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Presented by Ralph Hruban, M.D. and prepared by Amy Duffield, M.D., Ph.D.
Case 2: This 70-something year-old man developed intermittent abdominal pain.
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1. Question
Week 350: Case 2
This 70-something year-old man developed intermittent abdominal pain. He was found to have an abdominal mass.images/4_28_08 2A.jpg
images/4_28_08 2B.jpg
images/4_28_08 2C.jpg
images/4_28_08 2D.jpg
images/4_28_08 2E.jpgCorrect
Answer:
Histology: This neoplasm is composed of nests of small cells with uniform round nuclei. The nuclei of the neoplastic cells have classic “salt and pepper” chromatin. A relatively brisk mitotic rate (>2 mitoses per 10 hpf) is noted.
Discussion: Endocrine neoplasms can be broadly divided into three prognostic groups. Carcinoid tumors are well-differentiated endocrine neoplasms with a low mitotic rate (<2 per 10 high power fields [hpf]) and without significant necrosis. Atypical carcinoid tumors are distinguished by two features- they have a high mitotic rate (between 2 and <10 mitoses per 10 hpf) and necrosis. At the poorly differentiated end of the spectrum, undifferentiated small cell and large cell carcinomas have 10 or more mitoses per 10 hpf. Small cell carcinomas also have characteristic nuclear features and nuclear molding. In the case presented, the mitotic rate was between 2 and 10 mitoses per 10 hpfs, making this case an atypical carcinoid.
Reference(s):
- Travis, Clin. Chest Med. 2002 Mar;23(1):65-81.Incorrect
Answer:
Histology: This neoplasm is composed of nests of small cells with uniform round nuclei. The nuclei of the neoplastic cells have classic “salt and pepper” chromatin. A relatively brisk mitotic rate (>2 mitoses per 10 hpf) is noted.
Discussion: Endocrine neoplasms can be broadly divided into three prognostic groups. Carcinoid tumors are well-differentiated endocrine neoplasms with a low mitotic rate (<2 per 10 high power fields [hpf]) and without significant necrosis. Atypical carcinoid tumors are distinguished by two features- they have a high mitotic rate (between 2 and <10 mitoses per 10 hpf) and necrosis. At the poorly differentiated end of the spectrum, undifferentiated small cell and large cell carcinomas have 10 or more mitoses per 10 hpf. Small cell carcinomas also have characteristic nuclear features and nuclear molding. In the case presented, the mitotic rate was between 2 and 10 mitoses per 10 hpfs, making this case an atypical carcinoid.
Reference(s):
- Travis, Clin. Chest Med. 2002 Mar;23(1):65-81.
