Genetic Alterations in Goblet Cell Carcinoids of the Vermiform Appendix and Comparison with Gastrointestinal Carcinoid Tumors

• Published in: Modern pathology Vol. 16; no. 12; pp. 1189 - 1198
• Main Authors: Stancu, Mirela, Wu, Tsung-Teh, Wallace, Charita, Houlihan, Patrick S, Hamilton, Stanley R, Rashid, Asif
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2003; Elsevier Limited
• Subjects: 11q; 16q; Adult; Aged; Aged, 80 and over; Appendiceal Neoplasms - genetics; Appendiceal Neoplasms - metabolism; Appendiceal Neoplasms - pathology; Appendix; beta Catenin; Carcinoid Tumor - genetics; Carcinoid Tumor - metabolism; Carcinoid Tumor - pathology; Chromosomes, Human, Pair 11 - genetics; Chromosomes, Human, Pair 16 - genetics; Chromosomes, Human, Pair 18 - genetics; Cytoskeletal Proteins - genetics; DNA Mutational Analysis; DNA, Neoplasm - chemistry; DNA, Neoplasm - genetics; DNA-Binding Proteins - analysis; DNA-Binding Proteins - genetics; DPC4; Female; Gastrointestinal Neoplasms - genetics; Gastrointestinal Neoplasms - metabolism; Gastrointestinal Neoplasms - pathology; Genes, ras - genetics; Goblet cell carcinoid; Humans; Immunohistochemistry; K-ras; Loss of Heterozygosity; Loss of heterozygosity of 18q; Male; Microsatellite Repeats; Middle Aged; Mutation; p53; Smad4 Protein; Trans-Activators - analysis; Trans-Activators - genetics; Tumor Suppressor Protein p53 - analysis; β-Catenin; 11q; Goblet cell carcinoid; K-ras; β-Catenin; 16q; DPC4; Appendix; Loss of heterozygosity of 18q; p53
• ISSN: 0893-3952; 1530-0285
• DOI: 10.1097/01.MP.0000097362.10330.B1

Goblet cell carcinoid is a relatively rare neuroendocrine tumor of the vermiform appendix with poorly understood molecular pathogenesis. We studied the clinicopathologic features and genetic alterations, including allelic loss of chromosomes 11q, 16q, and 18q; sequencing of the K-ras, β-catenin, and DPC4 (SMAD4) genes; and p53 overexpression and loss of DPC4 by immunohistochemistry; in 16 goblet cell carcinoids. We compared the allelic loss in goblet cell carcinoids to those in 18 gastrointestinal carcinoid tumors. For goblet cell carcinoids, appendiceal perforation was the most common (70%, 7/10) clinical presentation. The mean tumor size was 2.0 ± 1.5 cm (range, 0.4 to 4.5 cm). The tumor invaded to appendiceal serosa in 50% (8/16) of patients, and two patients had metastasis in lymph nodes or adjoining viscera. With mean follow-up of 24 ± 14 months (median, 23 mo), 1 of 10 patients had died of disease, and 2 others had tumor recurrence. All four patients with metastases, recurrences, and/or death from disease had serosal involvement at presentation (P = .02). Loss of heterozygosity of chromosome 11q was present in 25% of goblet cell carcinoids, 14% of ileal carcinoid tumors, and 9% of nonileal carcinoid tumors; of chromosome 16q in 38%, 29%, and 0 (P = .02); and of chromosome 18q in 56%, 86%, and 9% (P = .002), respectively. No mutations of K-ras, β-catenin, or DPC4 genes; p53 overexpression; or loss of staining for DPC4 was present in any tumors. These findings suggest that allelic loss of chromosomes 11q, 16q, and 18q in goblet cell carcinoids and ileal carcinoids may have an important role in the pathogenesis of these tumors.