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Presented by Dr. Pedram Argani and prepared by Dr. Monica Butcher
This case talks about a 42 year old female with an appendiceal tumor.
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Question 1 of 1
1. Question
This is a 42 year old female with an appendiceal tumor
Diagnosis:
Correct
Answer: C
Histologic Description: The lesion has a concentric growth pattern around the uninvolved appendiceal mucosa, and permeates the appendiceal submucosa, muscularis propria and periappendiceal adipose tissue. The neoplastic cells form small nests that resemble native crypts. The nests are composed of goblet cells and associated bland epithelial cells which prove to have neuroendocrine differention (synaptophysin immunoreactivity). There’s not significant solid growth or mitotic activity. These are the features of a goblet cell adenocarcinoma, which is low grade in this section. Other areas showed more solid architecture, yielding an overall intermediate grade lesion.
Differential Diagnosis: Carcinoid tumors would demonstrate a uniform population of bland cells with dispersed chromatin and granular cytoplasm. They are consistently diffusely immunoreactive for neuroendocrine markers, whereas goblet cell adenocarcinomas may not stain for neuroendocrine markers in some cases. Typical carcinoid tumors do not have goblet cells. Conventional adenocarcinomas would demonstrate greater intestinal type differentiation (columnar nuclei, desmoplastic stroma, often luminal necrosis) and typically do not have the concentric growth pattern of a goblet cell adenocarcinoma. Mucinous neoplasms of low malignant potential are cystic, and associated with an abundant luminal mucin that may dissect through the wall of the appendix. Goblet cell adenocarcinomas were formerly referred to as goblet cell carcinoids. These may be graded based upon their resemblance to normal intestinal crypts, with cases demonstrating greater than 75% tubular/clustered growth being grade 1, those with less than 50% being grade 3, and those between being grade 2. It is wise to look carefully at any signet ring cell cancer of the appendix for low grade areas that suggest an underlying goblet cell adenocarcinoma. High grade features include single goblet cells, sheet like growth pattern, large clusters of goblet cells, and high grade glands resembling colonic adenocarcinoma.
Incorrect
Answer: C
Histologic Description: The lesion has a concentric growth pattern around the uninvolved appendiceal mucosa, and permeates the appendiceal submucosa, muscularis propria and periappendiceal adipose tissue. The neoplastic cells form small nests that resemble native crypts. The nests are composed of goblet cells and associated bland epithelial cells which prove to have neuroendocrine differention (synaptophysin immunoreactivity). There’s not significant solid growth or mitotic activity. These are the features of a goblet cell adenocarcinoma, which is low grade in this section. Other areas showed more solid architecture, yielding an overall intermediate grade lesion.
Differential Diagnosis: Carcinoid tumors would demonstrate a uniform population of bland cells with dispersed chromatin and granular cytoplasm. They are consistently diffusely immunoreactive for neuroendocrine markers, whereas goblet cell adenocarcinomas may not stain for neuroendocrine markers in some cases. Typical carcinoid tumors do not have goblet cells. Conventional adenocarcinomas would demonstrate greater intestinal type differentiation (columnar nuclei, desmoplastic stroma, often luminal necrosis) and typically do not have the concentric growth pattern of a goblet cell adenocarcinoma. Mucinous neoplasms of low malignant potential are cystic, and associated with an abundant luminal mucin that may dissect through the wall of the appendix. Goblet cell adenocarcinomas were formerly referred to as goblet cell carcinoids. These may be graded based upon their resemblance to normal intestinal crypts, with cases demonstrating greater than 75% tubular/clustered growth being grade 1, those with less than 50% being grade 3, and those between being grade 2. It is wise to look carefully at any signet ring cell cancer of the appendix for low grade areas that suggest an underlying goblet cell adenocarcinoma. High grade features include single goblet cells, sheet like growth pattern, large clusters of goblet cells, and high grade glands resembling colonic adenocarcinoma.
