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jsmc-10058


IDENTIFICATION OF GLANDULAR DIFFERENTIATION IN APPENDICEAL CARCINOID TUMOR- A STUDY IN SULAIMANIA CITY


Asmaa N. Abdullah *, Hadeel A. Yasseen *, Hassanain H. Khudier * and Ali Ibrahim *


* Department of Pathology and Forensic Pathology, School of Medicine, Faculty of Medical Sciences, University of Sulaimani.


Submitted: 18/12/2013; Accepted: 31/3/2014


ABSTRACT

Background 

Background
Carcinoid tumor of appendix is the most common appendiceal tumor. Both the classical and mixed carcinoid tumor could be identified using the routine H&E stain. Using additional stains such as Periodic Schiff stain, Alcian blue and cytokeratin 20 (CK20) stain have been used to detect these appendiceal mixed (glandular)
carcinoid tumors.

Objective

To identify glandular differentiation and mucin production in appendiceal carcinoid tumors by using special
stains and immunohistochemistry.

Patients and Methods

This retrospective case-control study was carried out in research laboratory of Pathology Department/School of Medicine. All pathological reports of patients with appendiceal carcinoid tumor were collected from the laboratory of pathology-Sulaimani Teaching Hospital over the period of six years (from the 1st of January 2006 to the 31st of December 2011), patient’s age, sex and histopathological diagnosis were documented. Fifteen cases (out of 10533 appendectomies) were divided into 2 groups: classical (insular) and mixed (insular with mucinous differentiation). Formalin-fixed, paraffin-embedded, 4- micrometer- thick sections were immunostained with CK20 using HIER-LSAB method. All cases were stained with Alcian blue stain for acidic mucin detection, and PAS stain for neutral mucin detection within the carcinoid tumor. Then the results of H&E stain, immunostain for epithelial differentiation and the special stains for mucin production were evaluated together and compared with similar studies.

Results

The carcinoid tumor is more common in females with a peak age range of 21-30 years, mean incidence 0.14% for fifteen cases of carcinoid tumors. Carcinoid tumor in patients above 50 years is usually mixed type. PAS and Alcian blue stains are of no statistically significant correlation with glandular differentiation, while CK20 has statistically significant correlation with glandular differentiation but staining intensity is variable.

Conclusion

H&E is the main method for the identification of glandular differentiation of carcinoid tumor, however CK20 has important value to assist the diagnosis, while mucin stains have limited value in the identification of glandular differentiation of carcinoid tumor.

KEYWORDS

Appendix, mixed carcinoid Tumor, PAS stain, Alcian blue, CK20.