Lesions of the Lower Intestinal Tract
Moderators: Dr. Henry Appelman and Dr. Joel K. Greenson
Case 7 -
Caecal goblet cell carcinoid with multiple ileal nodules and metastases
The case is of a 50 year old man with a caecal polypoid non-ulcerated tumour of 4 cm in diameter. The
terminal ileum is granular. Sections are from the terminal ileum.
Case 7 - Slide 1
Diagnosis: Caecal adenocarcinoma
In addition to the non-ulcerated caecal goblet cell carcinoid, multiple granular white lesions with a
similar histological appearance were present throughout all layers of the terminal ileum, including the
serosal fat. There were also several lymph nodes involved and many tumour metastases in the colonic
subserosal fat, perinephric fat and in the ureteric lamina propria and muscularis propria. This is thus
the case of a malignant tumour with unexpected goblet cell carcinoid histology and extensive metastatic
spread at diagnosis.
The goblet cell carcinoid is a rare neoplasm, mostly confined to the appendix, and it is considered to
be more aggressive than conventional carcinoids. The clinical outcome of the multifocal carcinoids seems
to be determined by the diameter of the largest tumour (Guzey et al. 2001) and young age (Zar et al.
2004). Other factors determining its prognosis are an increased amount of mucin and the secretion of
pancreatic polypeptide (Pahlavan and Kanthan. 2005). Multicentricity of the tumours is also a frequent
finding (in up to 30% of the cases) and colonic carcinoids have the poorest prognosis (Burke et al.
1997). The presence of multiple carcinoid tumours is a poor prognostic indicator as these patients tend
to die more of the disease or have more recurrent disease (Yantiss et al. 2003).
- Burke AP, Thomas RM, Elsayed AM, Sobin LH. Carcinoids of the jejunum and ileum. An immunohistochemical and clinicopathologic study of 167 cases. Cancer 1997; 79: 1086-93.
- Guzey D, Aytekin S, Gunes Z, Celebi F, Gursoy MA, Kaplan R. Multifocal carcinoid tumor resembling a solitary tumor: report of a case. Surg Today 2001; 31: 253-4.
- Pahlavan PS, Kanthan R. Goblet cell carcinoid of the appendix. World J Surg Oncol 2005; 3: 36.
- Yantiss RK, Odze RD, Farraye FA, Rosenberg AE. Solitary versus multiple carcinoid tumors of the ileum. A clinical and pathologic review of 68 cases. Am J Surg Pathol 2003; 27: 811-7.
- Zar N, Garmo H, Holmberg L, Rastad J, Hellman P. Long-term survival of patients with small intestinal carcinoid tumors. World J Surg 2004; 28: 1163-8.