Tang classification | Goblet cell carcinoid | Carcinoid | Adenocarcinoma |
Clinical features |
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Age | 5th - 6th decade | 4th decade | 7th decade |
Carcinoid syndrome | No | Yes | No |
Primary symptoms | Acute appendicitis | Acute appendicitis | Mass |
Gross appearance | >2 cm, ill defined thickening | <2 cm | >2 cm, well defined mass |
Microscopic appearance |
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Morphology | Clusters of goblet or signet-ring cells separated by fibrosis/pools of mucin | Nests of small cells | Well-formed glands to sheets of poorly differentiated signet-ring cells |
Atypia | Minimal | Minimal | Marked |
Mitosis | Rare | Rare | Increased |
Vascular and perineural invasion | Present | Absent | Present |
Infiltrative margins | Present | Absent | Present |
Special stains |
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Argyrophil | Positive | Positive | Usually negative |
Argentaffin | Negative | Positive | Negative |
Mucicarmine/PAS/PASD | Positive in goblet cells | Negative | Positive |
IHC |
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CEA | + | − | + |
CDX2 | + | − | + |
CAM5.2 | + | − | + |
CK20 | +/− | − | + |
CK7 | +/− | − | − |
CK19 | + | − | − |
Neuroendocrine markers | +/− | +/− | − |
Math1 and HD5 | + | − | + |
p53, p16 | − | − | + |
Molecular pathology |
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DPC4, Kras, β-catenin mutation and p53 over expression | − | − | + |