A Rare Case of Goblet Cell Carcinoid
Author(s): Sushma Nayar*
Objective: This case is presented for its rarity and importance of examining the tip of the appendix.
Case report: An 18 year’s old female presented with repeated haematuria, urinary tract infection and pain in the right lower abdomen. On MRI, an urachal cyst and acute appendicitis was diagnosed. The patient underwent surgery for the same. Incidentally, the patient was found to have a goblet cell carcinoid of the appendix on histopathological study. Goblet cell carcinoid can present with acute appendicitis as was seen in our patient.
Incidental finding of goblet cell carcinoid is seen in 3% cases. Goblet cell carcinoid can present with pain in right iliac fossa as in our case. Presentation with stage III/IV disease can be seen in 51% to 97% cases as was seen in our patient. Lymph node metastasis was seen in 17-38% cases with involvement of the mesenteric node. The patient did not have carcinoid syndrome. The tumour is generally seen at the tip of the appendix as an ill-defined mass with circumferential and longitudinal extension as was seen in our case. It may involve the whole of the appendix which was not seen in our case where the tumour was confined to the tip.
These tumours generally show strong positivity for CEA, CDX-2 CAM 5.2 and CK. They are inconsistently positive for neuroendocrine markers, though the tumour in our case showed diffuse Chromogranin positivity.
Conclusion: It is important to submit all appendixes for histopathological examination where especially the tip of the appendix should be examined.