Department of Pathology and Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Calgary, Alberta, Canada.
J Surg Oncol. 2014 May;109(6):548-55. doi: 10.1002/jso.23537. Epub 2013 Dec 24.
Goblet cell carcinoid (GCC) and appendiceal mucinous neoplasms (AMNs) are considered as different appendiceal tumors. Coexistence of both tumors was occasionally noted. We further observed the concurrence in both primary tumors and their peritoneal dissemination, that is, peritoneal carcinomatosis (PC) including pseudomyxoma peritonei (PMP).
Review of our 10-year file identified two subgroups of cases with such concurrence. Group 1 is 14 cases of PC/PMP treated by surgical cytoreduction. Morphologic components of GCC, low-grade mucinous neoplasm (LMN), mucinous adenocarcinoma (MCA), and non-mucinous adenocarcinoma (NMCA) were identified separately in different organs/tissues. Group 2 is eight cases of localized primary tumors of appendix and ileocecal junction.
In Group 1, primary tumors (11 GCC, 1 GCC + LMN, 1 MCA, 1 NMCA) were identified in appendix (13) and in rectum (1). Further review identified mixed morphologic components in 7/12 GCC cases, including GCC + LMN (2), GCC + MCA (2), GCC + NMCA (1), and GCC + MCA + NMCA (2). Over peritoneal dissemination, GCC and/or other components were coexistent at different sites and in variable combinations. In Group 2, primary tumors were initially diagnosed as GCC (7) and MCA (1). Further review identified mixed components in all cases, including GCC + LMN (3), GCC + LMN + MCA (3), GCC + MCA + NMCA (2).
GCC may present as a component mixed with AMNs and even with conventional adenocarcinoma in both primary tumors and metastatic lesions. AMN in any given single case may show a wide morphologic spectrum. GCC and AMN may share a common tumor stem cell with potential of multiple lineage differentiations.
杯状细胞类癌（GCC）和阑尾黏液性肿瘤（AMN）被认为是不同的阑尾肿瘤。这两种肿瘤同时存在的情况偶尔会被注意到。我们进一步观察到两种原发性肿瘤及其腹膜播散的同时存在，即包括假性黏液瘤腹膜癌（PMP）的腹膜癌病（PC）。
对我们 10 年的病历进行回顾，发现了两组具有这种同时存在的病例。第 1 组为 14 例接受手术细胞减灭术治疗的 PC/PMP 患者。在不同的器官/组织中分别鉴定出 GCC、低级别黏液性肿瘤（LMN）、黏液性腺癌（MCA）和非黏液性腺癌（NMCA）的形态学成分。第 2 组为 8 例阑尾和回盲部交界区局限性原发性肿瘤的病例。
在第 1 组中，在阑尾（13 例）和直肠（1 例）中发现了原发性肿瘤（11 例 GCC、1 例 GCC+LMN、1 例 MCA、1 例 NMCA）。进一步的回顾发现，7/12 例 GCC 病例存在混合形态学成分，包括 GCC+LMN（2 例）、GCC+MCA（2 例）、GCC+NMCA（1 例）和 GCC+MCA+NMCA（2 例）。在腹膜播散方面，GCC 和/或其他成分在不同部位以不同的组合共存。在第 2 组中，原发性肿瘤最初被诊断为 GCC（7 例）和 MCA（1 例）。进一步的回顾发现，所有病例均存在混合成分，包括 GCC+LMN（3 例）、GCC+LMN+MCA（3 例）、GCC+MCA+NMCA（2 例）。
GCC 可能表现为一种与 AMN 混合的成分，甚至在原发性肿瘤和转移病灶中与常规腺癌混合。任何单一病例的 AMN 可能表现出广泛的形态学谱。GCC 和 AMN 可能具有共同的肿瘤干细胞，具有多种谱系分化的潜力。
