Goblet cell carcinoid of appendix.Ultrastructural features and histogenetic aspects

Abstract

Light and electron microscopic examination of a goblet cell carcinoid revealed cells with pleomorphic neurosecretory-type granules, cells containing mucin some of which also contained these granules and less differentiated cells lacking the aforementioned features. Recent embryologic and anatomic studies of developing avian and mammalian gut, respectively, show that intestinal APUD cells are probably of endodermal origin. Therefore, mixed carcinoid tumors such as the goblet cell variant could arise in crypt base stem cells. Cancer 44:1700-1706, 1979. HE EXISTENCE OF TUMORS that possess the T morphologic characteristics of two or more discrete embryonic cell systems raises questions concerning the histogenesis and differentiation of these tumors. The goblet cell carcinoid30 is an example of a neoplasm with a mixed phenotype and as such has aroused much interest. Herein we describe the light and electron microscopic morphology of a goblet cell carcinoid. CASE REPORT A 62-year-old diabetic male was admitted with chills, a temperature of 104 F and colicky abdominal pain of 60 hours' duration. Moderate abdominal distention and left lower quadrant tenderness without rebound were noted. Chest and abdominal x-ray revealed linear atelectasis in the left mid-lung field. He was given antibiotics with physical and supportive therapy. Barium enema and colonoscopy were normal. After discharge an intermittent fever (101 F) developed and he was readmitted following collapse and brief loss of consciousness. The blood pressure was 90/60 and the temperature 99.8 F. Slight tenderness was elicited in the left lower quadrant. The hemoglobin was 11.4 g/dl and a neutrophil leucocytosis (WCC 18,000/mm3) was present; fasting blood sugar was 270 mg/dl. The stool contained melena and 2 liters of coffee-ground material were obtained on nasogastric suction. Arterial bleeding without evident ulceration was observed in the second part of the duodenum by endoscopy. The hemo-globin was 7.4 g/dl. At laparotomy, after blood transfusion, a shallow linear ulcer with an active bleeding point was oversewn. About 100 ml of pus was aspirated from an appendiceal abscess which lay between the sigmoid colon and a loop of jejunum and beneath extensive adhesions. The abscess with a partly necrotic appendix and fecalith were removed. A portion of the cecum with appendix stump was excised three months later. Recovery was uneventful and the patient is free of recurrence three years later. MATERIALS AND METHODS Sections of formalin-fixed paraffin-embedded blocks of tissue were stained with hematoxylin-eosin, periodic acid-Schiff, mu-cicarmine, Alcian blue, trichrome, basic fuchsin, naphthol-ASD-chloroacetate ester-ase,I7 Grimelius and Masson-Fontana methods. Immunoperoxidase staining for mur-amidase was performed using Pangalis' method.23 Normal appendix, ileum and an ileal carcinoid were used as controls. Tissue blocks for electron microscopy were taken from the formalin-fixed specimen within 36 hours, postfixed in 3% glutaraldehyde and subsequently processed i...

Goblet cell carcinoid tumors of the appendix: An overview

“…The histogenetic evolution of this tumor has been su bject to hypothesis in the last three decades, pioneered by Warner et al [5] in 1979. Isaacson [6] demonstrated IgA, a secretory component and lysozyme in these tumors , similar to intestinal crypt cells, and proposed the name "crypt cell carcinoma".…”

Goblet Cell Carcinoid Tumor, Mixed Goblet Cell Carcinoid-Adenocarcinoma, and Adenocarcinoma of the Appendix: Comparison of Clinicopathologic Features and Prognosis

“…3,5,[8][9][10] The GCTs' organoid growth pattern, presence of scattered neuroendocrine cells, ultrastructural evidence of neurosecretory granules, lack of cytologic atypia, lack of p53 mutations, and lack of an in situ mucosal precursor lesion have compelled many authors to consider GCTs as a type of carcinoid tumor. 2,5,[11][12][13][14][15] In addition, rare tumors with both GCT and classic carcinoid tumor components have been described. 16 However, the presence of intracellular mucin and characteristic transcoelomic spread with frequent metastases-including ovarian involvement in womenare features more in keeping with adenocarcinoma, or at least an entity distinct from classic carcinoid tumor.…”

Cytokeratins 7 and 20 Immunoexpression Profile in Goblet Cell and Classical Carcinoids of Appendix

“…[3][4][5][6]. However, others consider GCC to be a form of low-grade adenocarcinoma of the appendix, originating from a crypt cell [6,7] and exhibiting neuroendocrine differentiation [8,9]. Molecular studies have not been able to elucidate the exact nature of these enigmatic tumors, and, in fact, there is great overlap between GCC and classical carcinoid from a molecular standpoint [10,11].…”