All posts by GAtherton

Adenocarcinoma Ex-goblet Cell Carcinoid of the Appendix: a Case Report and Overview of the Disease.

A 47-year-old female presented to the emergency room with complaints of ongoing abdominal pain for 2 weeks. The patient had no medical problems and had not had any surgical procedures in the past.

At presentation, the patient’s computed tomography (CT) scan of the abdomen and pelvis showed bilateral complex adnexal masses measuring approximately 17 and 14 cm in greatest dimension and a large amount of abdominal and pelvic ascites. The findings were suspicious for neoplastic disease and the patient subsequently underwent exploratory laparotomy, total abdominal hysterectomy, and bilateral salpingo-oopherectomy.

Diagnostics

The frozen section of the specimen obtained during the procedure favored metastatic tumor described as signet ring cell carcinoid. Hence, an appendectomy was also performed. The cytology of ascitic fluid drained during the procedure showed rare clusters of atypical cells suspicious for carcinoma.

The final pathology was consistent with adenocarcinoma ex-goblet cell carcinoid, signet ring cell type. The size of the tumor was 2.2 cm in the greatest dimension predominantly in the distal half of the appendix with extension into the proximal half. Extensive lympho-vascular invasion and focal peri-neural invasion was identified. Pathologic staging was consistent with pT3 (tumor invading through the muscularis propria into the sub-serosa or mesoappendix), pNx (no lymph nodes were identified in the specimen), and M1b (non-peritoneal metastases present in the ovaries and fallopian tubes). Immunohistochemistry was positive for CDX2, CD56, CEAP (focally), synaptophysin, Cam 5.2, and pancytokeratin with Ki 67 being over 10%. Mucicarmine and periodic acid-Schiff (PAS) stains confirmed presence of intracytoplasmic mucin in signet ring cells (Fig. 1). Additional staining was performed including beta-catenin (negative), MUC-1, and MUC-2 (positive). Mutation testing for BRAF V600, KRAS at codons 12 and 13, and NRAS was reported negative.

Fig. 1

Histopathology of the tumor showing a goblet cells on hematoxylin and eosin stain at 60× magnification, b tumor cells in the ovary at 40× magnification, c positive periodic acid-Schiff stain of the appendix at 10× magnification, and d positive mucicarmine stain at 40× magnification

Treatment & use of biomarker

Given the aggressive nature of reported cases and metastatic nature of the disease, a decision was made to treat the patient with adjuvant chemotherapy with a fluorouracil-based regimen. The patient’s CA-125 level at the time was 41 units/ml and carcinoembryonic antigen (CEA) level was 1 ng/ml. A PET-CT scan done to complete staging showed a focal area of non-specific hypermetabolic uptake adjacent to the appendectomy bed likely related to post-surgical changes. No other regions of pathologic FDG uptake were seen.

Outcome

The patient was started on chemotherapy with FOLFOX (fluorouracil, leucovorin, and oxaliplatin) and follow-up imaging 4 and 8 months after diagnosis did not show any evidence of disease. Her CA 125 level at 4 months was down to 14 units/ml, and 16 units/ml at 8 months. The patient completed 16 cycles of chemotherapy without any complications and a decision was made to observe her thereafter. Sixteen months into diagnosis, she remains without any evidence of disease. It is planned to monitor her periodically with a CA 125 level and radiologic imaging.

1.
Ibrahim U, Valecha G, Garcia G, Saqib A, Wrzolek M, Dhar M. Adenocarcinoma Ex-goblet Cell Carcinoid of the Appendix: a Case Report and Overview of the Disease. J Gastrointest Cancer. February 2017. [PubMed]

Intestinal goblet cell carcinoid presenting with recurrent sterile peritonitis in a patient on peritoneal dialysis: a case report

BMC Nephrol. 2017 Feb 13;18(1):62. doi: 10.1186/s12882-017-0477-x.
Intestinal goblet cell carcinoid presenting with recurrent sterile peritonitis in a patient on peritoneal dialysis: a case report.
Chen CW1, Chu JS2, Hsieh LC3,4, Kao CC1,5, Lin YC1,5, Chen HH6,7.
Author information
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.

Link

Goblet cell carcinoids of the appendix.

ScientificWorldJournal. 2013;2013:543696. doi: 10.1155/2013/543696. Epub 2013 Jan 14.

Holt N, Grønbæk H.

Abstract
Goblet cell carcinoid (GCC) tumors are a rare subgroup of neuroendocrine tumors almost exclusively originating in the appendix. The tumor most often presents in the fifth or sixth decade with a clinical picture of appendicitis or in advanced cases an abdominal mass associated with abdominal pain. Histologically tumors are most often positive for chromogranin A and synaptophysin, however, less homogenous than for classic appendix carcinoids. The malignant potential is higher than that for the classic appendix carcinoids due to local spread and distant metastases at diagnosis and the proliferation markers (Ki67 index) may determine prognosis. Octreotide receptor scintigraphy is usually negative while CT/MRI scans may be useful. Chromogranin A is usually negative and other biomarkers related to the mucinous component or the tumor (CEA, CA-19-9, and CA-125) may be used. Surgery is the main treatment with appendectomy and right hemicolectomy while patients with disseminated disease should be treated with chemotherapy. Overall 5-year survival is approximately 75%. The diagnosis and treatment of GCC tumors should be restricted to high volume NET centers in order to accumulate knowledge and improve survival in GCC NET patients. The aim of this paper is to update on epidemiology, clinical presentation, and diagnostic markers including Ki67 index, treatment, and survival.

PMID: 23365545 PMCID: PMC3556879 DOI: 10.1155/2013/543696

[A Case of Curatively Resected Goblet Cell Carcinoid of the Appendix Diagnosed via Intraoperative Frozen Sectional Examination]. [Article in Japanese]

Gan To Kagaku Ryoho. 2016 Nov;43(12):1623-1625.

Ikeda T1, Yamauchi J, Miyazaki K, Yasuta S, Fujita S, Satoh M, Shirasaki K, Kobayashi S, Ajiki T, Tsuchihara K, Kondo N, Ishiyama S.
Author information
Abstract
A 52-year-old patient presented with epigastric pain.An enhanced CT scan showed a strongly enhanced appendix with abscess formation.Appendectomy was performed under the diagnosis of acute appendicitis with perityphlitic abscess.The stump of the appendix was white and hard, suggesting malignant transformation.Intraoperative frozen sectional examination indicated goblet cell carcinoid(GCC)of the appendix.Thereafter, we performed ileocecal resection with lymphadenectomy (D3).The final pathological diagnosis was GCC, pSS, pN1, Stage III a by the Japanese classification of colorectal carcinoma. Immunohistochemical examination was consistent with GCC including synaptophysin(+), chromogranin A(+), somatostatin receptor(SSTR)2(±), SSTR5(+), and cytokeratin 20(+).The patient received adjuvant chemotherapy and remains cancer-free over 5 years after the operation.

PMID: 28133078

Welcome to our website

We are about to depart to spend a weekend in North Wales by the sea to formally launch our memorial bench by taking our 86 year old mum to see it and give it her blessing. Keep an eye on our Instagram account to pictures celebrating the occasion.

I am going to attach information on how to access this website to the bench. It is a bit late in the year but hopefully the laminated notices will survive the gale force winds on their way over the next few months and we will get a few pictures of people enjoying the walk – perhaps even having lunch ‘over the top’ as dad used to say? If it works out I will do something more permanent in 2017.

NOTE Many thanks to the owners of the hill for allowing us to install the bench on one of our favourite places!