Terminal ileum carcinoid - well differentiated neuroendocrine tumor (pathology)
Diagnosis certain
Presentation
Presents with obstructive symptoms. The patient underwent a right hemicolectomy.
Patient Data
Age: 60 years
Gender: Female
Hemicolectomy.
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Macroscopic:
- right hemicolectomy photograph includes segment of terminal ileum, cecum and ascending colon with tumor just visible in the distal terminal ileum
- the tumor is
- 18 mm in diameter
- mucosally based
- pale, homogeneous
- shows extension into subserosal tissue (Nb the muscularis propria is invaded rather than destroyed and is seen as a 'C' shaped band of tissue within the tumor nodule)
Histology:
- the tumor forms variably sized, well circumscribed nests ('insular' pattern)
- high power shows
- uniform cells
- rounded nuclei
- granular chromatin (so-called 'salt and pepper' chromatin).
Case Discussion
This is good example of a terminal ileal carcinoid, now more commonly referred to as well differentiated neuroendocrine tumor. This lesion was staged as pT3 N1 (with lymph node metastases in 4 of 11 local lymph nodes.