Case presentation deshpande case 6.pptx
- 1. Case 6: 61/F appendectomy specimen
- 7. Keratin 20
- 13. Case 4 Diagnosis Combined classic carcinoid and goblet cell carcinoid and adenocarcinoma
- 14. Am J Surg Pathol. 2010 Aug;34(8):1163-7.
- 16. • Classical carcinoid • Goblet cell carcinoid • Adenocarcinoma ex goblet cell carcinoid
- 19. Goblet Cell Carcinoid • Synonyms – Mucinous carcinoid, adenocarcinoid, crypt cell carcinoma, microglandular carcinoma • Almost exclusively involve the appendi x • Mean age 53 years • Gross - Diffusely involve the appendix
- 20. Picture GCC
- 21. Mixed Goblet cell Carcinoid-Adenocarcinoma
- 22. • Classical carcinoid • Goblet cell carcinoid • Adenocarcinoma ex goblet cell carcinoid
Editor's Notes
- #3: Has a very low power view of the appendix is the tip of the appendix Lymph node
- #4: So we now looking at the central portion of the type of the appendix and what we see her nest of cells and little bit of mucin which is a bit weird for carcinoid
- #5: On higher power these nests of cells have this typical so-called type A+ C pattern that is nests plus liminal spaces along with these peripheral palisade in and break coppery granules at the periphery of the nests all of which is very typical for a serotonin producing midgut carcinoid. All right typical of a fantasy carcinoid
- #6: In other areas the cells were relatively clear, backed related focally clear cell change the big deal however she moved away from that may not do the areas in which they were aggregates of coverage like cells in this and he did look like a goblet cell carcinoma We have classic
- #7: Here's an imageShowing the classic carcinoid and goblet cell carcinoma
- #8: In fact there was evidence that it was non-endocrine differentiation within that classic endocrine component, this little strip of columnar cells in the sea of otherwise endocrine tumor was positive for keratin 20
- #9: And that focus that was positive for keratin 20 was negative for, Brandon
- #10: Now as you moved further away from the tumor now they were pools of mucin
- #11: And occasionally they were vascular spaces filled with these pools of mucin within which the signet ring type cells
- #12: A higher part of the signet ring cells within vascular spaces
- #13: kickerAnd the kicker in this case was the lymph node that we saw in very low power had metastatic carcinoid, and it wasn't the signet ring adenocarcinoma but instead it was from the classic carcinoid
- #14: This just a very a unique case in which you see all 3 elements
- #15: When I first saw this I couldn’t put it together And then I saw this reprot
- #16: This was focus
- #17: Generally the 3 elements are distinct and do not collide
- #20: 19
- #21: 20
- #22: 21
- #23: And very rarely as in this case you can see all 3 components