Goblet Cell Carcinoid of the Appendix

ABSTRACT

A goblet cell appendiceal carcinoid (GCAC) is an uncommon tumor. It shares the histologic features of both adenocarcinoma and conventional carcinoids. The metastatic potential of GCAC is higher than that of classic appendiceal carcinoids. Their management, whether an appendectomy alone is an adequate treatment or whether a right hemicolectomy is indicated, is still under debate. The metastatic potential of GCAC is similar to that of classic appendiceal carcinoids and depends on the tumor size and the mitosis rate. Therefore, some authors advocate a simple appendectomy, not expanding beyond the appendix adventitia, for selected patients with tumors less than 1 cm in diameter with a low mitosis rate (<2/10 HPF). Otherwise, a right hemicolectomy is indicated for all other patients to reduce the risk of developing metastatic disease. Chemotherapy is the usual treatment option for metastatic disease, but more data are required if an optimal regimen is to be determined. Finally, colonoscopy plays an important role in patients with an appendiceal adenocarcinoid because of their high risk of developing a colorectal adenocarcinoma. Recently, we discovered one case of a GCAC that was diagnosed incidentally at appendectomy. A 48-yr-old man visited the emergency department with the symptom of right lower quadrant abdominal pain. Acute appendicitis was suspected after evaluation, and a laparoscopic appendectomy was performed. The type of appendicitis was gangrenous, and there were no obvious signs of malignancy. However, a pathologic diagnosis of a goblet cell carcinoid was made. A laparoscopic right hemicolectomy was subsequently performed. The patient received 5 cycles of chemotherapy applied to the goblet cell carcinoid and has shown no other remarkable indispositions during the last 12 mo.