Surgical Pathology Criteria–

Carcinoma Ex-goblet Cell Carcinoid of the Appendix

Differential Diagnosis

Goblet Cell Carcinoid, Pure Carcinoma ex GCC, Signet Ring Cell Type Carcinoma ex GCC, Poorly Differentiated Carcinoma Type
Bland cytology Atypical cytology Atypical cytology
Cohesive clusters and cords Discohesive cells with single cell infiltration May have discohesive cells
No desmoplasia Desmoplastic response to invasion Desmoplastic response to invasion
Small clusters and cords, no poorly differentiated or undifferentiated carcinoma Irregular large clusters, no poorly differentiated or undifferentiated carcinoma May have confluent sheets of cells OR >1 low power field or >1 mm2 of conventional type adenocarcinoma, usually poorly differentiated or undifferentiated
Based on histopathologic findings in primary tumor
All must have at least focal typical goblet cell carcinoid
Based on Tang 2008

Appendiceal Adenocarcinoma Carcinoma Ex-goblet Cell Carcinoid
No typical goblet cell carcinoid At least focal typical goblet cell carcinoid
Usually low grade Usually high grade
Based on histopathologic findings in primary tumor

Appendiceal Carcinoid / Well Differentiated Neuroendocrine Cell Neoplasm Goblet Cell Carcinoid and/or Carcinoma ex-GCC
Chromogranin or synaptophysin positive Chromogranin and synaptophysin stain rare to scattered cells only
No intracytoplasmic mucin (lumenal mucin may be present in tubular carcinoid) Intracytoplasmic mucin in goblets
CK7 negative, CK20 variable CK7 variable, CK20 100%
Rare mitotic figures at most Mitotic figures may be numerous in carcinoma ex-GCC
Cohesive nests and cords Single cell infiltration or sheet like growth in carcinoma ex-GCC
No desmoplasia Desmoplasia may be present in carcinoma ex-GCC

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