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P1108 - Unusual Presentation of Adenocarcinoma Ex Goblet Cell Carcinoid

Monday, October 28

10:30 AM - 4:15 PM

Location: Exhibit Halls 3 and 4 (Street Level)

Presenting Author(s)

ER

Ernesto Robalino Gonzaga, MD

Orlando, Florida

Patricia Guzman Rojas, MD¹, Ernesto Robalino Gonzaga, MD¹, Richard Henriquez, MD¹, Jignesh Parikh, MD²

¹University of Central Florida College of Medicine, Orlando, FL; ²Orlando VA Medical Center, Orlando, FL

Introduction: Ex Goblet cell carcinoid (eGCC) is a type of goblet cell carcinoid tumor, characterized by both endocrine and exocrine features, that has carcinomatous growth patterns. The classical presentation is compatible with symptoms of acute appendicitis. However, other signs and symptoms such as bowel obstruction, GI bleed and less commonly mesenteric adenitis or iron deficiency have been reported.

Case Description/Methods: A 72 year old man with a recent hospitalization due to symptomatic anemia, presented to the ED complaining of diffuse abdominal pain for the past 3 weeks. He also reported nausea and emesis for 12 hours. At the previous admission, a CTE (Figure 1) showed thickening of the TI and an EGD was unremarkable. A colonoscopy was recommended, but it was scheduled for completion as an outpatient. At this admission, his hemoglobin was within normal limits, however his abdominal pain and nausea were persistent despite medical treatment. A repeated CT abdomen showed the same TI thickening with an associated new SBO (Figure 2). General surgery was then consulted and the patient underwent an exploratory laparotomy. Intraoperative findings showed possible carcinomatosis, and thence an ileocolectomy and ileocolostomy were performed. Pathology findings were compatible with adenocarcinoma ex goblet cell carcinoid of the appendix (Figure 3), and for this reason, he was referred to oncology for further management.

Discussion: GCC can be classified into 3 groups according to the presence of adenocarcinoma component and its degree of differentiation which directly correlates with its prognosis. Group A exhibits only pure goblet cell carcinoid cells; group B shows goblet cells with signet ring cells, and group C presents with goblet cell cells with a component of adenocarcinoma. eGCC corresponds with group C, which is the type presented in our case. Most patients have metastatic disease at the time of diagnosis, estimated in 60% to 91% of the cases. Due to the rarity of this type of tumor, currently there are no guidelines for treatment. However, the main approach is based on surgical resection of the appendix versus right hemicolectomy if the tumor is not confined to the submucosa. In terms of adjuvant treatment, FOLFOX/FOLFIRI are currently being used in most institutions.

We present this patient due to its rarity and unusual presentation. Furthermore, we would like to incentivize future researches that can focus on implementing treatment guidelines for this tumor, due to its associated poor prognosis.

CT enterography showing in the left panel a Short-segment (less than 20 mm in length) circumferential mural thickening and enhancement within the distal jejunum/proximal ileum within the anterior abdomen. Right panel shows terminal ileum with an abrupt "7-shaped" configuration.

CT abdomen showing chronic distortion with luminal narrowing of the distal and terminal ileum. The small bowel loops proximal to this region are fluid-filled and dilated measuring up to 4.5 cm, consistent with obstruction.

Histopathology: Tumor is arising from the basal crypts of appendix (Figure A). Tumor shows both goblet cell carcinoid (lower left) and classic adenocarcinoma (upper right) component (figure B). Higher magnification view of goblet cell carcinoid (Figure C) and classic adenocarcinoma (figure D). Tumor is directly extend into ileum (Figure E).

Disclosures:

Patricia Guzman Rojas indicated no relevant financial relationships.

Ernesto Robalino Gonzaga indicated no relevant financial relationships.

Richard Henriquez indicated no relevant financial relationships.

Jignesh Parikh indicated no relevant financial relationships.

Citation: Patricia Guzman Rojas, MD; Ernesto Robalino Gonzaga, MD; Richard Henriquez, MD; Jignesh Parikh, MD. P1108 - UNUSUAL PRESENTATION OF ADENOCARCINOMA EX GOBLET CELL CARCINOID. Program No. P1108. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.