Surgical Pathology Criteria

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

Goblet Cell Carcinoid

GI Tract Adenocarcinoma

Bland cytologic features Atypical cytology
Chromogranin or synaptophysin positive (scattered) Chromogranin and synaptophysin negative
No desmoplastic response Desmoplastic response frequent
Rare mitotic figures Mitotic figures frequently numerous
Cohesive nests and cords Frequent single cell infiltration
No surface adenoma or in situ lesion May have surface adenoma or in situ component
p53-, MUC1-, MUC2+ p53+, MUC1+, MUC2 only 5% positive

Goblet Cell Carcinoid

Tubular Carcinoid (variant of classical carcinoid)

Solid nests and cords, no open lumens Tubules with open lumens
Abundant cytoplasmic mucin May have mucin in lumen but not in cytoplasm
Signet ring / goblet cell morphology Usual carcinoid morphology
<25% of cells mark as neuroendocrine Majority of cells mark as neuroendocrine

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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