48,466
edits
Difference between revisions of "Neuroendocrine tumour of the appendix"
Jump to navigation
Jump to search
m
Neuroendocrine tumour of the appendix (view source)
Revision as of 14:41, 22 August 2019
, 14:41, 22 August 2019→Sign out: tweak
(split out) |
m (→Sign out: tweak) |
||
| (9 intermediate revisions by the same user not shown) | |||
| Line 1: | Line 1: | ||
'''Neuroendocrine tumour of the appendix''' is a common tumour of the [[vermiform appendix]]. | '''Neuroendocrine tumour of the appendix''' is a common tumour of the [[vermiform appendix]]. It is also known as '''appendiceal neuroendocrine tumour''', abbreviated '''appendiceal NET'''. | ||
It was previously known as '''appendiceal [[carcinoid]]'''. | |||
==General== | ==General== | ||
| Line 13: | Line 15: | ||
*<1.0 cm - do not metastasize. | *<1.0 cm - do not metastasize. | ||
*1.0-2.0 cm - rarely metastasize. | *1.0-2.0 cm - rarely metastasize. | ||
Management: | |||
*Simple resection, e.g. appendectomy, sufficient for most tumours <2 cm.<ref name=pmid25840530>{{Cite journal | last1 = Nussbaum | first1 = DP. | last2 = Speicher | first2 = PJ. | last3 = Gulack | first3 = BC. | last4 = Keenan | first4 = JE. | last5 = Ganapathi | first5 = AM. | last6 = Englum | first6 = BR. | last7 = Tyler | first7 = DS. | last8 = Blazer | first8 = DG. | title = Management of 1- to 2-cm Carcinoid Tumors of the Appendix: Using the National Cancer Data Base to Address Controversies in General Surgery. | journal = J Am Coll Surg | volume = 220 | issue = 5 | pages = 894-903 | month = May | year = 2015 | doi = 10.1016/j.jamcollsurg.2015.01.005 | PMID = 25840530 }}</ref><ref name=pmid18338494>{{Cite journal | last1 = Fornaro | first1 = R. | last2 = Frascio | first2 = M. | last3 = Sticchi | first3 = C. | last4 = De Salvo | first4 = L. | last5 = Stabilini | first5 = C. | last6 = Mandolfino | first6 = F. | last7 = Ricci | first7 = B. | last8 = Gianetta | first8 = E. | title = Appendectomy or right hemicolectomy in the treatment of appendiceal carcinoid tumors? | journal = Tumori | volume = 93 | issue = 6 | pages = 587-90 | month = | year = | doi = | PMID = 18338494 }}</ref> | |||
==Gross== | ==Gross== | ||
*Classically found in the tip of the appendix. | *Classically found in the tip of the appendix. | ||
*Characteristic yellow cut surface | *Characteristic yellow cut surface post-[[fixation]]. | ||
*Circumscribed but not encapsulated | *Circumscribed but not encapsulated. | ||
*Firm (due to desmoplasia) | *Firm (due to desmoplasia). | ||
*Centred in the submucosa | *Centred in the submucosa. | ||
*Nodules that do not usually cause erosion of the overlying mucosa. | *Nodules that do not usually cause erosion of the overlying mucosa. | ||
| Line 31: | Line 36: | ||
*Classically subepithelial/mural. | *Classically subepithelial/mural. | ||
*Various growth patterns: | *Various growth patterns: | ||
**Nested (insular) | **Nested (insular). | ||
**Trabecular | **Trabecular. | ||
**Palisading | **Palisading. | ||
**Ribbons, | **Ribbons, [[rosette]]s. | ||
*Fibrous stroma in between cell groups. | *Fibrous stroma in between cell groups. | ||
*Cytomorphology | *Cytomorphology: | ||
**Monotonous appearance with scanty mitoses. | **Monotonous appearance with scanty mitoses. | ||
**Round central nuclei | **Round central nuclei. | ||
**Stippled chromatin [[AKA]] salt-and-pepper chromatin | **Stippled chromatin ([[AKA]] ''salt-and-pepper chromatin'' and ''coarse chromatin''). | ||
**Eosinophilic granular cytoplasm | **Eosinophilic granular cytoplasm. | ||
DDx: | |||
*[[Colorectal adenocarcinoma]]. | |||
*Adenocarcinoid. | |||
*[[Crypt cell carcinoma]], also known as ''goblet cell carcinoid''. | |||
*[[Metastasis|Metastatic]] [[adenocarcinoma]]. | |||
*Normal ganglion cells in the Meissner plexus (submucosa) and Auerbach plexus (located between the inner and outer layers of the muscularis propria). | |||
===Special Types=== | ===Special Types=== | ||
*Tubular carcinoid | *Tubular carcinoid. | ||
**Neuroendocrine cells forming tubules (no cell nests) | **Neuroendocrine cells forming tubules (no cell nests). | ||
**Some tubules can contain mucin | **Some tubules can contain mucin. | ||
**Can be confused with adenocarcinoma | **Can be confused with adenocarcinoma. | ||
**Features suggesting tubular carcinoid (over adenocarcinoma): | **Features suggesting tubular carcinoid (over adenocarcinoma): | ||
***Arises from base of crypts, with no disruption of surface epithelium. | ***Arises from base of crypts, with no disruption of surface epithelium. | ||
***No associated epithelial precursor (no adenomatous change). | ***No associated epithelial precursor (no adenomatous change). | ||
***Neuroendocrine cytologic features, without prominent atypia | ***Neuroendocrine cytologic features, without prominent atypia. | ||
***IHC (NE markers +ve) | ***IHC (NE markers +ve). | ||
*Goblet cell carcinoid - dealt with in the article ''[[crypt cell carcinoma]]''. | |||
*Goblet cell carcinoid | *Signet-ring cells forming glandular structures. | ||
*Signet-ring cells forming glandular structures | *Possibly also with extra-cellular mucin.{{fact}} | ||
*Possibly also with extra-cellular mucin | |||
===Images=== | ===Images=== | ||
| Line 86: | Line 90: | ||
*Chromogranin A -ve/+ve. | *Chromogranin A -ve/+ve. | ||
*Synaptophysin +ve. | *Synaptophysin +ve. | ||
*Keratin positive | *Keratin positive.{{fact}} | ||
*S100 positive for appendix | *S100 positive for appendix.{{fact}} | ||
Others: | |||
*CK7 and CK20 variable.<ref name=pmid22461652>{{Cite journal | last1 = Matsukuma | first1 = KE. | last2 = Montgomery | first2 = EA. | title = Tubular carcinoids of the appendix: the CK7/CK20 immunophenotype can be a diagnostic pitfall. | journal = J Clin Pathol | volume = 65 | issue = 7 | pages = 666-8 | month = Jul | year = 2012 | doi = 10.1136/jclinpath-2011-200639 | PMID = 22461652 }}</ref> | |||
==Sign out== | |||
<pre> | |||
Vermiform Appendix, Appendectomy: | |||
- Low-grade neuroendocrine tumour (carcinoid tumour), see comment. | |||
-- Margins clear. | |||
-- Please see synoptic report. | |||
- Perforated acute appendicitis with periappendicitis. | |||
Comment: | |||
The tumour stains as follows: | |||
POSITIVE: AE1/AE3, chromogranin A, synaptophysin, CD56. | |||
NEGATIVE: CK7, CK20, S100. | |||
PROLIFERATION (Ki-67): <3%. | |||
The low-grade neuroendocrine tumour (in the planes of section) is in the tip and | |||
separate from the appendiceal perforation site/acute appendicitis. | |||
The specimen was submitted in total. | |||
</pre> | |||
==See also== | ==See also== | ||
*[[Vermiform appendix]]. | *[[Vermiform appendix]]. | ||
*[[ | *[[Neuroendocrine tumours]]. | ||
==References== | ==References== | ||