Mixed carcinoid and adenocarcinoma of the appendix: report of 4 cases with immunohistochemical studies and a review of the literature.

Four cases of mixed carcinoid and adenocarcinoma of the appendix were reported. All cases presented with a dominant cecal-appendiceal tumor mass and local metastasis. Two patients had multiple peritoneal implants mimicking primary peritoneal serous adenocarcinoma or carcinomatosis. Histopathologic features of the tumors are similar, with infiltrating microglandular and cribriform patterns of tumor nests, and variable numbers of goblet cells. A literature review of "goblet cell carcinoid" that included nonlocalized cases revealed a significant percentage (>14%) of tumor-associated death, in contrast to the classic carcinoid tumor. Immunohistochemical stains were helpful to separate these tumors from carcinoid tumors and primary peritoneal serous adenocarcinoma. Mixed carcinoid and adenocarcinomas were cytokeratin (CK)-20 positive, and negative or weakly positive for chromogranin A and synaptophysin. Carcinoid tumors were CK20 negative and diffusely positive for chromogranin A and synaptophysin. Peritoneal serous adenocarcinomas were CK20 negative. These cases were clinically aggressive, and 1 patient had multiple recurrences and responded partially to chemotherapy.

Malignant fibrous histiocytoma of the spermatic cord: report of two cases and review of the literature.

Malignant fibrous histiocytoma (MFH) of the spermatic cord is rare, and most published cases are single case reports that emphasize clinical presentation and management. We describe in detail the histopathologic features of 2 cases of high-grade storiform-pleomorphic MFH arising in the spermatic cord. Both tumors occurred in elderly men, 65 years and 70 years, and were 4 cm (Case 1) and 5 cm (Case 2) in greatest dimension. The tumor mass in Case 1 was associated with satellite tumor nodules. At last follow-up, in Case 1 the patient died of metastasis, and in Case 2, the patient is alive and well 46 months after diagnosis. Review of the literature reveals 33 additional cases published in English (17 cases) or Japanese (16 cases) that include histologic description. Including the 2 cases in this report, most of the tumors occurred in older (than 50 years) patients (28 of 35 cases, 80%) and occurred as solitary masses that ranged in diameter from less than 1 cm to more than 20 cm. Nine patients presented with satellite tumor nodules. Twenty-nine (83%) tumors were of the storiform-pleomorphic type, with 3 giant cell type, 2 inflammatory type, and 1 myxoid type. These features do not differ significantly from MFH in other anatomic sites. Clinical follow-up is available in 33 cases (3-174 months; mean, 31.5 months). Twelve patients developed recurrence and metastasis; at least 4 patients died of the disease. Tumor size does not predict the clinical progression; however, patients with progressive tumors were commonly associated with satellite nodules at time of presentation, an indication of early local metastasis.