Malignant Carcinoid Thmor of the Appendix with Liver
and Lung Metastasis : Report of a Case with a High Level
of Serum Carcinoembryonic Antigent
PLERNPIT PANOMREONGSAK, M.D.*,
SANYA SUKPANICHNANT, M.D.*,
YUDHTANA SATTAWATTHAMRONG,M.D.**,
CHUMPOL WONGWANIT, M.D.***,
CHALENGPOJ STHAPANACHAI, M.D.*,
KLEOPHANT THAKERNGPOL, B.Sc., M.Sc.*.
PHUNSUP WONGSURAKIAT, M.D.**,
PRASERT SEESILLAPACHAI, M.D.***
Affiliation : *** Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
t Presented in part at the 5th Asia Pacific Association of Surgical Pathologists and 9th National Congress of
Pathology, Bangkok, Thailand on December 2-5, 1997.
AbstractWe report elevated serum carcinoembryonic antigen (CEA) in a case of malignant
carcinoid tumor of the appendix with liver and lung metastasis. A 55-year-old Thai man was found
to have multiple nodules in the liver by ultrasonography. Serum CEA was 7,387.9 ng/mL (normal
0 - 4.1 ng/mL) leading to a clinical impression of colonic carcinoma with liver metastasis. During
the investigation, he developed acute abdomen caused by ruptured acute appendicitis. Malignant
carcinoid tumor of the appendix, I em in diameter and located proximal to the ruptured acute
appendicitis, was identified. The tumor cells showed trabecular or insular growth pattern, some
nuclear pleomorphism but typically fine nuclear chromatin, frequent mitoses and focal necrosis.
They were immunoreactive for antibody to chromogranin, neuron-specific enolase, CEA, and
cytokeratin. Tumor metastases were discovered in the liver, right lung, mediastinal and right
supraclavicular lymph nodes. Electron microscopic study demonstrated pleomorphic neuro-
secretory granules of the midgut type of carcinoid tumor.
Keywords : Carcinoid, Appendix, Liver, Lung, Metastasis, CEA, Immunohistochemistry, Electron Microscopy
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