathology, Fudan University, Shanghai, People's Republic of China
| | - Meng Zhang
- 1Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032 People's Republic of China.,2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,3Institute of Pathology, Fudan University, Shanghai, People's Republic of China
| | - Midie Xu
- 1Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032 People's Republic of China.,2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,3Institute of Pathology, Fudan University, Shanghai, People's Republic of China
| | - Lei Wang
- 1Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032 People's Republic of China.,2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,3Institute of Pathology, Fudan University, Shanghai, People's Republic of China
| | - Qinghua Xu
- CanHelp Genomics, Hangzhou, Zhejiang People's Republic of China
| | - Weiqi Sheng
- 1Department of Pathology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032 People's Republic of China.,2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,3Institute of Pathology, Fudan University, Shanghai, People's Republic of China
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69
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Zambrano-Vera K, Sardi A, Munoz-Zuluaga C, Studeman K, Nieroda C, Sittig M, King MC, Sipok A, Gushchin V. Outcomes in Peritoneal Carcinomatosis from Appendiceal Goblet Cell Carcinoma Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC). Ann Surg Oncol 2019; 27:179-187. [PMID: 31646450 DOI: 10.1245/s10434-019-07932-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Appendiceal goblet cell adenocarcinoma (GCA) is often misclassified and mistreated due to mixed histologic features. In general, cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is standard of care for peritoneal carcinomatosis (PC) from mucinous appendiceal tumors; however, in PC from GCA, data are limited and the role of CRS/HIPEC is controversial. We report outcomes in PC from appendiceal GCA treated with CRS/HIPEC. PATIENTS AND METHODS A prospective institutional database of 391 CRS/HIPEC patients with appendiceal carcinomatosis from 1998 to 2018 was reviewed. Twenty-seven patients with GCA were identified. Perioperative variables were described. Survival was estimated using the Kaplan-Meier method. RESULTS GCA occurred in 7% (27/391) of appendiceal CRS/HIPEC patients. Seven (26%) cases were aborted. Two patients underwent a second CRS/HIPEC for peritoneal recurrence. Median age at diagnosis was 53 years (range 39-72 years), and 12 (60%) were female. All underwent previous surgery. Seven (35%) had prior chemotherapy and received a median of 5 cycles (range 3-8). Median PCI was 6 (range 1-39). Complete cytoreduction was achieved in 95% (19/20). Grade III complications occurred in three (15%) patients, and no perioperative deaths occurred. Median follow-up was 97 months. Overall survival at 1, 3 and 5 years was 100%, 74% and 67%, respectively. Progression-free survival at 1, 3, and 5 years was 94%, 67% and 59%, respectively. CONCLUSION CRS/HIPEC should be considered as the main treatment option for patients with PC from appendiceal GCA. When performed at a CRS/HIPEC specialty center, 5-year OS of 67% can be achieved.
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Affiliation(s)
| | - Armando Sardi
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA.
| | | | | | - Carol Nieroda
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Michelle Sittig
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Mary Caitlin King
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Arkadii Sipok
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
| | - Vadim Gushchin
- The Institute for Cancer Care, Mercy Medical Center, Baltimore, MD, USA
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70
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Frizziero M, Wang X, Chakrabarty B, Childs A, Luong TV, Walter T, Khan MS, Morgan M, Christian A, Elshafie M, Shah T, Minicozzi A, Mansoor W, Meyer T, Lamarca A, Hubner RA, Valle JW, McNamara MG. Retrospective study on mixed neuroendocrine non-neuroendocrine neoplasms from five European centres. World J Gastroenterol 2019; 25:5991-6005. [PMID: 31660035 PMCID: PMC6815794 DOI: 10.3748/wjg.v25.i39.5991] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/15/2019] [Accepted: 09/10/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mixed neuroendocrine non-neuroendocrine neoplasm (MiNEN) is a rare diagnosis, mainly encountered in the gastro-entero-pancreatic tract. There is limited knowledge of its epidemiology, prognosis and biology, and the best management for affected patients is still to be defined.
AIM To investigate clinical-pathological characteristics, treatment modalities and survival outcomes of a retrospective cohort of patients with a diagnosis of MiNEN.
METHODS Consecutive patients with a histologically proven diagnosis of MiNEN were identified at 5 European centres. Patient data were retrospectively collected from medical records. Pathological samples were reviewed to ascertain compliance with the 2017 World Health Organisation definition of MiNEN. Tumour responses to systemic treatment were assessed according to the Response Evaluation Criteria in Solid Tumours 1.1. Kaplan-Meier analysis was applied to estimate survival outcomes. Associations between clinical-pathological characteristics and survival outcomes were explored using Log-rank test for equality of survivors functions (univariate) and Cox-regression analysis (multivariable).
RESULTS Sixty-nine consecutive patients identified; Median age at diagnosis: 64 years. Males: 63.8%. Localised disease (curable): 53.6%. Commonest sites of origin: colon-rectum (43.5%) and oesophagus/oesophagogastric junction (15.9%). The neuroendocrine component was; predominant in 58.6%, poorly differentiated in 86.3%, and large cell in 81.25%, of cases analysed. Most distant metastases analysed (73.4%) were occupied only by a poorly differentiated neuroendocrine component. Ninety-four percent of patients with localised disease underwent curative surgery; 53% also received perioperative treatment, most often in line with protocols for adenocarcinomas from the same sites of origin. Chemotherapy was offered to most patients (68.1%) with advanced disease, and followed protocols for pure neuroendocrine carcinomas or adenocarcinomas in equal proportion. In localised cases, median recurrence free survival (RFS); 14.0 months (95%CI: 9.2-24.4), and median overall survival (OS): 28.6 months (95%CI: 18.3-41.1). On univariate analysis, receipt of perioperative treatment (vs surgery alone) did not improve RFS (P = 0.375), or OS (P = 0.240). In advanced cases, median progression free survival (PFS); 5.6 months (95%CI: 4.4-7.4), and median OS; 9.0 months (95%CI: 5.2-13.4). On univariate analysis, receipt of palliative active treatment (vs best supportive care) prolonged PFS and OS (both, P < 0.001).
CONCLUSION MiNEN is most commonly driven by a poorly differentiated neuroendocrine component, and has poor prognosis. Advances in its biological understanding are needed to identify effective treatments and improve patient outcomes.
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Affiliation(s)
- Melissa Frizziero
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
| | - Xin Wang
- Department of Analytics and Development, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
| | - Bipasha Chakrabarty
- Department of Pathology, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
| | - Alexa Childs
- Department of Medical Oncology, Royal Free London NHS Foundation Trust, London NW3 2QG, United Kingdom
- UCL Cancer Institute, University College London, London WC1E 6AG, United Kingdom
| | - Tu V Luong
- Department of Histopathology, Royal Free London NHS Foundation Trust, London NW3 2QG, United Kingdom
| | - Thomas Walter
- Department of Gastroenterology and Medical Oncology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon 69003, France
| | - Mohid S Khan
- Department of Gastroenterology, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Meleri Morgan
- Department of Cellular Pathology, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Adam Christian
- Department of Cellular Pathology, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Mona Elshafie
- Department of Pathology, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
| | - Tahir Shah
- Department of Hepatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, United Kingdom
| | - Annamaria Minicozzi
- Department of Surgical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
| | - Wasat Mansoor
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
| | - Tim Meyer
- Department of Medical Oncology, Royal Free London NHS Foundation Trust, London NW3 2QG, United Kingdom
- UCL Cancer Institute, University College London, London WC1E 6AG, United Kingdom
| | - Angela Lamarca
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
| | - Richard A Hubner
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
| | - Juan W Valle
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
- Division of Cancer Sciences, University of Manchester, Manchester M13 9PL, United Kingdom
| | - Mairéad G McNamara
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom
- Division of Cancer Sciences, University of Manchester, Manchester M13 9PL, United Kingdom
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71
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Livoff A, Asna N, Gallego-Colon E, Daum AZ, Harkovsky T, Schaffer M. Goblet cell carcinoid of the appendix: Two case reports and a review of the literature. Mol Clin Oncol 2019; 11:493-497. [PMID: 31620280 PMCID: PMC6787945 DOI: 10.3892/mco.2019.1921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 08/16/2019] [Indexed: 01/22/2023] Open
Abstract
Goblet cell carcinoid or carcinoma (GCC) is a rare tumor found incidentally during routine management of acute appendicitis. GCCs are more aggressive compared with conventional appendiceal tumors but less aggressive compared with adenocarcinomas, and they often present with serosal and mesoappendiceal involvement. We herein report two cases of acute appendicitis in a 45-year-old female and a 60-year-old male with varied clinical symptoms. Pathological examination of the appendix revealed the presence of adenocarcinoma with goblet cells and a Ki-67 index of 25% (grade 3) and 15% (grade 2), respectively. Subsequent right hemicolectomy was performed according to the current guidelines. No signs of disease recurrence or metastasis were detected during regular follow-up. However, the lack of a standardized classification system for GCC and the discrepancies in specific reliable markers renders their prognostic and predictive value in GCC at diagnosis insufficient. The present study also aimed to address current concerns regarding the diagnosis, treatment and prognosis of GCC, as well as the need to review and update current guidelines. To conclude, proper clinical management and the prediction of outcome for patients with GCC varies according to the classifications or staging criteria used by the clinicians; hence, a review of the current guidelines should be considered.
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Affiliation(s)
- Alejandro Livoff
- Department of Pathology, Barzilai Medical Center, Ashkelon 30604, Israel
| | - Noam Asna
- Department of Oncology, Barzilai Medical Center, Ashkelon 30604, Israel
| | | | - Aner Zeev Daum
- Department of Pathology, Barzilai Medical Center, Ashkelon 30604, Israel
| | | | - Moshe Schaffer
- Department of Oncology, Barzilai Medical Center, Ashkelon 30604, Israel.,Faculty of Health Sciences, Ben Gurion University, Be'er Sheva 8410501, Israel
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72
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Fields AC, Lu P, Enzinger A, Goldberg J, Irani J, Bleday R, Nash G, Melnitchouk N. Treatment patterns and outcomes in goblet cell carcinoid tumors of the appendix. J Surg Oncol 2019; 120:1096-1101. [PMID: 31592538 DOI: 10.1002/jso.25723] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 09/21/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND Goblet cell carcinoid (GCC) tumors of the appendix are a rare malignancy. We aim to examine the overall survival per stage and the relationship between different treatment modalities and outcomes for patients with GCC tumors of the appendix. METHODS We identified patients with GCC tumors of the appendix from the National Cancer Database. The main outcome was overall patient survival and cox proportional hazard models were used to ascertain predictors of survival. RESULTS There were 2552 patients identified. The median age of diagnosis was 57 (interquartile range: 49-65) and 52.3% of patients were female. The 5-year survival for Stage I disease was 91.1% (95% confidence interval [CI]: 82.2%-95.7%), for Stage II disease was 90.5% (95% CI: 85.8%-93.7%), for Stage III disease was 57.0% (95% CI: 45.0%-67.3%), and for Stage IV disease was 18.9% (95% CI: 9.3%-31.0%). In a Cox proportional hazard model, older age (hazard ratio [HR]: 1.1; 95% CI: 1.03-1.12; P < .001), lymph node metastasis (HR: 6.9; 95% CI: 2.76-17.01; P < .001), and positive surgical margins (HR: 2.9; 95% CI:1.13-7.26; P = .003) were associated with worse overall survival for Stages I to III disease while only older age (HR: 1.03; 95% CI: 1.002-1.06; P = .04) was associated with worse overall survival for Stage IV disease. CONCLUSIONS Patients with GCC tumors of the appendix who have the nonmetastatic disease have a high 5-year survival. We have identified several prognostic factors for GCC.
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Affiliation(s)
- Adam C Fields
- Division of Colorectal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pamela Lu
- Division of Colorectal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrea Enzinger
- Center for Gastrointestinal Oncology, Dana Farber Cancer Center, Boston, Massachusetts
| | - Joel Goldberg
- Division of Colorectal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jennifer Irani
- Division of Colorectal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ronald Bleday
- Division of Colorectal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Garrett Nash
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nelya Melnitchouk
- Division of Colorectal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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73
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Lowes H, Rowaiye B, Carr NJ, Shepherd NA. Complicated appendiceal diverticulosis versus low‐grade appendiceal mucinous neoplasms: a major diagnostic dilemma. Histopathology 2019; 75:478-485. [DOI: 10.1111/his.13931] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Hannah Lowes
- Gloucestershire Cellular Pathology Laboratory Cheltenham General Hospital CheltenhamUK
| | - Babatunde Rowaiye
- Peritoneal Malignancy Institute Basingstoke and North Hampshire Hospital Basingstoke UK
| | - Norman J Carr
- Peritoneal Malignancy Institute Basingstoke and North Hampshire Hospital Basingstoke UK
| | - Neil A Shepherd
- Gloucestershire Cellular Pathology Laboratory Cheltenham General Hospital CheltenhamUK
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74
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Sinno SAJ, Jurdi NMH. Goblet cell tumors of the appendix: A review. Ann Diagn Pathol 2019; 43:151401. [PMID: 31675676 DOI: 10.1016/j.anndiagpath.2019.151401] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 08/04/2019] [Accepted: 08/20/2019] [Indexed: 12/21/2022]
Abstract
Goblet cell tumors are rare tumors of the appendix that exhibit both neuroendocrine and mucinous differentiation. This dual differentiation has led to a controversy regarding the proper classification of these neoplasms as to whether they should be considered neuroendocrine tumors or adenocarcinomas. Multiple grading systems have been proposed that were able to segregate these tumors into prognostically significant groups. Many of these grading systems rely on identifying and/or quantifying the carcinomatous growth pattern. Goblet cell tumors show patchy and focal expression of neuroendocrine markers and are characterized by a mutational profile that is different from both appendiceal adenocarcinomas and neuroendocrine tumors. They exhibit a more aggressive behavior than neuroendocrine tumors, and as such, many authors recommend that they be approached and treated as adenocarcinomas.
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Affiliation(s)
- Sara A J Sinno
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nawaf M H Jurdi
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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75
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Knowledge gaps in the appendix: a multi-institutional study from seven academic centers. Mod Pathol 2019; 32:988-996. [PMID: 30765881 DOI: 10.1038/s41379-019-0216-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/12/2019] [Accepted: 01/12/2019] [Indexed: 11/08/2022]
Abstract
Appendix pathology represents uncommonly encountered specimens with unique diagnostic challenges. To delineate common knowledge gaps, extramural consults submitted to seven institutions between 2016-2017 were reviewed. All appendix consults were resections (100%, n = 43), and the majority were directed for consultation by the originating pathologist (95%, n = 41) with no additional studies performed by the consultant (65%, n = 28). This study was dominated by inquiries related to low grade appendiceal mucinous neoplasms (44%, n = 19) and goblet cell carcinoid related neoplasms (19%, n = 8). Of the 43 appendiceal consults, 19 were submitted by the contributing pathologist as low grade appendiceal mucinous neoplasm, but only half of these were diagnosed by the consultant as such (n = 9). Low grade appendiceal mucinous neoplasm-related consultation themes included diverticular disease, criteria for invasion, high grade atypia, extra-appendiceal mucin, and staging. Examples of major disagreements that were downgraded included consults submitted as low grade appendiceal mucinous neoplasm and diagnosed by the consultant as serrated polyp (n = 3), appendicitis (n = 1), and benign appendix (n = 1). Examples of major disagreements-upgraded included cases submitted as low grade appendiceal mucinous neoplasm and diagnosed by the consultant as low grade appendiceal mucinous neoplasm with high-risk features (n = 2) and mucinous adenocarcinoma (n = 2). One case contained both a major disagreement-upgrade (low grade appendiceal mucinous neoplasm changed to high grade appendiceal mucinous neoplasm) and a major disagreement-downgrade (pT3 changed to Tis). Of the 15 cases diagnosed by the consultants as low grade appendiceal mucinous neoplasm, submitted diagnoses included low grade appendiceal mucinous neoplasm (n = 9), adenocarcinoma (n = 5), and one case was submitted without a diagnosis. For goblet cell carcinoid-related consults, the usual inquiry related to distinguishing goblet cell carcinoid from goblet cell carcinoid with adenocarcinoma (adenocarcinoma ex-goblet cell carcinoid). Of the 38 overall consults with a submitted diagnosis, 53% (n = 20) were disagreements, and most of these were major disagreements-downgraded (n = 13).
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76
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Amin A, Carr N. Diagnostic concordance in cases of appendiceal mucinous neoplasia referred to a tertiary referral centre. J Clin Pathol 2019; 72:639-641. [DOI: 10.1136/jclinpath-2019-205945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/24/2019] [Accepted: 05/25/2019] [Indexed: 11/03/2022]
Abstract
Accurate diagnosis of appendiceal tumours and any associated peritoneal disease is clinically important but can be difficult. We retrieved the records of patients referred to the Peritoneal Malignancy Institute, Basingstoke, in the years 2016, 2017 and 2018 with a diagnosis of mucinous appendiceal neoplasia and identified 323 patients in which slides were reviewed as part of the referral pathway. Comparing the local report from the referring centre with the central review report, in 57 (18%) we identified a discrepancy. In 39 (12%) the discrepancy was in overall diagnosis, including 22 (7%) in which the local diagnosis was low-grade appendiceal mucinous neoplasm whereas the review diagnosis was reactive mucosal changes, usually due to ruptured diverticulum, with no evidence of neoplasia. Our findings support the practice of central review of histopathology slides by experienced pathologists at tertiary referral centres. They also suggest that improvements in diagnostic criteria are needed.
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77
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Grunes D, Kim MK, Chessin DB, Yaeger RD, Ward SC. Perianal Goblet Cell Carcinoid With Pagetoid Spread. Int J Surg Pathol 2019; 27:788-791. [PMID: 31079516 DOI: 10.1177/1066896919845478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We present a case of perianal goblet cell carcinoid with pagetoid spread. Goblet cell carcinoid, also known as adenocarcinoid tumor, predominantly arises as a primary appendiceal tumor and contains nests of neuroendocrine and mucin-containing cells. When this tumor type is seen in other sites it usually represents a metastasis. We present the case of an 81-year-old woman with a perianal mass. Histologic and immunohistochemical examination following surgical excision showed a goblet cell carcinoid demonstrating pagetoid spread along the perianal squamous mucosa. There was no evidence of a primary appendiceal tumor by history or imaging studies. To our knowledge, this is the first report of a goblet cell carcinoid presenting in this manner. The patient died due to complications of metastatic disease 26 months after initial diagnosis.
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Affiliation(s)
- Dianne Grunes
- 1 Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - David B Chessin
- 1 Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rona D Yaeger
- 2 Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephen C Ward
- 1 Icahn School of Medicine at Mount Sinai, New York, NY, USA
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78
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Choudry HA, Bednar F, Shuai Y, Jones HL, Pai RK, Pingpank JF, Ahrendt SS, Holtzman MP, Zeh HJ, Bartlett DL. Repeat Cytoreductive Surgery-Hyperthermic Intraperitoneal Chemoperfusion is Feasible and Offers Survival Benefit in Select Patients with Peritoneal Metastases. Ann Surg Oncol 2019; 26:1445-1453. [PMID: 30825033 DOI: 10.1245/s10434-019-07218-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION We hypothesized that repeat cytoreductive surgery-hyperthermic intraperitoneal chemoperfusion (CRS-HIPEC) for peritoneal metastases (PM) may be associated with suboptimal resection, more frequent postoperative complications, and worse oncologic outcomes. METHODS Using a prospectively maintained database, we compared clinicopathologic, perioperative, and oncologic outcome data in patients undergoing single or repeat CRS-HIPEC procedures. The Kaplan-Meier method was used to estimate survival. Multivariate analyses identified associations with perioperative and oncologic outcomes. RESULTS Of the 1294 patients undergoing CRS-HIPEC procedures at our institution, only one CRS-HIPEC procedure (single HIPEC cohort) was performed in 1169 patients (90.3%), whereas 125 patients (9.7%) underwent repeat CRS-HIPEC procedures (repeat HIPEC cohort). Of the 1440 CRS-HIPEC procedures at our institution, a first CRS-HIPEC procedure was performed in 1294 patients (89.9%), whereas subsequent second, third, and fourth CRS-HIPEC procedures were performed in 125 patients (8.7%), 18 patients (1.3%), and 3 patients (0.2%), respectively. Progression-free survival (PFS) following the second CRS-HIPEC procedure was negatively impacted by shorter PFS following the first CRS-HIPEC procedure, independent of other significant variables related to the second procedure, including completeness of cytoreduction and postoperative complications. Patients undergoing multiple CRS-HIPEC procedures were not at higher risk for suboptimal resection or postoperative complications and demonstrated equivalent PFS following each successive procedure compared to the first procedure. CONCLUSIONS Repeat CRS-HIPEC procedures for PM were not associated with suboptimal perioperative and oncologic outcomes. Our data confirmed our ability to select patients appropriately for repeat CRS-HIPEC procedures.
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Affiliation(s)
- Haroon A Choudry
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Filip Bednar
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yongli Shuai
- The University of Pittsburgh Cancer Institute Biostatistics Facility, Pittsburgh, PA, USA
| | - Heather L Jones
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Reetesh K Pai
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - James F Pingpank
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Steven S Ahrendt
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Matthew P Holtzman
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Herbert J Zeh
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - David L Bartlett
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, PA, USA
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79
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Abstract
Goblet cell carcinoid (GCC) or goblet cell carcinoma is a unique mixed endocrine-exocrine neoplasm that is almost exclusively seen in the appendix. The hallmark of GCC is the concentric infiltration of the appendiceal wall by small tight clusters, nests or cords of tumor cells that exhibit a goblet cell morphology with a small compressed nucleus and conspicuous intracytoplasmic mucin. The coexistence of high-grade adenocarcinoma with GCC has been increasingly recognized as a common finding, which has been called adenocarcinoma ex GCC or mixed GCC-adenocarcinoma. A number of studies have shown that it is the high-grade adenocarcinomatous component that dictates the prognosis. Several histologic classification/grading systems have been proposed, which correlate with overall patient survival. Treatment options are primarily based on tumor stage and the presence or absence of a high-grade adenocarcinomatous component.
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80
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Ibrahim U, Valecha G, Garcia G, Saqib A, Wrzolek M, Dhar M. Adenocarcinoma Ex-goblet Cell Carcinoid of the Appendix: a Case Report and Overview of the Disease. J Gastrointest Cancer 2019; 49:497-500. [PMID: 28211016 DOI: 10.1007/s12029-017-9926-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Uroosa Ibrahim
- Department of Hematology/Oncology, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, New York, NY, 10305, USA.
| | - Gautam Valecha
- Department of Hematology/Oncology, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, New York, NY, 10305, USA
| | - Gwenalyn Garcia
- Department of Hematology/Oncology, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, New York, NY, 10305, USA
| | - Amina Saqib
- Department of Pulmonary and Critical Care Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, New York, NY, 10305, USA
| | - Monika Wrzolek
- Department of Pathology, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, New York, NY, 10305, USA
| | - Meekoo Dhar
- Department of Hematology/Oncology, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, New York, NY, 10305, USA
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81
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Jang KY, Park HS, Noh SJ, Lee H, Lee MR. Adenocarcinoma ex-goblet cell carcinoid of the ascending colon concurrent with conventional adenocarcinoma. Pathology 2018; 50:789-792. [DOI: 10.1016/j.pathol.2018.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/19/2018] [Accepted: 06/29/2018] [Indexed: 11/26/2022]
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82
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Tsang ES, Kennecke HF. ASO Author Reflections: Outcomes of Appendiceal Goblet Cell Carcinoid Tumors. Ann Surg Oncol 2018; 25:759-760. [PMID: 30465217 DOI: 10.1245/s10434-018-6980-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Erica S Tsang
- Division of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Hagen F Kennecke
- Virginia Mason Hospital and Seattle Medical Center, Virginia Mason Cancer Institute, Seattle, WA, USA.
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83
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Sato N, Irie K, Yotsumoto S, Honda S, Tasaki T, Nakayama T. Combined goblet cell carcinoid and low grade appendiceal mucinous neoplasm: A case report. HUMAN PATHOLOGY: CASE REPORTS 2018. [DOI: 10.1016/j.ehpc.2018.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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84
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Özemir İA, Baysal H, Zemheri E, Bilgiç Ç, Yiğitbaşı R, Alimoğlu O. Goblet cell carcinoid of the appendix accompanied by adenomatous polyp with high-grade dysplasia at the cecum. Turk J Surg 2018; 34:234-236. [PMID: 30302428 DOI: 10.5152/ucd.2016.3348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/16/2015] [Indexed: 12/20/2022]
Abstract
Goblet cell carcinoid tumor of the appendix is an uncommon neoplasia that shares the histological attributes of both adenocarcinoma and carcinoid tumors. Its prognosis has a more aggressive course than the other known carcinoid tumors. Clinical diagnosis of goblet cell carcinoid is seldom made preoperatively. The most common clinical presentation of goblet cell carcinoid tumor is acute appendicitis. In this study, we report a patient on whom right hemicolectomy was performed because of a cacal sessile polyp with high grade dysplasia; goblet cell carcinoid tumor of the appendix was revealed incidentally during microscopic evaluation of the appendectomy specimen. The patient healed uneventfully and no recurrence was observed after the 12-month follow-up period. Careful microscopic examination of the appendectomy specimen is key for the diagnosis of appendiceal tumors such as goblet cell carcinoid, especially in elderly patients.
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Affiliation(s)
- İbrahim Ali Özemir
- Department of General Surgery, İstanbul Medeniyet University School of Medicine, Göztepe Training and Research Hospital, İstanbul, Turkey
| | - Hakan Baysal
- Department of General Surgery, İstanbul Medeniyet University School of Medicine, Göztepe Training and Research Hospital, İstanbul, Turkey
| | - Ebru Zemheri
- Department of Pathology, İstanbul Medeniyet University School of Medicine, Göztepe Training and Research Hospital, İstanbul, Turkey
| | - Çağrı Bilgiç
- Department of General Surgery, İstanbul Medeniyet University School of Medicine, Göztepe Training and Research Hospital, İstanbul, Turkey
| | - Rafet Yiğitbaşı
- Department of General Surgery, İstanbul Medeniyet University School of Medicine, Göztepe Training and Research Hospital, İstanbul, Turkey
| | - Orhan Alimoğlu
- Department of General Surgery, İstanbul Medeniyet University School of Medicine, Göztepe Training and Research Hospital, İstanbul, Turkey
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85
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Choudry MHA, Shuai Y, Jones HL, Pai RK, Pingpank JF, Ahrendt SS, Holtzman MP, Zeh HJ, Bartlett DL. Postoperative Complications Independently Predict Cancer-Related Survival in Peritoneal Malignancies. Ann Surg Oncol 2018; 25:3950-3959. [DOI: 10.1245/s10434-018-6823-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Indexed: 01/26/2023]
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86
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Gilmore G, Jensen K, Saligram S, Sachdev TP, Arekapudi SR. Goblet cell carcinoid of the appendix - diagnostic challenges and treatment updates: a case report and review of the literature. J Med Case Rep 2018; 12:275. [PMID: 30244681 PMCID: PMC6151924 DOI: 10.1186/s13256-018-1789-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 08/01/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Goblet cell carcinoid is a rare but distinct entity of appendiceal tumors which is a hybrid or mixed tumor consisting of both epithelial (glandular) and neuroendocrine elements containing goblet cells. This entity is important to recognize and appropriately grade as it tends to be more aggressive than typical carcinoid tumors, often presenting with metastatic disease. As a result, the 5-year overall survival is 14-22% in stage III-IV disease. GCC therefore warrants more aggressive surgical and medical (chemotherapy) interventions than typical carcinoid tumors. Through this case report we give a brief update on GCC pathological features, staging, surgical management, and review the literature as a guide to indications for chemotherapy and choice of agents. CASE PRESENTATION We present the case of a 77-year-old Caucasian man with a history of stage I adenocarcinoma of transverse colon status post transverse colectomy who was incidentally found on surveillance colonoscopy to have an abnormal appendiceal orifice lesion. A biopsy revealed an appendiceal goblet cell carcinoid and he underwent a right hemicolectomy which revealed a pathologic stage III GCC for which he received eight cycles of adjuvant chemotherapy with capecitabine. CONCLUSIONS It is essential that patients who have tumors > 2 cm, are pT3 or pT4, have higher grade histology with signet ring (Tang grade B or grade C), locally advanced, or with positive surgical margins on appendectomy undergo a right hemicolectomy. Although there is no category 1 evidence, consensus recommendations are that patients with stage II (particularly Tang B and C) and stage III GCC be offered adjuvant chemotherapy with a regimen based on 5-fluorouracil, as these patients are known to have high rates of relapse.
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Affiliation(s)
- Gregory Gilmore
- Department of Medicine, Veterans Affairs Central California Health Care System, University of California San Francisco, 2615 E Clinton Ave, Fresno, CA, 93703, USA
| | - Kristin Jensen
- Department of Pathology, Veterans Affairs Palo Alto Health Care System, Stanford Hospital and Clinics, Palo Alto, CA, 94304, USA
| | - Shreyas Saligram
- Department of Medicine, Veterans Affairs Central California Health Care System, University of California San Francisco, 2615 E Clinton Ave, Fresno, CA, 93703, USA
| | - Thomas P Sachdev
- Department of Medicine, Veterans Affairs Central California Health Care System, University of California San Francisco, 2615 E Clinton Ave, Fresno, CA, 93703, USA
| | - Subramanyeswara R Arekapudi
- Department of Medicine, Veterans Affairs Central California Health Care System, University of California San Francisco, 2615 E Clinton Ave, Fresno, CA, 93703, USA.
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87
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Abstract
Appendiceal neoplasms are identified in 0.9 to 1.4% of appendiceal specimens, and the incidence is increasing. It has long been professed that neuroendocrine tumors (formerly carcinoids) are the most common neoplastic process of the appendix; recent data, however, has suggested a shift in epidemiology. Our intent is to distill the complex into an algorithm, and, in doing so, enable the surgeon to seamlessly maneuver through operative decisions, treatment strategies, and patient counseling. The algorithm for evaluation and treatment is complex, often starts from the nonspecific presenting complaint of appendicitis, and relies heavily on often subtle histopathologic differences.
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Affiliation(s)
- Quinton M Hatch
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon
| | - Erin W Gilbert
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon
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88
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Shibuya H, Hijioka S, Mizuno N, Kuwahara T, Okuno N, Tanaka T, Ishihara M, Hirayama Y, Oonishi S, Murakami Y, Yatabe Y, Tajika M, Niwa Y, Hara K. A Rare Case of Ampullary Goblet Cell Carcinoid. Intern Med 2018; 57:2489-2496. [PMID: 29607953 PMCID: PMC6172535 DOI: 10.2169/internalmedicine.0516-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
An asymptomatic 70-year-old woman was referred to our hospital because of liver enzyme elevation. Enhanced abdominal computed tomography demonstrated a small, round-shaped tumor with dilation of the common bile duct and main pancreatic duct. A biopsy specimen from the papilla showed mucin-containing cells that were positive for endocrine markers on immunohistochemical staining. Endoscopic snare resection was done, and there was a positive vertical margin on pathology. Pancreaticoduodenectomy was then performed later. The final diagnosis was goblet cell carcinoid, pT2N0M0, pStage IIA [Union for International Cancer Control (UICC) 7th edition]. Ampullary goblet cell carcinoid is an extremely rare disease of which there have been no recent reports.
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Affiliation(s)
- Hitoshi Shibuya
- Departments of Gastroenterology, Aichi Cancer Center Hospital, Japan
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Japan
| | - Susumu Hijioka
- Departments of Gastroenterology, Aichi Cancer Center Hospital, Japan
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Japan
| | - Nobumasa Mizuno
- Departments of Gastroenterology, Aichi Cancer Center Hospital, Japan
| | | | - Nozomi Okuno
- Departments of Gastroenterology, Aichi Cancer Center Hospital, Japan
| | - Tsutomu Tanaka
- Departments of Endoscopy, Aichi Cancer Center Hospital, Japan
| | - Makoto Ishihara
- Departments of Endoscopy, Aichi Cancer Center Hospital, Japan
| | - Yutaka Hirayama
- Departments of Endoscopy, Aichi Cancer Center Hospital, Japan
| | - Sachiyo Oonishi
- Departments of Endoscopy, Aichi Cancer Center Hospital, Japan
| | - Yoshiko Murakami
- Departments of Pathology and Molecular Diagnosis, Aichi Cancer Center Hospital, Japan
| | - Yasushi Yatabe
- Departments of Pathology and Molecular Diagnosis, Aichi Cancer Center Hospital, Japan
| | - Masahiro Tajika
- Departments of Endoscopy, Aichi Cancer Center Hospital, Japan
| | - Yasumasa Niwa
- Departments of Endoscopy, Aichi Cancer Center Hospital, Japan
| | - Kazuo Hara
- Departments of Gastroenterology, Aichi Cancer Center Hospital, Japan
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89
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Histologic and Outcome Study Supports Reclassifying Appendiceal Goblet Cell Carcinoids as Goblet Cell Adenocarcinomas, and Grading and Staging Similarly to Colonic Adenocarcinomas. Am J Surg Pathol 2018; 42:898-910. [PMID: 29579011 DOI: 10.1097/pas.0000000000001056] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Goblet cell carcinoid tumors are amphicrine tumors whose biological behavior ranges from indolent to highly aggressive, depending on tumor grade. Current grading systems for these tumors are based on identifying an adenocarcinoma arising in the setting of a goblet cell carcinoid tumor, which distinguishes this tumor from other gastrointestinal tract adenocarcinomas. Because goblet cell tumors are predominantly tumors of mucin secreting cells, we propose that they be classified as goblet cell adenocarcinomas, and graded using a methodology that has parallels in colorectal adenocarcinoma grading. We graded a large series of goblet cell adenocarcinomas by assessing the proportion of the tumor that demonstrates tubular or clustered growth. Histologic grade correlated with overall survival independent of stage, with median overall survival of 204, 86, and 29 months for low-grade, intermediate-grade, and high-grade goblet cell adenocarcinomas, respectively. Tumor stage also correlated with overall survival. We also graded the tumors according to previously proposed grading systems, and found that these systems are valid, in that they segregate patients according to prognosis.
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90
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Tsang ES, McConnell YJ, Schaeffer DF, Lee L, Yin Y, Zerhouni S, Schaff K, Speers C, Kennecke HF. Outcomes of Surgical and Chemotherapeutic Treatments of Goblet Cell Carcinoid Tumors of the Appendix. Ann Surg Oncol 2018; 25:2391-2399. [PMID: 29916007 DOI: 10.1245/s10434-018-6560-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Goblet cell carcinoids (GCCs) of the appendix are rare mucinous neoplasms, for which optimal therapy is poorly described. We examined prognostic clinical and treatment factors in a population-based cohort. METHODS Patients diagnosed with GCC from 1984 to 2014 were identified from the British Columbia Cancer Agency and the Vancouver Lower Mainland Pathology Archive. RESULTS Of 88 cases with confirmed appendiceal GCCs, clinical data were available in 86 cases (annual population incidence: 0.66/1,000,000). Median age was 54 years (range 25-91) and 42 patients (49%) were male. Metastasis at presentation was the strongest predictor of overall survival (OS), with median OS not reached for stage I-III patients, and measuring 16.2 months [95% confidence interval (CI) 9.1-29] for stage IV patients. In 67 stage I-III patients, 51 (76%) underwent completion hemicolectomy and 9 (17%) received adjuvant 5-fluorouracil-based chemotherapy. No appendicitis at initial presentation and Tang B histology were the only prognostic factors, with inferior 5-year recurrence-free survival (53 vs. 83% with appendicitis, p = 0.02; 45% Tang B vs. 89% Tang A, p < 0.01). Of 19 stage IV patients, 10 (62.5%) received 5-fluorouracil-based chemotherapy and 11 (61%) underwent multiorgan resection (MOR) ± hyperthermic intraperitoneal chemotherapy (HIPEC). Low mitotic rate and MOR ± HIPEC were associated with improved 2-year OS, but only MOR ± HIPEC remained significant on multivariate analysis (hazard ratio 5.4, 95% CI 1.4-20.9; p = 0.015). CONCLUSIONS In this population-based cohort, we demonstrate excellent survival outcomes in stage I-III appendiceal GCCs and clinical appendicitis. Hemicolectomy remains the standard treatment. In metastatic disease, outcomes remain poor, although MOR ± HIPEC may improve survival.
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Affiliation(s)
- Erica S Tsang
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Yarrow J McConnell
- Puyallup General Surgery, Proliance Surgeons, Puyallup, WA, USA.,Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - David F Schaeffer
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.,Division of Anatomic Pathology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Lawrence Lee
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.,Division of Anatomic Pathology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Yaling Yin
- Gastrointestinal Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Siham Zerhouni
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Kimberly Schaff
- Provincial Pharmacy, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Caroline Speers
- Gastrointestinal Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Hagen F Kennecke
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada. .,Virginia Mason Cancer Institute, Virginia Mason Hospital and Seattle Medical Center, Seattle, WA, USA.
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91
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Mutational landscape of goblet cell carcinoids and adenocarcinoma ex goblet cell carcinoids of the appendix is distinct from typical carcinoids and colorectal adenocarcinomas. Mod Pathol 2018; 31:989-996. [PMID: 29422640 DOI: 10.1038/s41379-018-0003-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/22/2017] [Accepted: 11/24/2017] [Indexed: 12/18/2022]
Abstract
There is limited data on the spectrum of molecular alterations in goblet cell carcinoids and adenocarcinoma ex goblet cell carcinoids of the appendix. We used next generation sequencing to determine mutations of potential pathogenetic and therapeutic significance in this rare group of tumors. Adequate DNA was successfully extracted in 34/46 cases and the final group included 18 goblet cell carcinoids and 16 adenocarcinoma ex goblet cell carcinoids. Illumina TruSeq™ was used for sequencing exons of a custom 282 gene panel using an Illumina HiSeq 2000. All cases had a minimum coverage depth of at least 50 reads. After filtering through the Exome Sequencing Project, the number of mutations per case ranged from 0-9 (mean:3). The mutational burden in adenocarcinoma ex goblet cell carcinoids was significantly higher than goblet cell carcinoids (mean 5 vs. 3; p < 0.05) but the spectrum of alterations overlapped between the two groups. The most frequent mutations included ARID1A (4/34), ARID2 (4/34), CDH1 (4/34), RHPN2 (4/34), and MLL2 (3/34). Some mutations typically seen in conventional colorectal adenocarcinomas were also identified but with much lower frequency (APC :4/34; KRAS :2/34). MLL2 and KRAS mutations were only seen in adenocarcinoma ex goblet cell carcinoids and TP53 mutations were limited to poorly differentiated adenocarcinoma ex goblet cell carcinoids (2/34). Copy number changes could be evaluated in 15/34 cases and showed low copy number gains in CDKN1B (6/15) and NFKBIA (6/15), among others. The overlapping molecular alterations suggest that goblet cell carcinoids and adenocarcinoma ex goblet cell carcinoids are best considered two grades of differentiation of the same tumor rather than two distinct histological types. Mutations in TP53, CDH1 and MLL2 mutations were predominantly present in the adenocarcinoma ex goblet cell carcinoid group consistent with transformation to a higher grade lesion. The unique mutational profile also offers an explanation for the poor chemosensitivity in these tumors and highlights the need for developing new targeted therapies.
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92
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Yang C, Sun L, Zhang L, Zhou L, Niu D, Cao W, Li Z, Huang X, Kang Q, Jia L, Platik M, Liu X, Lai J, Cao D. SATB2 Shows Different Profiles Between Appendiceal Adenocarcinomas Ex Goblet Cell Carcinoids and Appendiceal/Colorectal Conventional Adenocarcinomas: An Immunohistochemical Study With Comparison to CDX2. Gastroenterology Res 2018; 11:221-230. [PMID: 29915633 PMCID: PMC5997472 DOI: 10.14740/gr1015w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 04/10/2018] [Indexed: 01/06/2023] Open
Abstract
Background Special AT-rich sequence-binding protein 2 (SATB2) is a novel marker for colorectal adenocarcinomas but little is known about its expression in appendiceal adenocarcinomas. We aim to investigate SATB2 in these tumors and colorectal adenocarcinomas with comparison to CDX2. Methods Immunohistochemical stains for SATB2 and CDX2 were performed in 49 appendiceal adenocarcinomas (23 conventional, 26 adenocarcinoma ex goblet cell carcinoids (AdexGCCs)) and 57 colorectal adenocarcinomas. Their expression was correlated with tumor differentiation and growth patterns. Results SATB2 staining was positive in 26/26 (100%) appendiceal AdexGCCs and 15/23 (65%) appendiceal conventional adenocarcinomas (P = 0.001). Their mean percentage of SATB2-positive cells was 93% and 34%, respectively (P < 0.0001). CDX2 staining was seen in 26/26 (100%) AdexGCCs and 22/23 (96%) appendiceal conventional adenocarcinomas (P = 0.4694). SATB2 and CDX2 showed similar staining in AdexGCCs but CDX2 labeled more tumor cells than SATB2 in conventional adenocarcinomas (mean 84% vs. 34%, P < 0.0001). SATB2 and CDX2 staining was seen in 82% (47/57) and 96% (55/57) colorectal adenocarcinomas, respectively (P = 0.01). The mean percentage of cells positive for SATB2 and CDX2 was 48% and 91%, respectively (P < 0.00001). Decreased SATB2 immunoreactivity was associated with non-glandular differentiation particularly signet ring cells in colorectal (P = 0.001) and appendiceal conventional adenocarcinomas (P = 0.04) but not in appendiceal AdexGCCs. Conclusions SATB2 is a highly sensitive marker for appendiceal AdexGCCs with similar sensitivity as CDX2. In colorectal and appendiceal conventional adenocarcinomas, SATB2 is not as sensitive as CDX2 and its immunoreactivity is dependent on tumor differentiation.
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Affiliation(s)
- Chen Yang
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO 63110, USA.,These two authors contributed equally to this project
| | - Li Sun
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital (Beijing Cancer Hospital), Beijing, China.,These two authors contributed equally to this project
| | - Lingxin Zhang
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Lixin Zhou
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital (Beijing Cancer Hospital), Beijing, China
| | - Dongfeng Niu
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital (Beijing Cancer Hospital), Beijing, China
| | - Wenfeng Cao
- Department of Pathology, Tianjin Cancer Hospital, Tianjin Medical University, Tianjin, China
| | - Zhongwu Li
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital (Beijing Cancer Hospital), Beijing, China
| | - Xiaozheng Huang
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital (Beijing Cancer Hospital), Beijing, China
| | - Qiang Kang
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital (Beijing Cancer Hospital), Beijing, China
| | - Lin Jia
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital (Beijing Cancer Hospital), Beijing, China
| | - Marina Platik
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Xiuli Liu
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Jinping Lai
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Dengfeng Cao
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO 63110, USA
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Jesinghaus M, Konukiewitz B, Foersch S, Stenzinger A, Steiger K, Muckenhuber A, Groß C, Mollenhauer M, Roth W, Detlefsen S, Weichert W, Klöppel G, Pfarr N, Schlitter AM. Appendiceal goblet cell carcinoids and adenocarcinomas ex-goblet cell carcinoid are genetically distinct from primary colorectal-type adenocarcinoma of the appendix. Mod Pathol 2018; 31:829-839. [PMID: 29327707 DOI: 10.1038/modpathol.2017.184] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/24/2017] [Accepted: 11/08/2017] [Indexed: 12/23/2022]
Abstract
The appendix gives rise to goblet cell carcinoids, which represent special carcinomas with distinct biological and histological features. Their genetic background and molecular relationship to colorectal adenocarcinoma is largely unknown. We therefore performed a next-generation sequencing analysis of 25 appendiceal carcinomas including 11 goblet cell carcinoids, 7 adenocarcinomas ex-goblet cell carcinoid, and 7 primary colorectal-type adenocarcinomas, using a modified Colorectal Cancer specific Panel comprising 32 genes linked to colorectal and neuroendocrine tumorigenesis. The mutational profiles of these neoplasms were compared with those of conventional adenocarcinomas, mixed adenoneuroendocrine carcinomas, and neuroendocrine carcinomas of the colorectum. In addition, a large-scale pan-cancer sequencing panel covering 409 genes was applied to selected cases of goblet cell carcinoid/adenocarcinoma ex-goblet cell carcinoid (n=2, respectively). Mutations in colorectal cancer-related genes (eg, TP53, KRAS, APC) were rare to absent in both, goblet cell carcinoids and adenocarcinomas ex-goblet cell carcinoid, but frequent in primary colorectal-type adenocarcinomas of the appendix. Additional large-scale sequencing of selected goblet cell carcinoids and adenocarcinomas ex-goblet cell carcinoid revealed mutations in Wnt-signaling-associated genes (USP9X, NOTCH1, CTNNA1, CTNNB1, TRRAP). These data suggest that appendiceal goblet cell carcinoids and adenocarcinomas ex-goblet cell carcinoid constitute a morphomolecular entity, histologically and genetically distinct from appendiceal colorectal-type adenocarcinomas and its colorectal counterparts. Altered Wnt-signaling associated genes, apart from APC, may act as potential drivers of these neoplasms. The absence of KRAS/NRAS mutations might render some of these tumors eligible for anti-EGFR directed therapy regimens.
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Affiliation(s)
- Moritz Jesinghaus
- Institute of Pathology, Technical University of Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Björn Konukiewitz
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | | | - Albrecht Stenzinger
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Katja Steiger
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Alexander Muckenhuber
- Institute of Pathology, Technical University of Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Claudia Groß
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | | | - Wilfried Roth
- Institute of Pathology, University Hospital Mainz, Mainz, Germany
| | - Sönke Detlefsen
- Department of Clinical Pathology, University Hospital Odense, Odense, Denmark
| | - Wilko Weichert
- Institute of Pathology, Technical University of Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Günter Klöppel
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Nicole Pfarr
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Anna Melissa Schlitter
- Institute of Pathology, Technical University of Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
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94
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Barghi A, Grabbe J, Ghosh A. Goblet cell carcinoid of the appendix: Case report of a high grade tumor in a 20-year-old. Int J Surg Case Rep 2018; 46:69-73. [PMID: 29698881 PMCID: PMC6000770 DOI: 10.1016/j.ijscr.2018.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 04/10/2018] [Accepted: 04/11/2018] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Goblet cell carcinoid (GCC) is an extraordinarily rare appendiceal tumor that is usually an incidental diagnosis on post-operative histology. It typically presents in the fifth or sixth decade of life. Our patient is the only reported case study of GCC in a pediatric-young adult. Due to its potentially poor prognosis, GCC is surgically treated as an adenocarcinoma, with right hemicolectomy as the mainstay of treatment. PRESENTATION OF CASE The patient was a 20-year-old male who presented with a history, physical exam, and work up consistent with acute appendicitis. He underwent an uneventful laparoscopic appendectomy and was diagnosed with a high grade GCC post-operatively. DISCUSSION GCC is a rare tumor of the appendix with unique histological features including small rosettes with crescentic nuclei distended with mucin. It is often retroactively diagnosed with histology after a majority of patients present with acute appendicitis symptoms. The behavior of this tumor in pediatric-young adults is very poorly understood. CONCLUSION We review the literature for GCC of the appendix and illustrate a case report of a young, otherwise healthy 20-year-old who presented as appendicitis. Although rare, neoplasm must be kept in mind while offering non-operative management for acute appendicitis.
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Affiliation(s)
- Ameen Barghi
- Department of Surgery, The Cambridge Hospital, Harvard Medical School, Cambridge, MA, USA.
| | - John Grabbe
- Department of Pathology, The Cambridge Hospital, Massachusetts General Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Arundhati Ghosh
- Department of Surgery, The Cambridge Hospital, Harvard Medical School, Cambridge, MA, USA
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95
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Wen KW, Grenert JP, Joseph NM, Shafizadeh N, Huang A, Hosseini M, Kakar S. Genomic profile of appendiceal goblet cell carcinoid is distinct compared to appendiceal neuroendocrine tumor and conventional adenocarcinoma. Hum Pathol 2018; 77:166-174. [PMID: 29634977 DOI: 10.1016/j.humpath.2018.03.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/08/2018] [Accepted: 03/29/2018] [Indexed: 02/07/2023]
Abstract
Goblet cell carcinoid (GCC) is a rare appendiceal tumor with unique morphologic features that shows glandular and neuroendocrine differentiation on immunohistochemistry. An additional component of adenocarcinoma (AC) can be present (GCC-AC). Both GCC and GCC-AC are staged and treated like AC. The histogenesis and genetic alterations underlying GCC and GCC-AC are unclear. Capture-based next-generation DNA sequencing targeting 479 cancer genes was performed on 19 appendiceal tumors: 4 GCC, 9 GCC-AC, 3 neuroendocrine tumors (NET), and 3 AC (2 conventional, 1 mucinous). Somatic coding mutations were not seen in any NET. Pathogenic (P)/likely pathogenic (LP) mutations were present in 1 GCC, 8 GCC-AC and all 3 AC cases. P/LP mutations in chromatin remodeling genes were seen in 4 (44.4%) GCC-AC cases, but not in NET, GCC or AC. In GCC-AC, P/LP mutations in ARID1A and RHOA were each present in 3 cases, and KDM6A and SOX9 mutations were each seen in 2 cases. APC and KRAS mutations were present in 1 conventional AC case, but were not observed in any GCC or GCC-AC. This limited series reveals mutations in SOX9, RHOA, and chromatin-modifier genes in goblet cell tumors, and shows that the mutational profile of GCC/GCC-AC is distinct from NET and conventional appendiceal AC.
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Affiliation(s)
- Kwun Wah Wen
- Department of Pathology, University of California, San Francisco, San Francisco, CA 91343, United States
| | - James P Grenert
- Department of Pathology, University of California, San Francisco, San Francisco, CA 91343, United States
| | - Nancy M Joseph
- Department of Pathology, University of California, San Francisco, San Francisco, CA 91343, United States
| | | | - Anne Huang
- Vista Pathology, Medford, OR 97504, United States
| | - Mojgan Hosseini
- University of California, San Diego, San Diego, CA 92093, United States
| | - Sanjay Kakar
- Department of Pathology, University of California, San Francisco, San Francisco, CA 91343, United States.
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96
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Clift AK, Kornasiewicz O, Drymousis P, Faiz O, Wasan HS, Kinross JM, Cecil T, Frilling A. Goblet cell carcinomas of the appendix: rare but aggressive neoplasms with challenging management. Endocr Connect 2018; 7:268-277. [PMID: 29335251 PMCID: PMC5801558 DOI: 10.1530/ec-17-0311] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/15/2018] [Indexed: 12/17/2022]
Abstract
Goblet cell carcinomas (GCC) are a rare, aggressive sub-type of appendiceal tumours with neuroendocrine features, and controversy exists with regards to therapeutic strategy. We undertook a retrospective review of GCC patients surgically treated at two tertiary referral centres. Clinical and histopathological data were extracted from a prospectively maintained database. Survival analyses utilised Kaplan-Meier methodology. Twenty-one patients were identified (9 females). Median age at diagnosis was 55 years (range 32-77). There were 3, 6 and 9 grade 1, 2 and 3 tumours, respectively. One, 10, 5 and 5 patients had stage I, II, III and IV disease at diagnosis, respectively. There were 8, 10 and 3 Tang class A, B and C tumours, respectively. Index operation was appendectomy (n = 12), right hemicolectomy (n = 6) or resections including appendix/right colon, omentum and the gynaecological system (n = 3). Eight patients underwent completion right hemicolectomy. Surgery for recurrence included small bowel resection (n = 2), debulking with peritonectomy and heated intraperitoneal chemotherapy, and hysterectomy and bilateral salpingo-oophorectomy (all n = 1). Median follow-up was 30 months (range 2.5-123). One-, 3- and 5-year OS was 79.4, 60 and 60%, respectively. Mean OS (1-, 3-, and 5-year OS) for Tang class A, B and C tumours were 73.1 months (85.7, 85.7, 51.4%), 83.7 months (all 66.7%) and 28.5 months (66.7, 66.7%, not reached), respectively. Chromogranin A/B and 68Ga-DOTATATE PET/CT were not useful in follow-up, but CEA, CA 19-9, CA 125 and 18F-FDG PET/CT identified tumour recurrence. GCC must be clearly discriminated from relatively indolent appendiceal neuroendocrine neoplasms. 18F-FDG PET/CT and CEA/CA19-9/CA 125 are useful in detecting recurrence of GCC.
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Affiliation(s)
- Ashley K Clift
- Department of Surgery and CancerImperial College London, London, UK
| | - Oskar Kornasiewicz
- Department of Surgery and CancerImperial College London, London, UK
- Department of SurgeryWarsaw Medical University, Warsaw, Poland
| | | | - Omar Faiz
- Department of SurgerySt Mark's Hospital, London, UK
| | - Harpreet S Wasan
- Department of Surgery and CancerImperial College London, London, UK
| | - James M Kinross
- Department of Surgery and CancerImperial College London, London, UK
| | - Thomas Cecil
- Peritoneal Malignancy UnitBasingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Andrea Frilling
- Department of Surgery and CancerImperial College London, London, UK
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97
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Brathwaite SA, Smith SM, Wai L, Frankel W, Hays J, Yearsley MM, Abdel-Misih S. Mixed adenoneuroendocrine carcinoma: A review of pathologic characteristics. Hum Pathol 2017; 73:184-191. [PMID: 29288693 DOI: 10.1016/j.humpath.2017.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 12/25/2022]
Abstract
Mixed adenoneuroendocrine carcinoma (MANEC) is a rare pathologic entity defined as a tumor exhibiting both adenocarcinoma and neuroendocrine carcinoma components. Though uncommon, these tumors show aggressive behavior and generally portend a poor prognosis. This study seeks to further define clinicopathological characteristics of MANEC to aid in accurate diagnosis and properly direct clinical management. Thirty-four confirmed MANECs were identified in our 25-year retrospective review of cases arising in the gastrointestinal tract. Various gross and microscopic variables were compared to overall survival. Tumors diagnosed at advanced stage (pT4), had a prominent mucinous component and lacked goblet cell clusters, which were all significantly associated with worse overall survival. This study supports previous findings and further elucidates clinicopathologic characteristics of MANEC.
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Affiliation(s)
- Shayna A Brathwaite
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Stephen M Smith
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Lai Wai
- Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Wendy Frankel
- Department of Pathology, Division of Gastrointestinal and Liver Pathology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - John Hays
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Martha M Yearsley
- Department of Pathology, Division of Gastrointestinal and Liver Pathology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Sherif Abdel-Misih
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
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98
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Chai SM, Brown IS, Kumarasinghe MP. Gastroenteropancreatic neuroendocrine neoplasms: selected pathology review and molecular updates. Histopathology 2017; 72:153-167. [DOI: 10.1111/his.13367] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Siaw M Chai
- PathWest Laboratory Medicine; Queen Elizabeth II Medical Centre; Perth Australia
| | - Ian S Brown
- Envoi Pathology; Kelvin Grove; Queensland Australia
| | - M Priyanthi Kumarasinghe
- PathWest Laboratory Medicine; Queen Elizabeth II Medical Centre; Perth Australia
- School of Pathology and Laboratory Medicine; University of Western Australia; Perth Australia
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99
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Kanno-Okada H, Mitsuhashi T, Mabe K, Shimoda T, Matsuno Y. Composite neuroendocrine tumor and adenocarcinoma of the rectum. Diagn Pathol 2017; 12:85. [PMID: 29228981 PMCID: PMC5725937 DOI: 10.1186/s13000-017-0674-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 12/05/2017] [Indexed: 02/07/2023] Open
Abstract
Background Although adenocarcinomas showing neuroendocrine differentiation or those mixed with high-grade neuroendocrine carcinoma (NEC) are sometimes encountered, composite tumors comprising neuroendocrine tumor (NET) Grade 1 and adenocarcinoma are exceedingly rare. Case presentation A 64-year-old male presented after testing positive for fecal occult blood at a medical check-up. A biopsy demonstrated the presence of a NET and endoscopic submucosal dissection was undertaken. Histologic examination revealed that a well differentiated tubular adenocarcinoma was present in addition to the NET. Furthermore, histological transition between the two tumors was evident. Accordingly, this case was considered to be a composite tumor comprising NET and adenocarcinoma. Conclusion Composite tumors consisting of NET Grade 1 and adenocarcinoma are exceedingly rare, and only a few examples have been reported hitherto.
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Affiliation(s)
- Hiromi Kanno-Okada
- Department of Surgical Pathology, Hokkaido University Hospital, North 14, West 5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan.
| | - Tomoko Mitsuhashi
- Department of Surgical Pathology, Hokkaido University Hospital, North 14, West 5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Katsuhiro Mabe
- Department of Gastroenterology, Hakodate National Hospital, Kawahara-cho 18-16, Hakodate, Hokkaido, 041-8512, Japan
| | - Tadakazu Shimoda
- Department of Surgical Pathology, Hokkaido University Hospital, North 14, West 5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan.,Division of Pathology, Shizuoka Cancer Center, Shimonakakubo 1007, Izumi-cho, Suntou-gun, Pref., Shizuoka, 411-8777, Japan
| | - Yoshihiro Matsuno
- Department of Surgical Pathology, Hokkaido University Hospital, North 14, West 5, Kita-ku, Sapporo, Hokkaido, 060-8648, Japan
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100
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Madsen AH, Ladekarl M, Villadsen GE, Grønbæk H, Sørensen MM, Stribolt K, Verwaal VJ, Iversen LH. Effects of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in the Treatment of Goblet Cell Carcinoma: A Prospective Cohort Study. Ann Surg Oncol 2017; 25:422-430. [DOI: 10.1245/s10434-017-6272-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Indexed: 12/12/2022]
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