101
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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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102
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Expert Commentary on Appendiceal Neoplasms. Dis Colon Rectum 2017; 60:1239-1240. [PMID: 29112558 DOI: 10.1097/dcr.0000000000000984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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103
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Abstract
Pathologists use immunohistochemistry is their day-to-day practices to assist in distinguishing site of origin of metastatic carcinomas. Here, the work-up is discussed neuroendocrine carcinomas, squamous cell carcinomas and adenocarcinomas with particular attention to tumor incident rates and predictive values of the best-performing immunohistochemical markers.
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Affiliation(s)
- Edward B Stelow
- Department of Pathology, University of Virginia, Charlottesville, VA, United States.
| | - Hadi Yaziji
- Vitro Molecular Laboratories, Miami, FL, United States
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104
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Pure mucinous (colloid) adenocarcinoma of the conjunctiva. J Cutan Pathol 2017; 45:78-83. [DOI: 10.1111/cup.13060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/04/2017] [Accepted: 10/10/2017] [Indexed: 11/26/2022]
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105
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Maedler C, Arnason T, Dorreen A, Sapp H, Castonguay M, Murphy J, Selegean S, Huang WY. Goblet cell carcinoid of the appendix - An interobserver variability study using two proposed classification systems. Ann Diagn Pathol 2017; 32:51-55. [PMID: 29414399 DOI: 10.1016/j.anndiagpath.2017.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/04/2017] [Indexed: 10/18/2022]
Abstract
Goblet cell carcinoid (GCC) is an uncommon tumor of the vermiform appendix. Due to a broad spectrum of morphological differentiation, subclassification and grading of GCCs remains an area of controversy. Two separate systems have proposed classifying GCC tumors into three (classical GCC; adenocarcinoma ex-GCC, signet ring cell type; adenocarcinoma ex-GCC, poorly differentiated carcinoma type) OR two subgroups (low and high grade GCC) based on morphological criteria. We independently compared the inter-observer variability associated with each classification system. Overall, both systems had moderate interobserver agreement, with the two-tiered system (κ=0.54) performing slightly better than the three-tiered system (κ=0.42). GI-specialist pathologists had substantial agreement for both two and three-tiered systems (κ=0.65 vs. 0.65). Non-GI trained pathologists had lower overall agreement than GI trained pathologists, but their agreement was better using the two-tiered system (κ=0.44) than the three-tiered system (κ=0.22). A sub-analysis of 6 cases with a high rate of discordant classification revealed several challenges that exist in applying current criteria, including differentiating "goblet" vs. "signet ring" cell morphology, applying a 1 mm2 criteria to multifocal non-contiguous glandular and single infiltrating cell architecture, differentiating fibro-inflammatory stroma from desmoplastic stroma, and solid architecture in cases with abundant extracellular mucin, and distinguishing "reactive" nuclear atypia from true "cytologic atypia". Despite these challenges, the study identified better agreement among GI pathologists than non-GI trained pathologists. While GI pathologist review may be helpful, further research on objective classification criteria remains an area of interest.
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Affiliation(s)
- Chelsea Maedler
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Thomas Arnason
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alastair Dorreen
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Heidi Sapp
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mathieu Castonguay
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joanne Murphy
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sorin Selegean
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Weei-Yuarn Huang
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.
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106
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Kim MJ, Lee EJ, Kim DS, Lee DH, Youk EG, Kim HJ. Composite intestinal adenoma-microcarcinoid in the colon and rectum: a case series and historical review. Diagn Pathol 2017; 12:78. [PMID: 29116005 PMCID: PMC5688820 DOI: 10.1186/s13000-017-0665-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 10/19/2017] [Indexed: 12/18/2022] Open
Abstract
Background Composite intestinal adenoma-microcarcinoid (CIAM) is a rare colorectal lesion that mostly comprises a conventional adenomatous component with a minute proportion of neuroendocrine (NE) component. Although microcarcinoids are well-recognized in the setting of chronic inflammatory disorders of the gastrointestinal tract, large intestinal microcarcinoids associated with intestinal adenoma are exceedingly rare and their clinicopathologic characteristics are yet to be elucidated. This study was performed to clarify their clinicopathologic characteristics and to review the relevant literature. Methods In total, 24 cases of CIAM in which tumors were excised endoscopically (n = 22) or surgically (n = 2) were retrieved from the Department of Pathology, Daehang Hospital. We analyzed their clinicopathologic characteristics and performed immunohistochemical staining for NE markers to determine their endocrine nature. Results CIAM usually developed in middle-aged and elderly patients, with a mean age of 62.0 years (range, 44–81 years). Thirteen patients were men and 11 were women, indicating a nearly equal sex ratio. Unlike classic carcinoid tumors, CIAMs occurred mostly in the colon (83.3% of cases), particularly in the proximal colon. Histologically, the microcarcinoid component consisted of low-grade NE cells arranged in small nests, glands or cords interspersed with glandular elements or less frequently resembled squamous morules. There was no expansile nodular or organoid growth pattern, which is typical of carcinoid tumors. The microcarcinoids were 1–20 mm in size (mean size, 4.7 mm) and were mostly situated in the basal lamina propria with no submucosal layer involvement; none showed desmoplastic reaction or increased proliferative activity. Follow-up data (mean, 23.1 months) were available for 18 patients; all patients are alive and well. Conclusions To the best of our knowledge, ours is the largest series of patients with CIAM in the English-language literature. Microcarcinoids found in CIAMs appear to show favorable clinical outcomes regardless of their size, likely due to the absence of submucosal extension and/or increased proliferative activity. We recommend avoiding additional radical surgeries in patients who have endoscopically undergone complete CIAM excision unless they exhibit ominous histologic features such as submucosal extension or increased proliferative activity.
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Affiliation(s)
- Mi-Jung Kim
- Department of Pathology, Daehang hospital, 481-10 BangBae3-dong, Seocho-gu, 137-820, Seoul, Republic of Korea
| | - Eun-Jung Lee
- Department of Surgery, Daehang hospital, 481-10 BangBae3-dong, Seocho-gu, 137-820, Seoul, Republic of Korea
| | - Do Sun Kim
- Department of Surgery, Daehang hospital, 481-10 BangBae3-dong, Seocho-gu, 137-820, Seoul, Republic of Korea
| | - Doo Han Lee
- Department of Surgery, Daehang hospital, 481-10 BangBae3-dong, Seocho-gu, 137-820, Seoul, Republic of Korea
| | - Eui Gon Youk
- Department of Surgery, Daehang hospital, 481-10 BangBae3-dong, Seocho-gu, 137-820, Seoul, Republic of Korea
| | - Hyun-Jung Kim
- Department of Pathology, University of Inje College of Medicine, Sanggye Paik hospital, Dongil-ro 1342, Nowon-gu, Seoul, Republic of Korea.
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107
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Peritoneal Involvement Is More Common Than Nodal Involvement in Patients With High-Grade Appendix Tumors Who Are Undergoing Prophylactic Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Dis Colon Rectum 2017; 60:1155-1161. [PMID: 28991079 DOI: 10.1097/dcr.0000000000000869] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Right hemicolectomy is routinely recommended in patients with histologic findings of high-grade appendix tumors after appendicectomy. Undetected peritoneal disease may be encountered at surgery. In high-grade appendix tumors with disease detected radiologically, complete cytoreduction may not be possible and outcomes poor. For these reasons, we adopted a policy of prophylactic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. OBJECTIVE The purpose of this study was to quantify the rates of peritoneal and nodal metastatic disease in patients with high-grade appendix tumors without obvious metastatic disease and to report the long-term outcomes of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in these patients. DESIGN Data regarding peritoneal and nodal metastatic disease were extracted from surgical and histologic records. SETTINGS The study was conducted at a high-volume tertiary referral center for peritoneal malignancy. PATIENTS Patients referred with histologically high-grade appendix tumors at appendicectomy, without detectable metastatic spread, between January 1994 and September 2016 were included MAIN OUTCOME MEASURES:: A total of 62 patients with high-grade pathology at appendicectomy, without clinical or radiological peritoneal disease, underwent complete cytoreduction with hyperthermic intraperitoneal chemotherapy. RESULTS Thirty-five (57%) of 62 patients had peritoneal disease (median peritoneal cancer index 5 (range, 1-28)). Eleven (31%) of 35 had microscopic peritoneal disease. Overall, 23 (37%) of 62 had peritoneal disease beyond the confines of a standard right hemicolectomy. Nine (15%) of 62 had nodal involvement. Mean overall and disease-free survival were 110.9 (95% CI, 94.8-127.0 mo) and 102.1 months (95% CI, 84.3-119.9 mo), with 5-year overall and disease-free survival of 83.2% and 76.0%. LIMITATIONS The retrospective nature limits the interpretation of these results. CONCLUSIONS Complete cytoreduction was achieved in all of the patients, with excellent long-term survival. The incidence of peritoneal spread (57%) compared with nodal involvement (15%) supports cytoreductive surgery and hyperthermic intraperitoneal chemotherapy as definitive treatment rather than prophylaxis in patients with high-grade appendix tumors, even without radiologically detectable disease. High-grade appendix tumors benefit from early aggressive operative management to deal with potential peritoneal and nodal spread and should be considered for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. See Video Abstract at http://links.lww.com/DCR/A360.
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108
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Pakraftar S, Ramalingam L, Shuai Y, Jones HL, Pingpank JF, Ahrendt SS, Holtzman MP, Zureikat AH, Zeh HJ, Bartlett DL, Choudry HA. Institutional Experience with Ostomies Created During Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemoperfusion. Ann Surg Oncol 2017; 24:3811-3817. [PMID: 29019111 DOI: 10.1245/s10434-017-6114-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion (CRS-HIPEC) is a complex procedure that often requires ostomy creation to protect high-risk anastomoses. This study aimed to evaluate the authors' institutional experience with CRS-HIPEC-associated ostomies, determine predictors of ostomy creation and reversal, and assess their impact on survival. METHODS The study analyzed clinicopathologic, perioperative, and oncologic data from a prospective database of 1435 CRS-HIPEC procedures for peritoneal metastases. The Kaplan-Meier method was used to estimate survival. Multivariate analyses identified associations with ostomy creation/reversal and survival. RESULTS Ostomies were created in 34% of the patients, most commonly loop ileostomies (82%). Loop ileostomies were reversed in the majority of patients (83%), whereas non-loop ileostomies were infrequently reversed (< 10% reversal rate). In a multivariate logistic regression model, intermediate or high tumor grade, colectomy/proctectomy, longer operative time, and lower Charlson comorbidity index were associated with loop ileostomy creation, whereas incomplete macroscopic resection, colorectal histology, and major postoperative complications were associated with non-reversal of loop ileostomy. In a multivariate Cox proportional hazards model, intermediate or high tumor grade and non-reversal of loop ileostomy were associated with worse overall survival. CONCLUSIONS Loop ileostomies were almost always reversed, whereas non-loop ileostomies were almost always permanent. Hospital readmissions for loop ileostomy-related complications were common. Therefore, formal outpatient protocols for prevention and management should be implemented. Non-reversal of loop ileostomy was associated with very poor survival.
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Affiliation(s)
- Sam Pakraftar
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lekshmi Ramalingam
- 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
| | - 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
| | - Amer H Zureikat
- 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
| | - Haroon A Choudry
- Division of Surgical Oncology, Koch Regional Perfusion Center, University of Pittsburgh, Pittsburgh, PA, USA.
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109
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Macak J, Nemejcova K, Dvorackova J. Are goblet cell carcinoids a group of heterogeneous tumors? Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2017; 161:281-285. [DOI: 10.5507/bp.2017.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/19/2017] [Indexed: 01/01/2023] Open
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110
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Adenocarcinoma Ex Goblet Cell Carcinoid of Appendix: Two Case Reports. Case Rep Pathol 2017; 2017:5930978. [PMID: 28890838 PMCID: PMC5584355 DOI: 10.1155/2017/5930978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/26/2017] [Accepted: 07/13/2017] [Indexed: 12/01/2022] Open
Abstract
Adenocarcinoma ex goblet cell carcinoid is a rare tumor incidentally found in specimens of appendicitis. Most patients present with acute abdomen, similar to acute appendicitis. Here we present two cases, which were found incidentally after operation. We give a brief summary about clinical and biological behavior of this entity.
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111
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Frilling A, Clift AK. Peritoneal Metastases from Gastroenteropancreatic Neuroendocrine Tumors. Ann Surg Oncol 2017; 24:3466-3468. [PMID: 28815440 DOI: 10.1245/s10434-017-6055-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Andrea Frilling
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Ashley K Clift
- Department of Surgery and Cancer, Imperial College London, London, UK
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112
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Nonaka D, Papaxoinis G, Lamarca A, Fulford P, Valle J, Chakrabarty B. A study of appendiceal crypt cell adenocarcinoma (so-called goblet cell carcinoid and its related adenocarcinoma). Hum Pathol 2017; 72:18-27. [PMID: 28823572 DOI: 10.1016/j.humpath.2017.08.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/27/2017] [Accepted: 08/05/2017] [Indexed: 11/28/2022]
Abstract
Goblet cell carcinoids (GCCs) of the appendix are rare tumors, characterized by a carcinoid-like organoid growth pattern. Despite the term carcinoid, neuroendocrine features are inconspicuous, and its behavior is distinct from carcinoid. Its high-grade counterpart is designated as adenocarcinoma ex GCC. We conducted a retrospective study of 105 tumors to find prognostic values of a variety of clinicopathologic features. The tumors were subclassified as low grade, equivalent to classic type, and high grade, defined as loss of organoid pattern, and a proportion (%) of low and high grades were documented in each tumor. Correlations between survival and various clinicopathologic parameters were investigated. One-third were pure low grade, while the remainder contained variable high-grade component ranging from 5% to 95%. Neuroendocrine cell component ranged from 0% to 90% (median, 5), while mucus cell component ranged from 5% to 100% (median, 70). By univariate analysis, size, stage, high-grade component, nuclear grade, surgery, and chemotherapy correlated with cancer-related survival (CSS), and by multivariate analysis, stage (P=.001), high-grade component (P=.008), and tumor size (P=.005) correlated with CSS. There was significant difference in CSS when the cases were grouped by high-grade component: <40%, 40% to 90%, and ≤90% (P<.001). Our results indicate that staging and proportion of high-grade histology may provide important prognostic information. Neuroendocrine component was insignificant in both low- and high-grade areas. In light of our findings, this tumor type is best regarded as a variant of adenocarcinoma, and the term crypt cell adenocarcinoma more appropriately reflects the nature and origin of this tumor group.
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Affiliation(s)
- Daisuke Nonaka
- Department of Histopathology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK; Institute of Cancer Sciences, The University of Manchester, Manchester M20 4BX, UK.
| | - George Papaxoinis
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK
| | - Angela Lamarca
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK
| | - Paul Fulford
- Department of Surgery, The Christie NHS Foundation Trust, Manchester M20 4BX, UK
| | - Juan Valle
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK; Institute of Cancer Studies, The University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, UK
| | - Bipasha Chakrabarty
- Department of Histopathology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK
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113
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Karaman H, Şenel F, Güreli M, Ekinci T, Topuz Ö. Goblet cell carcinoid of the appendix and mixed adenoneuroendocrine carcinoma: Report of three cases. World J Gastrointest Oncol 2017; 9:308-313. [PMID: 28808504 PMCID: PMC5534399 DOI: 10.4251/wjgo.v9.i7.308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 02/24/2017] [Accepted: 04/10/2017] [Indexed: 02/05/2023] Open
Abstract
Neuroendocrine neoplasms are the most common epithelial tumors among appendix tumors. Appendix tumors that are completely or partially composed of neuroendocrine cells are divided into two categories: Classic carcinoid tumors and goblet cell carcinoid tumors (GCCT). They are known to progress more aggressively than classic (neuro) endocrine tumors. In this study, three cases with acute appendicitis symptoms are presented, including their clinical and histopathological findings. Microscopic examination detected GCCT in two cases and mixed adenoneuroendocrine carcinoma in one case, in addition to acute appendicitis.
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114
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De Vito C, Sarker D, Ross P, Heaton N, Quaglia A. Histological heterogeneity in primary and metastatic classic combined hepatocellular-cholangiocarcinoma: a case series. Virchows Arch 2017; 471:619-629. [PMID: 28707055 DOI: 10.1007/s00428-017-2196-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/22/2017] [Accepted: 07/05/2017] [Indexed: 12/23/2022]
Abstract
Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare and aggressive primary liver cancer with both hepatocellular and cholangiocellular differentiation. Due to its bi-phenotypic component, cHCC-CC is a heterogeneous tumour and histopathological analysis of metastatic deposits is poorly characterized. In this retrospective study, we describe four patients in whom the histology from resected specimens of both primary and recurrent and/or metastatic tumour was available for comparison and immunohistochemical characterization. Our study shows that recurrent or metastatic deposits replicate the heterogeneity of the primary cHCC-CC, that even originally small foci of divergent differentiation can become predominant later on and that hepatocellular and cholangiocellular components can show different tropism in distant organs. In our experience, the behaviour of recurrent/metastatic cHCC-CC is unpredictable and histological examination is necessary to guide treatment options at present.
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Affiliation(s)
- Claudio De Vito
- King's College Hospital, Institute of Liver Studies, London, UK. .,Division of Clinical Pathology, Service de Pathologie Clinique, Geneva University Hospital, 1211, Geneva, Switzerland.
| | - Debashis Sarker
- Department of Research Oncology, Division of Cancer Studies, King's College London, London, UK.,Department of Medical Oncology, Guy's and St Thomas' Hospital, London, UK
| | - Paul Ross
- Department of Medical Oncology, Guy's and St Thomas' Hospital, London, UK
| | - Nigel Heaton
- King's College Hospital, Institute of Liver Studies, London, UK
| | - Alberto Quaglia
- King's College Hospital, Institute of Liver Studies, London, UK
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115
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Valasek MA, Thung I, Gollapalle E, Hodkoff AA, Kelly KJ, Baumgartner JM, Vavinskaya V, Lin GY, Tipps AP, Hosseini MV, Lowy AM. Overinterpretation is common in pathological diagnosis of appendix cancer during patient referral for oncologic care. PLoS One 2017; 12:e0179216. [PMID: 28591173 PMCID: PMC5462425 DOI: 10.1371/journal.pone.0179216] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 05/25/2017] [Indexed: 11/18/2022] Open
Abstract
CONTEXT Low-grade appendiceal mucinous neoplasm (LAMN) and appendiceal adenocarcinoma are known to cause the majority of pseudomyxoma peritonei (PMP, i.e. mucinous ascites); however, recognition and proper classification of these neoplasms can be difficult despite established diagnostic criteria. OBJECTIVE To determine the pathological diagnostic concordance for appendix neoplasia and related lesions during patient referral to an academic medical center specialized in treating patients with PMP. DESIGN The anatomic pathology laboratory information system was searched to identify cases over a two-year period containing appendix specimens with mucinous neoplasia evaluated by an outside pathology group and by in-house slide review at a single large academic medical center during patient referral. RESULTS 161 cases containing appendix specimens were identified over this period. Forty-six of 161 cases (28.6%) contained appendiceal primary neoplasia or lesions. Of these, the originating pathologist diagnosed 23 cases (50%) as adenocarcinoma and 23 cases (50%) as LAMN; however, the reference pathologist diagnosed 29 cases (63.0%) as LAMN, 13 cases (28.3%) as adenocarcinoma, and 4 cases (8.7%) as ruptured simple mucocele. Importantly, for cases in which the originating pathologist rendered a diagnosis of adenocarcinoma, the reference pathologist rendered a diagnosis of adenocarcinoma (56.5%, 13 of 23), LAMN (39.1%, 9 of 23), or simple mucocele (4.3%, 1 of 23). The overall diagnostic concordance rate for these major classifications was 71.7% (33 of 46) with an unweighted observed kappa value of 0.48 (95% CI, 0.27-0.69), consistent with moderate interobserver agreement. All of the observed discordance (28.3%) for major classifications could be attributed to over-interpretation. In addition, the majority of LAMN cases (65.5%) had potential diagnostic deficiencies including over-interpretation as adenocarcinoma and lacking or discordant risk stratification (i.e. documentation of extra-appendiceal neoplastic epithelium). CONCLUSIONS Appendiceal mucinous lesions remain a difficult area for appropriate pathological classification with substantial discordance due to over-interpretation in this study. The findings highlight the critical need for recognition and application of diagnostic criteria regarding these tumors. Recently published consensus guidelines and a checklist provided herein may help facilitate improvement of diagnostic concordance and thereby reduce over-interpretation and potential overtreatment. Further studies are needed to determine the extent of this phenomenon and its potential clinical impact.
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Affiliation(s)
- Mark A. Valasek
- Department of Pathology, Division of Anatomic Pathology, University of California San Diego Medical Center, San Diego, California, United States of America
- * E-mail:
| | - Irene Thung
- Department of Pathology, Division of Anatomic Pathology, University of California San Diego Medical Center, San Diego, California, United States of America
| | - Esha Gollapalle
- Department of Pathology, Division of Anatomic Pathology, University of California San Diego Medical Center, San Diego, California, United States of America
| | - Alexey A. Hodkoff
- Department of Pathology, Division of Anatomic Pathology, University of California San Diego Medical Center, San Diego, California, United States of America
| | - Kaitlyn J. Kelly
- Department of Surgery, Division of Surgical Oncology, University of California San Diego Moores Cancer Center, La Jolla, California, United States of America
| | - Joel M. Baumgartner
- Department of Surgery, Division of Surgical Oncology, University of California San Diego Moores Cancer Center, La Jolla, California, United States of America
| | - Vera Vavinskaya
- Department of Pathology, Division of Anatomic Pathology, University of California San Diego Medical Center, San Diego, California, United States of America
| | - Grace Y. Lin
- Department of Pathology, Division of Anatomic Pathology, University of California San Diego Medical Center, San Diego, California, United States of America
| | - Ann P. Tipps
- Department of Pathology, Division of Anatomic Pathology, University of California San Diego Medical Center, San Diego, California, United States of America
| | - Mojgan V. Hosseini
- Department of Pathology, Division of Anatomic Pathology, University of California San Diego Medical Center, San Diego, California, United States of America
| | - Andrew M. Lowy
- Department of Surgery, Division of Surgical Oncology, University of California San Diego Moores Cancer Center, La Jolla, California, United States of America
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116
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Wen KW, Hale G, Shafizadeh N, Hosseini M, Huang A, Kakar S. Appendiceal goblet cell carcinoid: common errors in staging and clinical interpretation with a proposal for an improved terminology. Hum Pathol 2017; 65:187-193. [PMID: 28551326 DOI: 10.1016/j.humpath.2017.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/09/2017] [Accepted: 05/12/2017] [Indexed: 01/13/2023]
Abstract
Goblet cell carcinoid (GCC) is staged and treated as adenocarcinoma (AC) and not as neuroendocrine tumor (NET) or neuroendocrine carcinoma. The term carcinoid may lead to incorrect interpretation as NET. The aim of the study was to explore pitfalls in staging and clinical interpretation of GCC and mixed GCC-AC, and propose strategies to avoid common errors. Diagnostic terminology, staging, and clinical interpretation were evaluated in 58 cases (27 GCCs, 31 mixed GCC-ACs). Opinions were collected from 23 pathologists using a survey. Clinical notes were reviewed to assess the interpretation of pathology diagnoses by oncologists. NET staging was incorrectly used for 25% of GCCs and 5% of mixed GCC-ACs. In the survey, 43% of pathologists incorrectly indicated that NET staging is applicable to GCCs, and 43% incorrectly responded that Ki-67 proliferation index is necessary for GCC grading. Two cases each of GCC and mixed GCC-AC were incorrectly interpreted as neuroendocrine neoplasms by oncologists, and platinum-based therapy was considered for 2 GCC-AC cases because of the mistaken impression of neuroendocrine carcinoma created by use of the World Health Organization 2010 term mixed adenoneuroendocrine carcinoma. The term carcinoid in GCC and use of mixed adenoneuroendocrine carcinoma for mixed GCC-AC lead to errors in staging and treatment. We propose that goblet cell carcinoid should be changed to goblet cell carcinoma, whereas GCC with AC should be referred to as mixed GCC-AC with a comment about the proportion of each component and the histologic subtype of AC. This terminology will facilitate appropriate staging and clinical management, and avoid errors in interpretation.
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Affiliation(s)
- Kwun Wah Wen
- Department of Pathology, University of California, San Francisco, San Francisco, CA 91343, United States
| | - Gillian Hale
- Department of Pathology, University of California, San Francisco, San Francisco, CA 91343, United States
| | | | - Mojgan Hosseini
- University of California, San Diego, San Diego, CA 92093, United States
| | - Anne Huang
- Vista Pathology, Medford, OR 97504, United States
| | - Sanjay Kakar
- Department of Pathology, University of California, San Francisco, San Francisco, CA 91343, United States.
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117
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Lowenthal BM, Lin GY, Tipps AMP, Hosseini M. Adenocarcinoma Ex-Goblet Cell Carcinoid of the Appendix With Metastatic Peritoneal Spread to Meckel's Diverticulum and Endometriosis. Int J Surg Pathol 2017; 25:623-628. [PMID: 28449607 DOI: 10.1177/1066896917707042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Adenocarcinoma ex-goblet cell carcinoid is a very rare and histologically unique appendiceal malignancy with dual glandular and neuroendocrine differentiation. There is a high incidence of this tumor among middle-aged women with metastasis to the gynecologic tract with the mode of metastasis following peritoneal spread rather than hematogenous distribution. Adenocarcinoma ex-goblet cell carcinoid can spread to any peritoneal site including ovaries or omentum. We report a 37-year-old healthy woman who initially presented with right lower quadrant abdominal pain and pseudomyxoma peritonei. Histopathology of the appendectomy specimen revealed an adenocarcinoma ex-goblet cell carcinoid, signet ring cell type. Follow-up right hemicolectomy, omentectomy, bilateral salpingo-oophorectomy, and regional peritoneal resections revealed metastatic involvement by adenocarcinoma ex-goblet cell carcinoid, signet ring cell type. In this report, we describe a case of appendiceal adenocarcinoma ex goblet cell carcinoid with metastases to Meckel's diverticulum and areas of pelvic endometriosis, which have not been previously reported.
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Affiliation(s)
| | - Grace Y Lin
- 1 University of California San Diego Health System, San Diego, CA, USA
| | | | - Mojgan Hosseini
- 1 University of California San Diego Health System, San Diego, CA, USA
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118
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Recent updates on grading and classification of neuroendocrine tumors. Ann Diagn Pathol 2017; 29:11-16. [PMID: 28807335 DOI: 10.1016/j.anndiagpath.2017.04.005] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 04/12/2017] [Indexed: 12/24/2022]
Abstract
Neuroendocrine tumors (NETs) are originating from neuroendocrine cells in diffuse endocrine systems. NETs are diagnosed by characteristic histologic features and immunoprofiles. Recent 2010 WHO classification for gastroenteropancreatic NETs introduced grading system based on mitotic count and Ki-67 proliferation index. Gastroenteropancreatic NETs are classified as NET grade 1, NET grade 2, and neuroendocrine carcinoma (NET grade 3). However, the carcinoid is still used in classification of NETs of the lung and uterine cervix. Some issues with grading system such as methodologies for evaluation of Ki-67 index and subclassification of neuroendocrine carcinoma (NET grade 3) are arising. The importance of Ki-67 labeling index is emerging in differential diagnosis of lung carcinoids. In this review, we focus on recent grading and classification of NETs and related issues in various organs, including gastrointestinal tract, pancreas, lung, and female reproductive organs.
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119
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Teixeira FJR, Couto Netto SDD, Akaishi EH, Utiyama EM, Menegozzo CAM, Rocha MC. Acute appendicitis, inflammatory appendiceal mass and the risk of a hidden malignant tumor: a systematic review of the literature. World J Emerg Surg 2017; 12:12. [PMID: 28286544 PMCID: PMC5343298 DOI: 10.1186/s13017-017-0122-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 02/08/2017] [Indexed: 01/13/2023] Open
Abstract
Introduction Acute appendicitis is significantly common. Despite the increased use of computed tomography, the number of perforated cases has been stable in the past three decades. Between 2% and 6% of patients with acute appendicitis present appendiceal mass, often described as inflammatory phlegmon or abscess. Malignant tumors are confirmed by pathological analysis in 0.9–1.4% of all appendectomies performed to treat acute appendicitis. However, recent series demonstrate an elevated incidence of malignancies, ranging from 5.9 to 12%, in patients with inflammatory appendiceal mass. Methods The analysis was based on a systematic review of the literature. The articles were searched in PubMed for the period from 1987 to 2016. Articles presenting the incidence of the hidden malignancy among patients with appendiceal inflammatory mass were selected. Variables as age, interval appendectomy rate, the incidence of neoplasm, time to surgery, minimally invasive assessment, histology, right colectomy rate and morbidity were analyzed. Results A total of 13.244 patients were described as presenting acute appendicitis. Appendiceal tumor is present in approximately 1% of the appendectomies, while the rate of neoplasm varies from 10 to 29% in patients presenting appendiceal inflammatory mass. Interval appendectomies, despite been the minority of the procedures, disregard the higher morbidity associated with right sided colectomies. The review of literature also describes oncologic, histologic and clinical aspects of patients presenting appendiceal neoplasm, describing the most frequent histologic subtypes of this illness. Conclusion Hidden appendiceal neoplasm in acute appendicitis are rare, fortunately. However, its incidence is much higher in patients presenting appendiceal inflammatory mass. Hence, interval appendectomy should be considered in this subgroup of patients.
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Affiliation(s)
- Frederico José Ribeiro Teixeira
- Surgical Oncology Group from the III Surgical Clinic Division, Hospital das Clínicas of the University of São Paulo (USP), School of Medicine, Rua Dr. Ovídio Pires de Campos, 255, 8 th floor, room 8131, Cerqueira César, 05403-010 São Paulo Brazil
| | - Sérgio Dias do Couto Netto
- Surgical Oncology Group from the III Surgical Clinic Division, Hospital das Clínicas of the University of São Paulo (USP), School of Medicine, Rua Dr. Ovídio Pires de Campos, 255, 8 th floor, room 8131, Cerqueira César, 05403-010 São Paulo Brazil.,Emergency Surgical Service, Hospital das Clínicas of the University of São Paulo (USP), School of Medicine, Rua Dr. Ovídio Pires de Campos, 255, 8 th floor, room 8131, Cerqueira César, 05403-010 São Paulo Brazil.,850, Francisco Matarazzo Avenue, apt 181, Bloco 2, Zip Code 05001-200 Perdizes, São Paulo Brazil
| | - Eduardo Hiroshi Akaishi
- Sarcoma and Melanoma Surgery group - São Paulo Cancer Institute, University of São Paulo, School of Medicine, Cerqueira César, Brazil
| | - Edivaldo Massazo Utiyama
- General and Trauma Surgery - III Surgical Clinic Division, Hospital das Clínicas of the University of São Paulo (USP), School of Medicine, Rua Dr. Ovídio Pires de Campos, 255, 8 th floor, room 8131, Cerqueira César, 05403-010 São Paulo Brazil
| | - Carlos Augusto Metidieri Menegozzo
- General Surgery Senior Resident - III Surgical Clinic Division, Hospital das Clínicas of the University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Marcelo Cristiano Rocha
- Chief of Staff of the Emergency Surgical Service - III Surgical Clinic Division, Hospital das Clínicas of the University of São Paulo, School of Medicine, São Paulo, Brazil
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120
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Clift AK, Frilling A. Neuroendocrine, goblet cell and mixed adeno-neuroendocrine tumours of the appendix: updates, clinical applications and the future. Expert Rev Gastroenterol Hepatol 2017; 11:237-247. [PMID: 28081662 DOI: 10.1080/17474124.2017.1282314] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Appendiceal neuroendocrine neoplasms are rare, clinically challenging tumours that are typically incidentally diagnosed, have a poorly understood biology and have controversy surrounding their management. Most are adequately treated with appendectomy, and although distant metastases are rare, the threat of disease dissemination remains and current guidelines possess poor accuracy in terms of selecting patients requiring more extensive surgery, i.e. oncological right-hemicolectomy. Areas covered: In this article, we discuss the presentation and diagnostic work-up of patients with appendiceal neuroendocrine neoplasms, and also examine the evidence base for existing management strategies. We highlight controversies within the management of these tumours, and anticipate avenues for further progress. Although no longer classified as neuroendocrine neoplasms, we also discuss two related forms of tumours with neuroendocrine features - goblet cell cancers and mixed adeno-neuroendocrine carcinomas. Expert commentary: Existing guidelines for the treatment of appendiceal neuroendocrine neoplasms are derived from a limited evidence base and are unable to accurately predict which patients require extensive attempts at surgical disease control. Future advances in the field of improved patient selection for more extensive surgery may be possible with multi-factorial tumour assessment integrating morphological and molecular analyses.
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Affiliation(s)
- Ashley K Clift
- a Department of Surgery and Cancer , Imperial College London , London , UK
| | - Andrea Frilling
- a Department of Surgery and Cancer , Imperial College London , London , UK
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121
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Kim JY, Hong SM. Recent Updates on Neuroendocrine Tumors From the Gastrointestinal and Pancreatobiliary Tracts. Arch Pathol Lab Med 2017; 140:437-48. [PMID: 27128301 DOI: 10.5858/arpa.2015-0314-ra] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT -Gastrointestinal (GI) and pancreatobiliary tracts contain a variety of neuroendocrine cells that constitute a diffuse endocrine system. Neuroendocrine tumors (NETs) from these organs are heterogeneous tumors with diverse clinical behaviors. Recent improvements in the understanding of NETs from the GI and pancreatobiliary tracts have led to more-refined definitions of the clinicopathologic characteristics of these tumors. Under the 2010 World Health Organization classification scheme, NETs are classified as grade (G) 1 NETs, G2 NETs, neuroendocrine carcinomas, and mixed adenoneuroendocrine carcinomas. Histologic grades are dependent on mitotic counts and the Ki-67 labeling index. Several new issues arose after implementation of the 2010 World Health Organization classification scheme, such as issues with well-differentiated NETs with G3 Ki-67 labeling index and the evaluation of mitotic counts and Ki-67 labeling. Hereditary syndromes, including multiple endocrine neoplasia type 1 syndrome, von Hippel-Lindau syndrome, neurofibromatosis 1, and tuberous sclerosis, are related to NETs of the GI and pancreatobiliary tracts. Several prognostic markers of GI and pancreatobiliary tract NETs have been introduced, but many of them require further validation. OBJECTIVE -To understand clinicopathologic characteristics of NETs from the GI and pancreatobiliary tracts. DATA SOURCES -PubMed (US National Library of Medicine) reports were reviewed. CONCLUSIONS -In this review, we briefly summarize recent developments and issues related to NETs of the GI and pancreatobiliary tracts.
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Affiliation(s)
| | - Seung-Mo Hong
- From the Department of Pathology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea (Dr Kim); and the Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Dr Hong)
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Chen CW, Chu JS, Hsieh LC, Kao CC, Lin YC, Chen HH. Intestinal goblet cell carcinoid presenting with recurrent sterile peritonitis in a patient on peritoneal dialysis: a case report. BMC Nephrol 2017; 18:62. [PMID: 28193185 PMCID: PMC5307795 DOI: 10.1186/s12882-017-0477-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 02/08/2017] [Indexed: 11/30/2022] Open
Abstract
Background Goblet cell carcinoid is a rare variant of appendiceal carcinoid with mixed endocrine and exocrine features. The most common symptom and signs are abdominal pain, acute appendicitis and palpable mass. Additionally, abdominal pain is common in patient on peritoneal dialysis, which may confound the diagnosis in such patient. Case presentation We report a 71- years- old woman on peritoneal dialysis that experienced several episodes of abdominal cramping pain and sterile peritonitis. She had one episode of severe pain and underwent an appendectomy for suspicion of appendicitis. Goblet cell carcinoid was diagnosed. She had no further abdominal pain after she received appendectomy. Conclusions Malignant dialysate was rarely reported in patient with peritoneal dialysis. However, goblet cell carcinoid can initially present with acute appendicitis, chronic intermittent abdominal pain and mimicking peritonitis. In systemically reviewing the literature, this is the first case report of sterile peritonitis with peritoneal dialysis caused by goblet cell carcinoid.
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Affiliation(s)
- Chih-Wei Chen
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Jan-Show Chu
- Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li-Chun Hsieh
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan.,Translational Imaging Research Center, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chih-Chin Kao
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yen-Chung Lin
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsi-Hsien Chen
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan. .,Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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La Rosa S, Sessa F, Uccella S. Mixed Neuroendocrine-Nonneuroendocrine Neoplasms (MiNENs): Unifying the Concept of a Heterogeneous Group of Neoplasms. Endocr Pathol 2016; 27:284-311. [PMID: 27169712 DOI: 10.1007/s12022-016-9432-9] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The wide application of immunohistochemistry to the study of tumors has led to the recognition that epithelial neoplasms composed of both a neuroendocrine and nonneuroendocrine component are not as rare as traditionally believed. It has been recommended that mixed neuroendocrine-nonneuroendocrine epithelial neoplasms are classified as only those in which either component represents at least 30 % of the lesion but this cutoff has not been universally accepted. Moreover, since their pathogenetic and clinical features are still unclear, mixed neuroendocrine-nonneuroendocrine epithelial neoplasms are not included as a separate clinicopathological entity in most WHO classifications, although they have been observed in virtually all organs. In the WHO classification of digestive tumors, mixed neuroendocrine-nonneuroendocrine neoplasm is considered a specific type and is defined as mixed adenoneuroendocrine carcinoma, a definition that has not been accepted for other organs. In fact, this term does not adequately convey the morphological and biological heterogeneity of digestive mixed neoplasms and has created some misunderstanding among both pathologists and clinicians. In the present study, we have reviewed the literature on mixed neuroendocrine-nonneuroendocrine epithelial neoplasms reported in the pituitary, thyroid, nasal cavity, larynx, lung, digestive system, urinary system, male and female genital organs, and skin to give the reader an overview of the most important clinicopathological features and morphological criteria for diagnosing each entity. We also propose to use the term "mixed neuroendocrine-nonneuroendocrine neoplasm (MiNEN)" to define and to unify the concept of this heterogeneous group of neoplasms, which show different characteristics mainly depending on the type of neuroendocrine and nonneuroendocrine components.
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Affiliation(s)
- Stefano La Rosa
- Department of Pathology, Ospedale di Circolo, viale Borri 57, 21100, Varese, Italy.
| | - Fausto Sessa
- Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
| | - Silvia Uccella
- Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy
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124
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Shenoy S. Goblet cell carcinoids of the appendix: Tumor biology, mutations and management strategies. World J Gastrointest Surg 2016; 8:660-669. [PMID: 27830037 PMCID: PMC5081547 DOI: 10.4240/wjgs.v8.i10.660] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/30/2016] [Accepted: 08/29/2016] [Indexed: 02/06/2023] Open
Abstract
Malignant neoplasms of the appendix are rare and represent less than 1% of gastrointestinal cancers. Goblet cell carcinoids (GCC) tumors are a distinctive group of heterogeneous appendiceal neoplasm that exhibit unique clinical and pathologic features. This review focuses on the current diagnostic procedures, pathogenesis, possible signaling mechanisms and treatment options for GCC. Perspectives for future research are discussed. The tumor likely arises from pluripotent intestinal epithelial crypt base stem cells. Previous findings of Notch signaling as a tumor suppressor in Neuroendocrine tumors may have a similar role in this tumor too. Loss of Notch signaling may be the driver mutation with other successive downstream mutations likely favors them into progressing and behavior similar to poorly differentiated adenocarcinoma with minimal neuroendocrine differentiation. A multidisciplinary approach is suggested for optimal outcomes. Surgery remains the main treatment modality. Simple appendectomy may be sufficient in early stages while right hemicolectomy is recommended for advanced tumors. Cytoreductive surgery with heated intraperitoneal chemotherapy may improve survival in a select few with metastatic peritoneal disease. These tumors have an unpredictable behavior even in early stages and local recurrence and delayed metastases may be seen. Lifelong surveillance is warranted.
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125
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Adenocarcinoma ex-goblet cell carcinoid (appendiceal-type crypt cell adenocarcinoma) is a morphologically distinct entity with highly aggressive behavior and frequent association with peritoneal/intra-abdominal dissemination: an analysis of 77 cases. Mod Pathol 2016; 29:1243-53. [PMID: 27338636 PMCID: PMC5389379 DOI: 10.1038/modpathol.2016.105] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 04/26/2016] [Accepted: 04/27/2016] [Indexed: 11/09/2022]
Abstract
High-grade versions of appendiceal goblet cell carcinoids ('adenocarcinoma ex-goblet cell carcinoids') are poorly characterized. We herein document 77 examples. Tumors occurred predominantly in females (74%), mean age 55 years (29-84), most with disseminated abdominal (77% peritoneal, 58% gynecologic tract involvement) and stage IV (65%) disease. Many presented to gynecologic oncologists, and nine had a working diagnosis of ovarian carcinoma. Metastases to liver (n=3) and lung (n=1) were uncommon and none arose in adenomatous lesions. Tumors had various histologic patterns, in variable combinations, most of which were fairly specific, making them recognizable as appendiceal in origin, even at metastatic sites: I: Ordinary goblet cell carcinoid/crypt pattern (rounded, non-luminal acini with well-oriented goblet cells), in variable amounts in all cases. II: Poorly cohesive goblet cell pattern (diffusely infiltrative cords/single files of signet ring-like/goblet cells). III: Poorly cohesive non-mucinous cell (diffuse-infiltrative growth of non-mucinous cells). IV: Microglandular (rosette-like glandular) pattern without goblet cells. V: Mixed 'other' carcinoma foci (including ordinary intestinal/mucinous). VI: goblet cell carcinoid pattern with high-grade morphology (marked nuclear atypia). VII: Solid sheet-like pattern punctuated by goblet cells/microglandular units. Ordinary nested/trabecular ('carcinoid pattern') was very uncommon. In total, 33(52%) died of disease, with median overall survival 38 months and 5-year survival 32%. On multivariate analysis perineural invasion and younger age (<55) were independently associated with worse outcome while lymph-vascular invasion, stage, and nodal status trended toward, but failed to reach, statistical significance. Worse behavior in younger patients combined with female predilection and ovarian-affinity raise the possibility of hormone-assisted tumor progression. In conclusion, 'adenocarcinoma ex-goblet cell carcinoid' is an appendix-specific, high-grade malignant neoplasm with distinctive morphology that is recognizable at metastatic sites and recapitulates crypt cells (appendiceal crypt cell adenocarcinoma). Unlike intestinal-type adenocarcinoma, it occurs predominantly in women, is disguised as gynecologic malignancy, and spreads along peritoneal surfaces with only rare hematogenous metastasis. It appears to be significantly more aggressive than appendiceal mucinous neoplasms.
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126
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Radomski M, Pai RK, Shuai Y, Ramalingam L, Jones H, Holtzman MP, Ahrendt SA, Pingpank JF, Zeh HJ, Bartlett DL, Choudry HA. Curative Surgical Resection as a Component of Multimodality Therapy for Peritoneal Metastases from Goblet Cell Carcinoids. Ann Surg Oncol 2016; 23:4338-4343. [PMID: 27401448 DOI: 10.1245/s10434-016-5412-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND The impact of histopathologic features on oncologic outcomes for patients with peritoneal metastases from goblet cell carcinoid (GCC) undergoing multimodality therapy, including cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS-HIPEC), is unknown. METHODS This study prospectively analyzed 43 patients with GCC undergoing CRS-HIPEC between 2005 and 2013. Pathology slides were re-reviewed to classify GCC into histologic subtypes according to the Tang classification. Kaplan-Meier survival curves and multivariate Cox-regression models identified prognostic factors affecting oncologic outcomes. RESULTS The 43 patients in this study underwent 50 CRS-HIPEC procedures for peritoneal metastases from GCC, and the majority received neoadjuvant and/or adjuvant systemic chemotherapy. The GCC demonstrated an aggressive phenotype with frequent lymph node and peritoneal metastases without systemic dissemination. The majority of the patients had Tang B GCC. The estimated median overall survival times after surgery for the patients with Tang A, B, and C GCC were respectively 59, 22, and 13 months. In a multivariate Cox-regression analysis, poor survival was associated with patients who had Tang B or C GCC, those undergoing incomplete macroscopic resection, and those with symptoms at the time of CRS-HIPEC. The patients with Tang A GCC demonstrated oncologic outcomes similar to those with intermediate-grade (American Joint Committee on Cancer [AJCC] grade 2) disseminated mucinous appendiceal neoplasms, whereas the patients with Tang B and C GCC demonstrated survival rates similar to or worse than those with high-grade (AJCC grade 3) disseminated mucinous appendiceal neoplasms. CONCLUSIONS Tang classification is an independent prognostic factor for poor survival after multimodality therapy for GCC. Patients with Tang C GCC demonstrate limited survival and are not ideal candidates for a surgical approach.
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Affiliation(s)
- Michal Radomski
- Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, USA
| | - Reetesh K Pai
- Department of Pathology, University of Pittsburgh, Pittsburgh, USA
| | - Yongli Shuai
- The University of Pittsburgh Cancer Institute Biostatistics Facility, Pittsburgh, USA
| | - Lekshmi Ramalingam
- Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, USA
| | - Heather Jones
- Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, USA
| | - Matthew P Holtzman
- Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, USA
| | - Steven A Ahrendt
- Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, USA
| | - James F Pingpank
- Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, USA
| | - Herbert J Zeh
- Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, USA
| | - David L Bartlett
- Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, USA
| | - Haroon A Choudry
- Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, USA.
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127
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Brathwaite S, Yearsley MM, Bekaii-Saab T, Wei L, Schmidt CR, Dillhoff ME, Frankel WL, Hays JL, Wu C, Abdel-Misih S. Appendiceal Mixed Adeno-Neuroendocrine Carcinoma: A Population-Based Study of the Surveillance, Epidemiology, and End Results Registry. Front Oncol 2016; 6:148. [PMID: 27379210 PMCID: PMC4904130 DOI: 10.3389/fonc.2016.00148] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/30/2016] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Mixed adeno-neuroendocrine carcinoma (MANEC) is a rare pathological diagnosis recently defined by the World Health Organization (WHO) in 2010. Prior to the definition by the WHO, tumors with both adenocarcinoma and neuroendocrine components were given multiple pathological designations making it difficult to characterize the disease. The aim of our study is to better characterize MANEC to better understand its natural history to influence patient care and positively impact outcomes. MATERIALS AND METHODS The surveillance, epidemiology, and end results program database was queried for all patients aged 18 years or older between 1973 and 2012 who had the diagnosis composite carcinoid (n = 249) of the appendix. Composite carcinoid tumors refer to tumors that have both adenocarcinoma and carcinoid tumor components present, consistent with that pathological diagnosis MANEC. For comparison, the database was also queried for carcinoid tumor of the appendix (n = 950), signet ring cell carcinoma of the appendix (n = 579), and goblet cell carcinoid (GCC) tumors of the appendix (n = 944). The data were retrospectively reviewed, and clinicopathological characteristics, treatment regimens, and survival data were obtained. RESULTS The median age of diagnosis of MANEC tumors was 58 years of age. Eighty percent of patients were White, and 49% were female. Fifty-four percent of patients underwent hemicolectomy and 31% had partial/subtotal colectomy as their surgical management. Median overall survival for MANEC was 6.5 years (95% CI 4.5-9.7), which was statistically significantly shorter (p < 0.0001) in comparison to 13.8 years (95% CI 12.1-16.5) for GCC, 2.1 years (95% CI 1.8-2.3) for signet ring cell carcinoma, and 39.4 years (95% CI 37.1-NA) for carcinoid tumors. DISCUSSION MANEC is a more aggressive clinical entity than both GCC of the appendix and carcinoid tumors of the appendix. Based on these findings, patients with MANEC tumors should undergo aggressive multidisciplinary cancer management.
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Affiliation(s)
- Shayna Brathwaite
- Department of General Surgery, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Martha M Yearsley
- Department of Pathology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Tanios Bekaii-Saab
- Department of Internal Medicine, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Lai Wei
- Center for Biostatistics, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Carl R Schmidt
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Mary E Dillhoff
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Wendy L Frankel
- Department of Pathology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - John L Hays
- Department of Internal Medicine, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Christina Wu
- Department of Internal Medicine, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Sherif Abdel-Misih
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
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A Consensus for Classification and Pathologic Reporting of Pseudomyxoma Peritonei and Associated Appendiceal Neoplasia: The Results of the Peritoneal Surface Oncology Group International (PSOGI) Modified Delphi Process. Am J Surg Pathol 2016; 40:14-26. [PMID: 26492181 DOI: 10.1097/pas.0000000000000535] [Citation(s) in RCA: 432] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Pseudomyxoma peritonei (PMP) is a complex disease with unique biological behavior that usually arises from appendiceal mucinous neoplasia. The classification of PMP and its primary appendiceal neoplasia is contentious, and an international modified Delphi consensus process was instigated to address terminology and definitions. A classification of mucinous appendiceal neoplasia was developed, and it was agreed that "mucinous adenocarcinoma" should be reserved for lesions with infiltrative invasion. The term "low-grade appendiceal mucinous neoplasm" was supported and it was agreed that "cystadenoma" should no longer be recommended. A new term of "high-grade appendiceal mucinous neoplasm" was proposed for lesions without infiltrative invasion but with high-grade cytologic atypia. Serrated polyp with or without dysplasia was preferred for tumors with serrated features confined to the mucosa with an intact muscularis mucosae. Consensus was achieved on the pathologic classification of PMP, defined as the intraperitoneal accumulation of mucus due to mucinous neoplasia characterized by the redistribution phenomenon. Three categories of PMP were agreed-low grade, high grade, and high grade with signet ring cells. Acellular mucin should be classified separately. It was agreed that low-grade and high-grade mucinous carcinoma peritonei should be considered synonymous with disseminated peritoneal adenomucinosis and peritoneal mucinous carcinomatosis, respectively. A checklist for the pathologic reporting of PMP and appendiceal mucinous neoplasms was also developed. By adopting the classifications and definitions that were agreed, different centers will be able to use uniform terminology that will allow meaningful comparison of their results.
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129
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Klöppel G. [Neoplasms of the disseminated neuroendocrine cell system of the gastrointestinal tract]. DER PATHOLOGE 2016; 36:237-45. [PMID: 25947223 DOI: 10.1007/s00292-015-0015-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The classification of neuroendocrine neoplasms (NEN) of the gastrointestinal tract and also the pancreas is based on the World Health Organization (WHO) classification from 2010, the site-related TNM stage classification and the clinicopathological characterization. This allows a classification of NEN that is adapted to the individual patient, is of high prognostic relevance and serves the needs of an adequate treatment. This article summarizes the current knowledge on the clinical pathology of gastrointestinal NEN, in order to enable a rapid diagnostic orientation.
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Affiliation(s)
- G Klöppel
- Institut für Pathologie, Konsultationszentrum für Pankreas und endokrine Tumore, TU München, Ismaningerstr. 22, 81675, München, Deutschland,
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130
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Clinical utility of endoscopic ultrasound-guided fine-needle aspiration in mixed adenoneuroendocrine carcinoma with signet-ring cells of the pancreas: a case report and review of the literature. Clin J Gastroenterol 2016; 9:43-8. [DOI: 10.1007/s12328-016-0625-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 01/18/2016] [Indexed: 01/06/2023]
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131
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González-Sánchez-Migallón E, Valero-Navarro G, Sola-Pérez J, García-Marín JA, Verdú-Fernández MÁ, Soria-Aledo V, Aguayo-Albasini JL. Surgical management of appendiceal adenocarcinoid. Case report and literature review. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2016; 108:166-7. [PMID: 26817453 DOI: 10.17235/reed.2016.4049/2015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Adenocarcinoid tumour of the appendix is a rare entity characterised by the presence of a double component (neuroendocrine and glandular). It originates in the neuroendocrine cells of the appendicular mucosa. A preoperative diagnosis of a primary appendiceal tumour is uncommon and more so one suggesting an adenocarcinoid pathology. Optimal treatment is debated between a simple appendectomy and a more extensive resection, which occasionally includes hysterectomy and bilateral ovariectomy. Our aim is to report this rare entity and conduct a review of the literature on the different treatment options.
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Affiliation(s)
| | | | - Joaquín Sola-Pérez
- Anatomía Patológica, Hospital Universitario Virgen de la Arrixaca, España
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132
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Pape UF, Niederle B, Costa F, Gross D, Kelestimur F, Kianmanesh R, Knigge U, Öberg K, Pavel M, Perren A, Toumpanakis C, O'Connor J, Krenning E, Reed N, O'Toole D. ENETS Consensus Guidelines for Neuroendocrine Neoplasms of the Appendix (Excluding Goblet Cell Carcinomas). Neuroendocrinology 2016; 103:144-52. [PMID: 26730583 DOI: 10.1159/000443165] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- U-F Pape
- Department of Hepatology and Gastroenterology, Campus Virchow Klinikum, Charitx00E9; Universitx00E4;tsmedizin Berlin, Berlin, Germany
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133
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Lamarca A, Nonaka D, Lopez Escola C, Hubner RA, O'Dwyer S, Chakrabarty B, Fulford P, Valle JW. Appendiceal Goblet Cell Carcinoids: Management Considerations from a Reference Peritoneal Tumour Service Centre and ENETS Centre of Excellence. Neuroendocrinology 2016; 103:500-17. [PMID: 26356507 DOI: 10.1159/000440725] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 08/28/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Appendix goblet cell carcinoids are known to share histological features of adenocarcinoma and neuroendocrine tumours. Due to their low incidence, quality evidence is lacking for the management of these patients. METHODS We performed a single-centre retrospective study of patients with a confirmed diagnosis of appendiceal goblet cell carcinoid (GCC; 1996-2014). Patients were divided into curative intent (CI) and palliative intent (PI) cohorts. Our primary end point was overall survival (OS). RESULTS Seventy-four patients were eligible; 76% were treated with CI [surgery only (36%), cytoreductive surgery (CRS) and hyperthermic intra-peritoneal chemotherapy (HIPEC; 36%), adjuvant chemotherapy (20%) and a combination of CRS and HIPEC followed by adjuvant chemotherapy (9%)], and 23% had advanced-stage disease amenable to palliative treatment (chemotherapy or supportive care) only. Completion right hemicolectomy, performed in 64% of the CI cohort, did not impact on the relapse rate or disease-free survival. FOLFOX chemotherapy was used in both the adjuvant and palliative settings; safety was as expected, and we observed a high rate (60%) of disease control in the palliative cohort. The estimated median OS (all patients), disease-free survival (CI patients) and progression-free survival (PI patients) were 52.1 (95% CI 29.4-90.3), 75.9 (26.6-not reached) and 5.3 (0.6-5.7) months, respectively. Age and stage were independent factors associated with OS in the multivariable analysis. Tang classification showed a trend for impact on OS. No benefit from specific adjuvant approach was identified; however, selection bias for treatment approach was observed. CONCLUSION Prospective trials are needed to define optimal approaches in GCC. All GCC patients should be managed by specialized centres due to their esoteric behaviour; we provide management considerations based on our experience and conclusions.
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134
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Abstract
Primary cancers of the appendix are rare and are frequently diagnosed after surgery for appendicitis, presumed ovarian primary malignancy, or other indications. Primary appendix cancers are histologically diverse, and classification of these tumors has historically been confusing because of the nonstandardized nomenclature that is used. This review aimed to describe the epidemiology, presentation, workup, staging, and management of primary appendix cancers using current, recommended nomenclature. For this purpose, tumors were broadly classified as colonic-type or mucinous adenocarcinoma, goblet cell adenocarcinoma, or neuroendocrine carcinoma. Signet ring cell carcinoma was not regarded as an individual entity. The presence of signet ring cells is a histologic feature that may or may not be present in colonic-type or mucinous adenocarcinoma. The management of primary appendix cancer is complex and is dependent on the histologic subtype and extent of disease. Randomized, prospective trials do not exist for these rare tumors and management is largely guided by retrospective data expert consensus guidelines, which are summarized here.
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Affiliation(s)
- Kaitlyn J Kelly
- Department of Surgery, University of California San Diego, San Diego, California
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135
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Romeo M, Quer A, Tarrats A, Molina C, Radua J, Manzano JL. Appendiceal mixed adenoneuroendocrine carcinomas, a rare entity that can present as a Krukenberg tumor: case report and review of the literature. World J Surg Oncol 2015; 13:325. [PMID: 26612593 PMCID: PMC4661956 DOI: 10.1186/s12957-015-0740-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 11/23/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Mixed adenoneuroendocrine carcinoma is a rare tumor recently recognized as a new category in the last World Health Organization (WHO) classification of appendiceal tumors (2010). This term has been proposed to designate carcinomas of the appendix that arise by progression from a pre-existing goblet cell carcinoid. Mixed adenoneuroendocrine carcinomas are more aggressive tumors than typical goblet cell carcinoids and usually present with peritoneal spreading and ovarian masses. Staging, some histological features, and completeness of surgery are factors that determine its evolution. CASE PRESENTATION We report the case of a mixed adenoneuroendocrine carcinoma--signet ring cell subtype--that presented as a Krukenberg tumor of unknown primary. CONCLUSION The review of literature is focused on the most recent WHO pathologic classification of appendiceal tumors containing goblet cell clusters, which seems to correlate with prognosis. A management proposal for mixed adenoneuroendocrine carcinomas reported in previous literature is also discussed. This ranges from right hemicolectomy to cytoreduction plus hyperthermic intraperitoneal chemotherapy, in both cases usually followed by intravenous chemotherapy.
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Affiliation(s)
- Margarita Romeo
- Medical Oncology Department, Institut Català d'Oncologia Badalona (Hospital Germans Trias i Pujol), Carretera del Canyet s/n, 08916, Badalona, Barcelona, Spain.
| | - Ariadna Quer
- Pathology Department, Hospital Germans Trias i Pujol, Carretera del Canyet s/n, 08916, Badalona, Barcelona, Spain.
| | - Antoni Tarrats
- Gynecology Department, Gynecologic Oncology Section, Hospital Germans Trias i Pujol, Carretera del Canyet s/n, 08916, Badalona, Barcelona, Spain.
| | - Carlos Molina
- Gynecology Department, Hospital de l'Esperit Sant, Av. Mossèn Pons i Rabadà, s/n, 08923, Santa Coloma de Gramanet, Barcelona, Spain.
| | - Joaquim Radua
- King's College London, 16 De Crespigny Park, SE5 8AF, London, UK. .,FIDMAG Germanes Hospitalàries-CIBERSAM, Dr. Antoni Pujadas, 38, 08830, Sant Boi de Llobregat, Barcelona, Spain.
| | - José-Luís Manzano
- Medical Oncology Department, Institut Català d'Oncologia Badalona (Hospital Germans Trias i Pujol), Carretera del Canyet s/n, 08916, Badalona, Barcelona, Spain.
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136
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Abstract
The pathologic classification of neuroendocrine neoplasms has evolved over the past decades, as new understanding of the biological behavior, histologic characteristics, and genetic features have emerged. Nonetheless, many aspects of the classification systems remain confusing or controversial. Despite these difficulties, much progress has been made in determining the features predicting behavior. Genetic findings have helped establish relationships among different types of neuroendocrine neoplasms and revealed potential therapeutic targets. This review summarizes the current approach to the diagnosis, classification, grading, and therapeutic stratification of neuroendocrine neoplasms, with a focus on those arising in the lung and thymus, pancreas, and intestines.
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Affiliation(s)
- David S Klimstra
- Weill Cornell Medical College, 1305 York Avenue, New York, NY 10021, USA; Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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137
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Taggart MW, Abraham SC, Overman MJ, Mansfield PF, Rashid A. Goblet cell carcinoid tumor, mixed goblet cell carcinoid-adenocarcinoma, and adenocarcinoma of the appendix: comparison of clinicopathologic features and prognosis. Arch Pathol Lab Med 2015; 139:782-90. [PMID: 26030247 DOI: 10.5858/arpa.2013-0047-oa] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
CONTEXT The prognosis of appendiceal goblet cell carcinoid tumors (GCTs) is believed to be intermediate between appendiceal adenocarcinomas and conventional carcinoid tumors. However, GCTs can have mixed morphologic patterns, with variable amount of adenocarcinoma. OBJECTIVE To evaluate the behavior of GCTs and related entities with variable components of adenocarcinoma. DESIGN We classified 74 cases of appendiceal tumors into 3 groups: group 1, GCTs or GCTs with less than 25% adenocarcinoma; group 2, GCTs with 25% to 50% adenocarcinoma; group 3, GCTs with more than 50% adenocarcinoma; and a comparison group of 68 adenocarcinomas without a GCT component (group 4). Well-differentiated mucinous adenocarcinomas were excluded. Clinicopathologic features and follow-up were obtained from computerized medical records and the US Social Security Death Index. RESULTS Of the 142 tumors studied, 23 tumors (16%) were classified as group 1; 27 (19%) as group 2; 24 (17%) as group 3; and 68 (48%) as group 4. Staging and survival differed significantly among these groups. Among 140 patients (99%) with available staging data, stages II, III, and IV were present in 87%, 4%, and 4% of patients in group 1 patients; 67%, 7%, and 22% of patients in group 2; 29%, 4%, and 67% of patients in group 3; and 19%, 6%, and 75% of patients in group 4, respectively (P = .01). Mean (SD) overall survival was 83.8 (34.6), 60.6 (30.3), 45.6 (39.7), and 33.6 (27.6) months for groups 1, 2, 3, and 4, respectively (P = .01). By multivariate analysis, only stage and tumor category were independent predictors of overall survival. CONCLUSION Our data highlight the importance of subclassifying the proportion of adenocarcinoma in appendiceal tumors with GCT morphology because that finding reflects disease stage and affects survival.
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Affiliation(s)
- Melissa W Taggart
- From the Departments of Pathology (Drs Taggart, Abraham, and Rashid), Medical Oncology (Dr Overman), and Surgical Oncology (Dr Mansfield), MD Anderson Cancer Center, University of Texas, Houston
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138
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Lee LH, McConnell YJ, Tsang E, Zerhouni S, Speers C, Kennecke H, Schaeffer DF. Simplified 2-tier histologic grading system accurately predicts outcomes in goblet cell carcinoid of the appendix. Hum Pathol 2015; 46:1881-9. [PMID: 26433702 DOI: 10.1016/j.humpath.2015.08.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 07/31/2015] [Accepted: 08/13/2015] [Indexed: 01/10/2023]
Abstract
Goblet cell carcinoid (GCC) is a rare appendiceal malignancy with both neuroendocrine and glandular features. Clinical outcomes of patients with GCC vary widely and a histology-based 3-tiered prognostic scheme has been previously suggested; however, this scheme is subjective and challenging to apply in day-to-day practice. We sought to construct a simplified and prognostic grading system based on objective histologic features with specific criteria. A continuous population-based cohort of GCC with clinical outcome data and archival tissue available for review was extracted from regional databases. For the 78 patients with confirmed appendiceal GCC, specific histologic features, including cytologic atypia, peritumoral stromal desmoplasia, and solid growth pattern, were recorded, and a scoring system was devised, which separates patients with GCC into low-grade (n = 55; 71%) or high-grade (n = 23; 29%) histology. Correspondingly, clinical follow-up data show good prognosis in those with low-grade histology with median and 10-year overall survival of 51.0 months and 80.5%, respectively, whereas those with high-grade histology have a poor prognosis with median and 10-year overall survival of 16.5 months (P = .006) and 0% (P < .001), respectively. Multivariate Cox proportional hazard modeling demonstrates that this 2-tier histologic system remains predictive of overall survival when controlled for TNM clinicopathological stage. These data show that a simple and objective histologic scoring system separates GCC into low- and high-grade histology with divergent clinical outcomes.
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Affiliation(s)
- Lawrence H Lee
- Division of Anatomic Pathology, Vancouver General Hospital, Vancouver, BC, Canada V5Z 1M9; The University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, Canada V6T 1Z3
| | - Yarrow J McConnell
- The University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, Canada V6T 1Z3; Surgical Oncology, Division of General Surgery, Vancouver General Hospital, Vancouver, BC, Canada V5Z 1M9
| | - Erica Tsang
- The University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, Canada V6T 1Z3; Division of Medical Oncology, BC Cancer Agency, Vancouver, BC, Canada, V5Z 1L3
| | - Siham Zerhouni
- The University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, Canada V6T 1Z3
| | - Caroline Speers
- Gastrointestinal Cancer Outcomes Unity, BC Cancer Agency, Vancouver, BC, Canada, V5Z 1L3
| | - Hagen Kennecke
- The University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, Canada V6T 1Z3; Division of Medical Oncology, BC Cancer Agency, Vancouver, BC, Canada, V5Z 1L3
| | - David F Schaeffer
- Division of Anatomic Pathology, Vancouver General Hospital, Vancouver, BC, Canada V5Z 1M9; The University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, Canada V6T 1Z3.
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139
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Shaib W, Krishna K, Kim S, Goodman M, Rock J, Chen Z, Brutcher E, Staley CI, Maithel SK, Abdel-Missih S, El-Rayes BF, Bekaii-Saab T. Appendiceal Neuroendocrine, Goblet and Signet-Ring Cell Tumors: A Spectrum of Diseases with Different Patterns of Presentation and Outcome. Cancer Res Treat 2015; 48:596-604. [PMID: 26044156 PMCID: PMC4843718 DOI: 10.4143/crt.2015.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/17/2015] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Appendiceal tumors are a heterogeneous group of diseases that include typical neuroendocrine tumors (TNET), goblet cell carcinoids (GCC), and atypical GCC. Atypical GCC are classified into signet-ring cell cancers (SRCC) and poorly differentiated appendiceal adenocarcinoids. The prognosis and management of these diseases is unclear because there are no prospective studies. The aim of this study is to assess the characteristics and outcome of appendiceal TNET, GCC, and SRCC patients. MATERIALS AND METHODS Appendiceal TNET, GCC, and SRCC patients diagnosed between 1973 and 2011 were identified in the Surveillance Epidemiology and End Results (SEER) database. Demographics, type of surgery, and clinicopathologic characteristics were collected. Survival functions were estimated by the Kaplan-Meier method, and log-rank test was used to assess the difference in overall survival (OS) among the three histologies. RESULTS The SEER database yielded 1,021 TNET patients, 1,582 with GCC, and 534 SRCC patients. TNET presented at a younger age (p < 0.001). Patients with SRCC presented with advanced stage disease (p < 0.001). The median OS (mOS) for GCC and TNET patients was not reached; mOS for SRCC was 24 months. Multivariate analysis stratified for stage revealed significantly longer survival for TNET and GCC than SRCC (p < 0.001). CONCLUSION This is the largest report to date for appendiceal neuroendocrine tumor patients, suggesting a spectrum of diseases with different characteristics and outcomes. In this report, we present a treatment approach for this complex spectrum of disease, based on the experience of Ohio State and Emory Universities investigators.
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Affiliation(s)
- Walid Shaib
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Kavya Krishna
- Division of Hematology Oncology, The Ohio State University, Columbus, OH, USA
| | - Sungjin Kim
- Department of Biostatistics, Emory University, Atlanta, GA, USA
| | | | - Jonathan Rock
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Zhengjia Chen
- Department of Biostatistics, Emory University, Atlanta, GA, USA
| | - Edith Brutcher
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Charles Iii Staley
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Shishir K Maithel
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Samih Abdel-Missih
- Department of Surgical Oncology, The Ohio State University, Columbus, OH, USA
| | - Bassel F El-Rayes
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Tanios Bekaii-Saab
- Division of Hematology Oncology, The Ohio State University, Columbus, OH, USA
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140
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Youn SI, Namgung H, Yun JS, Park YJ, Park DG. Peritoneal metastatic goblet-cell carcinoid tumor treated with cytoreductive surgery and intraperitoneal chemotherapy. Ann Coloproctol 2015; 31:74-8. [PMID: 25960976 PMCID: PMC4422991 DOI: 10.3393/ac.2015.31.2.74] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 12/22/2014] [Indexed: 01/03/2023] Open
Abstract
We report a case of a goblet-cell carcinoid tumor of the appendix which metastasized to the peritoneum and was treated by using cytoreductive surgery (CRS) with intraperitoneal chemotherapy. A 47-year-old male presented with chronic constipation and was diagnosed as having a rectal adenocarcinoma with a signet-ring-cell component under colonoscopy. Computed tomography suggested peritoneal metastases with diffuse nodular parietal peritoneal thickening of the entire abdomen and focal invasion of the upper rectum by a seeding mass. CRS with intraperitoneal chemotherapy was done under the diagnosis of a rectal adenocarcinoma with peritoneal metastases. The pathologic diagnosis was a goblet-cell carcinoid tumor of the appendix with peritoneal metastasis. The histological discrepancy between a peritoneal metastatic mass and a rectal mass was due to the mixed histological pattern of a goblet-cell carcinoid tumor. A metastatic mass may not share identical immunohistochemical characteristics from its origin. This histologic discrepancy necessitates caution in diagnosing a distant metastasis of a goblet-cell carcinoid tumor.
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Affiliation(s)
- Sang Il Youn
- Department of Surgery, Dankook University School of Medicine, Cheonan, Korea
| | - Hwan Namgung
- Department of Surgery, Dankook University School of Medicine, Cheonan, Korea
| | - Jeong Seok Yun
- Department of Surgery, Dankook University School of Medicine, Cheonan, Korea
| | - Yun Jun Park
- Department of Surgery, Dankook University School of Medicine, Cheonan, Korea
| | - Dong-Guk Park
- Department of Surgery, Dankook University School of Medicine, Cheonan, Korea
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141
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Goblet cell carcinoids: characteristics of a Danish cohort of 83 patients. PLoS One 2015; 10:e0117627. [PMID: 25671432 PMCID: PMC4324995 DOI: 10.1371/journal.pone.0117627] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 12/30/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Appendiceal goblet cell carcinoids (GCCs) exhibit neuroendocrine and adenocarcinoma features. PATIENTS AND METHODS Analysis of demography, pathology, prognostic markers, treatment and survival in 83 GCC patients (f/m: 56/27) diagnosed 1992-2013. RESULTS Median age for f/m was 59/58 years, respectively, and similar for localized and disseminated disease. At diagnosis 54 patients had localized appendiceal disease (f/m: 29/25). According to TNM 24% had Stage I, 70% had Stage II and 6% had Stage III. Twenty-nine patients had disseminated disease (f/m: 27/2). Chromogranin A, synaptophysin and p53 were positive in >90%. Serotonin was positive in 70%. Median Ki67 index was 32% (6-75%) and higher in Tang group C (50%) compared to group A (30%; p<0.0001), and group B (30%; p<0.004). All patients had surgery. Sixty-three (76%) had radical resections including all patients with localized disease. Median OS was 83 months. The 1-, 5- and 10-year survival rates were 90%, 58%, and 38%, respectively. For localized disease OS was 164 months and 1-, 5- and 10-year survival rates were 100%, 80%, and 55%, respectively. For disseminated disease OS was 19 months and 1-, 5- and 10-year survival rates were 73%, 18% and 6%, respectively. The 1-, 5- and 10 year-survival rates for f/m were 87%/96%, 49%/76% and 31%/57%, respectively (p = 0.02). According to the Tang classification group A, B, and C OS was 118, 83 and 20 months, respectively (p = 0.0002). CONCLUSION The Tang classification was found to be a significant prognostic factor, while the Ki67 index was not. Localized GCCs occurred equally in males and females, while disseminated GCCs were mostly seen in females. Median age of patients with localized disease and disseminated disease was identical. Cox regression analysis found Stage IV, focally positive synaptophysin and non-radical surgery as strongest negative prognostic factors.
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142
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Nash GM, Smith JD, Tang L, Weiser MR, Temple LK, O'Reilly E, Saltz LB, Guillem JG, Paty PB. Lymph Node Metastasis Predicts Disease Recurrence in a Single-Center Experience of 70 Stages 1-3 Appendix Cancers: A Retrospective Review. Ann Surg Oncol 2015; 22:3613-7. [PMID: 25663593 DOI: 10.1245/s10434-015-4415-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND Previous reports on the surgical management of appendix cancer show high recurrence rates among patients initially presenting with localized disease. This study sought to characterize predictors of outcome among patients treated for stages 1-3 appendix cancer at the authors' institution. METHODS Patients with nonmetastatic appendix cancer undergoing definitive surgery at a single cancer center from 1994 to 2013 were retrospectively reviewed. Patients with appendiceal adenomas, cystadenomas, or classical carcinoids were excluded from the study. The median follow-up period was 5.2 years (interquartile range 2.9-6.7 years). RESULTS The study identified 70 patients, 49 % of whom were women. The median age was 52 years (range 20-84 years). All were explored by an expert surgeon who had treated at least 20 appendiceal cancers. The procedures were appendectomy (n = 2), right hemicolectomy (n = 66), and diagnostic laparoscopy and placement of an intraperitoneal port (n = 2). The final pathology showed that transmural (30 T4, 32 T3, 4 T2, 4 T1) and node-negative disease (80 %) were common. Goblet cell carcinoid (GCC) features were identified in 54 % of the tumors. These were smaller and more likely to present as acute appendicitis than appendiceal adenocarcinoma (AA), but were otherwise similar in clinical presentation and outcome. The presence of lymph node (LN) metastasis was associated with a higher risk of recurrence than of stage 2 appendix cancer (78 vs. 4 % at 5 years; p < 0.0001). A total of 12 patients experienced recurrence (5 GCC, 7 AA): 9 in the peritoneum, 2 in mesenteric LNs, and 1 in the surgical incision. CONCLUSION Stages 1-3 invasive AA and GCC behave similarly in terms of clinical presentation and outcome. Perforated appendix and T4 tumor stage were common but not associated with recurrence. Although uncommon, LN metastasis strongly predicted recurrence.
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Affiliation(s)
- Garrett M Nash
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - James D Smith
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Laura Tang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin R Weiser
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Larissa K Temple
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eileen O'Reilly
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Leonard B Saltz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - José G Guillem
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Philip B Paty
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Johnson DH, Jimenez RE, Sweetser S. Abdominal pain and ileocolitis in a 51-year-old woman. Gastroenterology 2015; 148:e9-e10. [PMID: 25529814 DOI: 10.1053/j.gastro.2014.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 09/03/2014] [Indexed: 12/02/2022]
Affiliation(s)
- David H Johnson
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Rafael E Jimenez
- Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
| | - Seth Sweetser
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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Rossi RE, Luong TV, Caplin ME, Thirlwell C, Meyer T, Garcia-Hernandez J, Baneke A, Conte D, Toumpanakis C. Goblet cell appendiceal tumors--management dilemmas and long-term outcomes. Surg Oncol 2015; 24:47-53. [PMID: 25686643 DOI: 10.1016/j.suronc.2015.01.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 12/09/2014] [Accepted: 01/19/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND Appendiceal Goblet cell tumors (GCTs) are clinically more aggressive, and have a worse outcome than midgut neuroendocrine tumors (mNETs). Guidelines for management of GCTs are limited. METHODS A retrospective case-study analysis was performed in patients with a diagnosis of GCT, confirmed on histological review. Patients were evaluated clinically, biochemically, and radiologically. RESULTS 48 patients were identified (TNM stage I-II: 27, stage III: 15, stage IV: 6). Median follow-up was 44 months and was complete in all patients. 68.8% presented with acute appendicitis. 44/48 patients had initial appendectomy, followed by prophylactic right hemicolectomy in 41. 10/48 patients had recurrent disease [median time to recurrence 28 months (range 4-159)]. Of those, 9 received systemic chemotherapy (FOLFOX/FOLFIRI), which was also given in 5/48 patients with disseminated disease at diagnosis. Partial response, stable disease and disease progression was noted in 22%, 22% and 56%, respectively. Adjuvant chemotherapy was also administered in 9/48 patients with stage III disease after right hemicolectomy, however in 3/9 the disease recurred. Median progression/disease-free-survival was 44 months (range 3-159) and overall 5-year survival rate was 41.6%. CONCLUSIONS The clinical behaviour of GCTs is more similar to colorectal adenocarcinomas than to NETs. A prophylactic right hemicolectomy is recommended to reduce the risk of recurrence. Systemic chemotherapy, using colorectal adenocarcinoma regimens, is indicated for advanced or recurrent disease and has encouraging results. Prospective studies are needed to define the role of adjuvant chemotherapy and the optimal chemotherapy regimen.
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Affiliation(s)
- Roberta Elisa Rossi
- Neuroendocrine Tumor Unit, Centre of Gastroenterology, Royal Free Hospital, London, UK; Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda - Ospedale Maggiore Policlinico and Department of Pathophysiology and Transplantation, Università degli Studi Milano, Italy.
| | - Tu-Vinh Luong
- Department of Histopathology, Royal Free Hospital, London, UK
| | - Martyn Evan Caplin
- Neuroendocrine Tumor Unit, Centre of Gastroenterology, Royal Free Hospital, London, UK
| | - Christina Thirlwell
- UCL Cancer Institute, University College London, Huntley Street, London, UK; Department of Oncology, Royal Free Hospital, London, UK
| | - Tim Meyer
- UCL Cancer Institute, University College London, Huntley Street, London, UK; Department of Oncology, Royal Free Hospital, London, UK
| | | | - Alex Baneke
- Neuroendocrine Tumor Unit, Centre of Gastroenterology, Royal Free Hospital, London, UK
| | - Dario Conte
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda - Ospedale Maggiore Policlinico and Department of Pathophysiology and Transplantation, Università degli Studi Milano, Italy
| | - Christos Toumpanakis
- Neuroendocrine Tumor Unit, Centre of Gastroenterology, Royal Free Hospital, London, UK
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145
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Tonooka A, Oda KI, Hayashi M, Sakazume KI, Tanaka H, Kaburaki KH, Uekusa T. Cytological findings of appendiceal mixed adenoneuroendocrine carcinoma in pleural effusion: Morphological changes evident after metastasis. Diagn Cytopathol 2014; 43:577-80. [PMID: 25425263 DOI: 10.1002/dc.23236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 10/23/2014] [Accepted: 11/09/2014] [Indexed: 11/09/2022]
Abstract
Goblet cell carcinoid (GCC) of the appendix is now regarded as a malignant tumor, and mixed adenoneuroendocrine carcinoma (MANEC) is a carcinoma progressing from GCC. We describe a man initially diagnosed with GCC of the appendix who died 4 years after diagnosis. Pleural fluid due to metastasis was noted in the terminal phase. Histological findings of the initial tumor indicated that cells with signet-ring morphology were predominant, but the cytological morphology of the fluid was more atypical, making it difficult to diagnose as metastatic GCC by cellular morphology alone. The cells in the pleural fluid were immunopositive for synaptophysin, which was compatible with GCC, but p53 and ki67 staining indicated that the metastatic tumor was more aggressive. These findings suggested a final diagnosis of poorly differentiated adenocarcinoma-type MANEC, which we define as a tumor with typical GCC characteristics and foci that cannot be distinguished from a poorly differentiated adenocarcinoma. This case, which we believe is reported here for the first time, indicates the cytological features of GCC cells may change at metastatic sites to be more atypical and aggressive as the tumor progresses, and these changes should be considered in diagnosis.
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Affiliation(s)
- Akiko Tonooka
- Department of Diagnostic Pathology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara, Kawasaki, Kanagawa, 211-8510, Japan
| | - Ken-Ichi Oda
- Department of Diagnostic Pathology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara, Kawasaki, Kanagawa, 211-8510, Japan
| | - Mamoru Hayashi
- Department of Diagnostic Pathology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara, Kawasaki, Kanagawa, 211-8510, Japan
| | - Ko-Ichi Sakazume
- Department of Diagnostic Pathology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara, Kawasaki, Kanagawa, 211-8510, Japan
| | - Hiroki Tanaka
- Department of Diagnostic Pathology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara, Kawasaki, Kanagawa, 211-8510, Japan
| | - Kyo-Hei Kaburaki
- Department of Diagnostic Pathology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara, Kawasaki, Kanagawa, 211-8510, Japan
| | - Toshimasa Uekusa
- Department of Diagnostic Pathology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshi-cho, Nakahara, Kawasaki, Kanagawa, 211-8510, Japan
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146
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Malkan AD, Sandoval JA. Controversial tumors in pediatric surgical oncology. Curr Probl Surg 2014; 51:478-520. [PMID: 25524425 DOI: 10.1067/j.cpsurg.2014.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 11/17/2014] [Indexed: 12/13/2022]
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147
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Madani A, van der Bilt JDW, Consten ECJ, Vriens MR, Borel Rinkes IHM. Perforation in appendiceal well-differentiated carcinoid and goblet cell tumors: impact on prognosis? A systematic review. Ann Surg Oncol 2014; 22:959-65. [PMID: 25190118 DOI: 10.1245/s10434-014-4023-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Carcinoid tumors are the most common malignant lesions arising from Appendix and are mostly found incidentally during surgery for appendicitis. Perforation of Appendix occurs in 10-20% of cases with appendicitis. Currently, no guidelines exist for the treatment of perforated carcinoids of Appendix. METHODS A systematic literature search was performed to identify relevant articles on classical carcinoid or goblet cell carcinoid of Appendix in an attempt to evaluate the impact of perforation on management and prognosis. All articles on carcinoids reporting perforation of Appendix were included. RESULTS In total, 23 articles on carcinoid of Appendix with an associated perforation were found. Perforation was never investigated or mentioned as a possible negative factor on recurrence or prognosis. Among a total of 103 patients with classical carcinoids and associated perforation, no peritoneal recurrence or death was described, although follow-up data were often unspecified or scarce. Among a total of 18 goblet cell carcinoids with perforation, metastatic spread to the peritoneum was described in one case and two tumor-related deaths occurred among these cases. No specific relation to perforation could be distilled. CONCLUSIONS The best available evidence suggests that perforation has no influence on prognosis of classical appendiceal carcinoids. In contrast, peritoneal carcinomatosis is much more common in goblet cell carcinoids but the true impact of perforation remains unclear. Careful follow-up should therefore be considered in these cases.
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Affiliation(s)
- Ariana Madani
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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148
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Rindi G, Petrone G, Inzani F. The 2010 WHO classification of digestive neuroendocrine neoplasms: a critical appraisal four years after its introduction. Endocr Pathol 2014; 25:186-92. [PMID: 24699927 DOI: 10.1007/s12022-014-9313-z] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This paper briefly illustrates the basis, rules of application, and present outcome of the current World Health Organization (WHO) classification for neuroendocrine neoplasms. Established in 2010 upon the proposal from the European Neuroendocrine Tumor Society (ENETS), the WHO 2010 fostered some definitional changes (most notably the use of neuroendocrine tumor (NET) instead of carcinoid) and indicated the tools of grading and staging. Specific rules for its application were also defined. The data generated from the use of WHO 2010 classification substantially endorsed its rules and prognostic efficacy. In addition, the application demonstrated some issues, among which are the possible re-definition of the cutoff for grading G1 vs G2, as well as the possible identification of cases with somewhat different clinical behavior within the G3 neuroendocrine cancer class. Overall, since the recent introduction of WHO 2010 grading and staging, it appears wise to keep the current descriptors to avoid unnecessary confusion and to generate comparable data. Homogenous data on large series are ultimately needed to solve such issues.
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Affiliation(s)
- G Rindi
- Institute of Anatomic Pathology, Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, Roma, 00168, Italy,
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149
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Ho KC, Liu CL, Lee JJ, Liu TP, Ko WC, Lin JC. Goblet Cell Carcinoid of Appendix. JOURNAL OF CANCER RESEARCH AND PRACTICE 2014. [DOI: 10.1016/s2311-3006(16)30029-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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150
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Dimmler A, Geddert H, Faller G. EGFR, KRAS, BRAF-mutations and microsatellite instability are absent in goblet cell carcinoids of the appendix. Pathol Res Pract 2014; 210:274-8. [DOI: 10.1016/j.prp.2014.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 11/20/2013] [Accepted: 01/13/2014] [Indexed: 02/07/2023]
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