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IDENTIFICATION OF GLANDULAR DIFFERENTIATION IN APPENDICEAL CARCINOID TUMOR- A STUDY IN SULAIMANIA CITY
IDENTIFICATION OF GLANDULAR DIFFERENTIATION IN APPENDICEAL CARCINOID TUMOR- A STUDY IN SULAIMANIA CITY
Asmaa N. Abdullah *, Hadeel A. Yasseen *, Hassanain H. Khudier * and Ali Ibrahim *
* Department of Pathology and Forensic Pathology, School of Medicine, Faculty of Medical Sciences, University of Sulaimani.
Submitted: 18/12/2013; Accepted: 31/3/2014; Published 1/12/2014
DOI Link: https://doi.org/10.17656/jsmc.10058
ABSTRACT
Background
Background
Carcinoid tumor of appendix is the most common appendiceal tumor. Both the classical and mixed carcinoid tumor could be identified using the routine H&E stain. Using additional stains such as Periodic Schiff stain, Alcian blue and cytokeratin 20 (CK20) stain have been used to detect these appendiceal mixed (glandular)
carcinoid tumors.
Objective
To identify glandular differentiation and mucin production in appendiceal carcinoid tumors by using special
stains and immunohistochemistry.
Patients and Methods
This retrospective case-control study was carried out in research laboratory of Pathology Department/School of Medicine. All pathological reports of patients with appendiceal carcinoid tumor were collected from the laboratory of pathology-Sulaimani Teaching Hospital over the period of six years (from the 1st of January 2006 to the 31st of December 2011), patient’s age, sex and histopathological diagnosis were documented. Fifteen cases (out of 10533 appendectomies) were divided into 2 groups: classical (insular) and mixed (insular with mucinous differentiation). Formalin-fixed, paraffin-embedded, 4- micrometer- thick sections were immunostained with CK20 using HIER-LSAB method. All cases were stained with Alcian blue stain for acidic mucin detection, and PAS stain for neutral mucin detection within the carcinoid tumor. Then the results of H&E stain, immunostain for epithelial differentiation and the special stains for mucin production were evaluated together and compared with similar studies.
Results
The carcinoid tumor is more common in females with a peak age range of 21-30 years, mean incidence 0.14% for fifteen cases of carcinoid tumors. Carcinoid tumor in patients above 50 years is usually mixed type. PAS and Alcian blue stains are of no statistically significant correlation with glandular differentiation, while CK20 has statistically significant correlation with glandular differentiation but staining intensity is variable.
Conclusion
H&E is the main method for the identification of glandular differentiation of carcinoid tumor, however CK20 has important value to assist the diagnosis, while mucin stains have limited value in the identification of glandular differentiation of carcinoid tumor.
KEYWORDS
Appendix, mixed carcinoid Tumor, PAS stain, Alcian blue, CK20.
References
1. Prommegger R, Obrist P, Ensinger C, Profanter C, Mittermair R, Hager J. Retrospective evaluation of carcinoid tumors of the appendix in children. World J Surg 2002; 26: 1489-1492.
2. Connor SJ, Hanna GB, Frizelle FA. Appendiceal tumors: Retrospective clinicopathologic analysis of appendiceal tumors from 7907 appendectomies. Dis Colon Rectum. 1998; 41:75-80.
3. Carmen Adina Petcu, V. Şurlin, Fl. Bogda. Study of clinical-morphological correlations in carcinoid tumors of the colon.Rom J MorpholEmbryol 2011, 52(1 suppl):389-393.
4. Rothmund M. Kisker O. Surgical Treatment of Carcinoid tumors of the small bowel, appendix, colon and rectum. Digestion 1994: 86-91.
5. Godwin JD 2nd, Carcinoid tumors: an analysis of 2837 cases. Cancer 1975,36(2):560-569.
6. Timmins PF. Kuo DY, Anderson PS, Fields AL, Whitney KD, Goldberg GL. Ovarian carcinoids: management of primary and recurrent tumors. Gynecol Oncol 2000; 76(1):112-4.
7. Ichiro Fukai, Akira Masaoka, Yoshitaka Fujii et al. Thymic neuroendocrine tumor (thymic carcinoid): a clinicopathologic study in 15 patients. Ann ThoracSurg 1999; 67: 208-211.
8. Glazier DB, Murphy DP, Barnard N, Cummings KB, Weiss RE. Primary carcinoid tumour of the testis. BJU Int 1999;83:153-4..
9. Memon MA, Nelson H. Gastrointestinal carcinoid tumors: Current management strategies. Dis Colon Rectum 1997; 40: 1101-1118.
10. Gagne F, Fortin P, Dufour V, Delage C. Tumeurs de l’appendice associant des carretteres histologiques de cardinoide et d’adenocarcinome. Ann Anat Pathol 1969; 14: 393–406.
11. Warkel RL, Cooper PH, Helwig EB Adenocarcinoid, a mucin producing carcinoid tumor of the appendix.Cancer.1978; 42: 2781-2793.
12. Gallegos NC, Milroy C, Linehan IP, Boulos PB. Crypt cell carcinoma of the appendix. EurJSurgOncol. 1992; 18: 386-7.
13. Klein HZ. Mucinous carcinoid tumor of the vermiform appendix. Cancer.1974;33:770-777.
14.Payam SP, Rani Kanthan. Review of Goblet cell carcinoid of the appendix. World J SurgOncol 2005; 3: 36.
15. Park K, Blessing K, Kerr K, Chetty U, Gilmour H. Goblet cell carcinoid of the appendix. Gut. 1990;31:322–324.
16. Butler JA, Houshiar A, Lin F, Wilson SE. Goblet cell carcinoid of the appendix. Am J Surg. 1994;168:685–687.
17. Kanthan R, Saxena A, Kanthan SC. Goblet cell carcinoids of the appendix: immunophenotype and ultrastructural study. Arch Pathol Lab Med. 2001;125:386–390.
18. Edmonds P, Merino MJ, LiVolsi VA, Duray PH. Adenocarcinoid (mucinous carcinoid) of the appendix. Gastroenterology 1984; 86: 302–9.
19. Ramnani DM, Wistuba II, Behrens C, Gazdar AF, Sobin LH, Albores-Saavedra J. K-ras and p53 mutations in the pathogenesis of classical and goblet cell carcinoids of the appendix. Cancer. 1999;86(1):14–21.
20. From Wikipedia, the free encyclopedia retrieved from http://en.wikipedia.org/wiki/Periodic_acid–Schiff_stain .
21. M. A. Hayat. Stains and Cytochemical Methods. 1993 ed, Chapter 8, page 80
22. Marie R. Green and Jullia V. Pastewka. Simultaneous Differential Staining by a Cationic Carbocyanine Dye of Nucleic Acids Proteins and Conjugated Proteins Ii. Carbohydrate and Sulfated Carbohydrate-containing Proteins. J Histochem Cytochem 1974 22: 774.
23. Surgical pathology – histology staining manual - carbohydrates Page: 1 of 2 retrieved from: http://library.med.utah.edu/WebPath/HISTHTML/MANUALS/ALCIAN.PDF.
24. Zea-Iriarte WL, Ito M, Naito S et al. Goblet cell carcinoid of the appendix. Intern Med 1994, 33:422–426.
25. Kende AI, Carr NJ, Sobin LH. Expression of CK 7 & CK 20 in carcinoma of the GIT. Histopatholgy 2003; 42:137-140.
26. Cytokeration 20 Antibody Staining Protocol for Immunohistochemistry. Retrieved from www.ihcworld.com/_protocols/antibody_protocols/ck20_dako.htm
27. Naish SJ. Hand book-immunohistochemical Staining Methods. Carpinteria: Dako 1989.
28. Erik Thunnissen, Lukas Bubendorf, Manfred Dietel et al. EML4-ALK testing in non-small cell carcinomas of the lung: a review with recommendations. Springer Virchows Arch (2012) 461:245–257.
29. Kim H, Yoo SB, Choe JY et al. Detection of ALKgene rearrangement in non-small cell lung cancer: a comparison of fluorescence in situ hybridization and chromogenic in situ hybridization with correlation of ALK protein expression. J ThoracOncol 2011 6:1359–1366
30. Cortina R, McCormick J, Kolm P, Perry RR. Management and prognosis of adenocarcinoma of the appendix. Dis Colon Rectum 1995; 38: 848-52.
31. Pelizzo G, La Riccia A, Bovier R, Chappius JP. Carcinoid tumours of appendix in children. Pediatric Surg Int; 17: 399-402.
32. Moertel CL, Weiland LH, Telander RL. Carcinoid tumor of the appendix: Treatment and prognosis. N Eng J Med 1987;317:1699-701.
33. Peter H. Watson, Antonio Alguacil-Garcia. Mixed crypt cell carcinoma. Virchows Archiv A 1987, Volume 412, Issue 2, pp 175-182
34. Stancu M, Wu TT, Wallace C, Houlihan PS, Hamilton SR, Rashid A. Genetic alterations in goblet cell carcinoids of the vermiform appendix and comparison with gastrointestinal carcinoid tumors. Mod Pathol. 2003;16:1189–1198.
35. McCusker ME, Coté TR, Clegg LX, Sobin LH. Primary malignant neoplasms of the appendix: a population-based study from the surveillance, epidemiology and end-results program, 1973-1998.Cancer. 2002;94:3307–3312.
36. Anderson NH, Somerville JE, Johnston CF, Hayes DM, Buchanan KD, Sloan JM. Appendiceal goblet cell carcinoids: a clinicopathological and immunohistochemical study. Histopathology. 1991;18:61–65.
37. Tang LH, Shia J, Soslow RA et al. Pathologic classification and clinical behavior of the spectrum of goblet cell carcinoid tumors of the appendix. Am J Surg Pathol. 2008;32:1429–1443.
38. Pahlavan PS, Kanthan R. Goblet cell carcinoid of the appendix. World J Surg Oncol. 2005;3:36 .
39. Appendiceal Carcinoid / Well Differentiated Endocrine Neoplasm. Surgical Pathology Criteria retrieved from: http://surgpathcriteria.stanford.edu/gitumors/appendix-carcinoid-well-differentiated-neuroendocrine-neoplasm-tumor/index.html
40. Alsaad KO, Serra S, Schmitt A, Perren A, Chetty R. Cytokeratins 7 and 20 immunoexpression profile in goblet cell and classical carcinoids of appendix. Endocr Pathol. 2007;18 (1):16-22.
41. Lin BT, Gown AM. Mixed carcinoid and adenocarcinoma of the appendix. Appl Immunohistochem Mol Morphol. 2004 Sep;12(3):271-6.
42. Peiguo Chu, Emerald Wu B.S and Lawrence M Weiss. Cytokeratin 7 and Cytokeratin 20 Expression in Epithelial Neoplasms. Mod Pathol 2000;13(9):962–972
43 Matsukuma KE, Montgomery EA. Tubular carcinoids of the appendix: the CK7/CK20 immunophenotype can be a diagnostic pitfall. J Clin Pathol. 2012 Jul;65(7):666-8.
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