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Year : 2009  |  Volume : 52  |  Issue : 2  |  Page : 285-286
Concurrent occurrence of terminal ileum carcinoid tumor and cecal adenocarcinoma: A collision tumor or composite tumor?


1 Department of Pathology, Jagruti Hospital and Research Centre, Godhra, Gujarat, India
2 Department of Surgery, Jagruti Hospital and Research Centre, Godhra, Gujarat, India

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How to cite this article:
Jain M, Das K K. Concurrent occurrence of terminal ileum carcinoid tumor and cecal adenocarcinoma: A collision tumor or composite tumor?. Indian J Pathol Microbiol 2009;52:285-6

How to cite this URL:
Jain M, Das K K. Concurrent occurrence of terminal ileum carcinoid tumor and cecal adenocarcinoma: A collision tumor or composite tumor?. Indian J Pathol Microbiol [serial online] 2009 [cited 2020 Feb 20];52:285-6. Available from: http://www.ijpmonline.org/text.asp?2009/52/2/285/48953


Sir,

We report a case of collision tumor. A 56-year-old male was admitted in the surgical ward with history of loss of appetite, weight loss, malaise, abdominal distention, melena and abdominal pain of 1-month duration. Endoscopy showed a growth at the terminal ileum and a constrictive lesion at proximal end of ascending colon. A hemicolectomy was done with removal of lymph nodes and a piece of omentum.

A right hemicolectomy specimen measuring 28 × 7cm along with piece of omentum was received. On cutting open, cut surface showed a polypoidal growth measuring 5 × 4cm occupying the terminal ileum and showing buckling of bowel wall. Cecum showed thickened wall which was grayish white in color and measured 6cm in length and was 1.5cms thick. Histological examination showed that the tumor was composed of two distinct neoplastic cell lines. One was a well differentiated adenocarcinoma, which infiltrated the muscle layer [Figure 1] and the other was a carcinoid tumor composed of small uniform tumor cells arranged in nests and lobules [Figure 2]. Tumor cells had scanty cytoplasm and stippled chromatin. There was no admixture of components. Immunohistochemical studies on the tumor showing small uniform tumor cells showed positivity for chromogranin and synaptophysin.

Tumors of the gut with composite features of both adenocarcinoma and carcinoid have been recognized mainly in the appendix. Similar tumors arising from other parts of the gastrointestinal tract have also been reported. [1] In the present case, we observed carcinoid tumor in the terminal ileum and adenocarcinoma in the cecum. This combination of tumors is divided into two morphologic groups. When the two elements are juxtapositioned, a collision tumor is formed; that is, a tumor with a distinct boundary between the two components represent collision tumor. [2],[3] When there is intermingling between the two components it is called a composite tumor. [4] In our case, there was well differentiated adenocarcinoma in the cecum and carcinoid at the terminal ileum, indicating the collision tumor. Intermingling between the two components was not found. There are two schools of thought regarding the origin of this tumor. [5] One is that these tumors seem to be derived from multipotential stem cell capable of bi-directional differentiation. [6] The other hypothesis is that both tumors have different cells of origin. It has been observed that patients with carcinoids have an increased risk of developing secondary neoplasms and about half of these cases also have an adenocarcinoma in the gastrointestinal tract. It is generally concluded that these tumors have a worse prognosis than ordinary adenocarcinoma. [6],[7]


   Acknowledgement Top


We express our sincere thanks to Dr. Deval Doshi for providing help during execution of this work.

 
   References Top

1.Hulya L, Conard A.Cox, Venkat N. Composite tumors of gastrointestinal tract. Digestive diseases and Sciences 1990;35:519-25.  Back to cited text no. 1    
2.Morishita Y, Tanaka T, Kato K, Kawamori T, Amano K, Funato T, et al . Gastric collision tumour (carcinoid and adenocarcinoma) with gastritis cystica profunda. Arch Pathol Lab Med 1991;115:1006-11.  Back to cited text no. 2  [PUBMED]  
3.Hamilton SR, Aaltonen LA. World health Organization Classification of Tumours: Pathology and Genetics of Tumours of the Digestive system. Lyon: IARC Press; 2000. p. 45.  Back to cited text no. 3    
4.Jayaram A, Ramesh S, Jeyasingh R, Bagyalakshmi KR. Gastric collision tumour: A case report. Indian J Pathol Microbiol 2005;48:264-5.  Back to cited text no. 4    
5.Fukui H, Takada M, Chiba T. Concurrent occurence of gastric ­adenocarcinoma and duodenal neuroendocrine cell carcinoma: A composite tumour or collision tumour? Gut 2001;48:835-6.  Back to cited text no. 5    
6.Anagnostopoulos GK, Arvanitidis D, Sakorafas G, Pavlakis G, Kolilekas L, Arkoumani E, et al . Combined carcinoid-adenocarcinoma tumour of the anal canal. Scand J Gastroenterol 2004;39:198-200.  Back to cited text no. 6  [PUBMED]  
7.Yamashina M, Flinner RA. Concurrent occurrence of adenocarcinoma and carcinoid tumour in the stomach: A composite tumour or collision tumors? Am J Clin Pathol 1985;83:233-6.  Back to cited text no. 7  [PUBMED]  

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Correspondence Address:
Meenal Jain
c/o H.J. Doshi, Sevalay Hospital, LIC Road, Near Chitra cinema, Godhra, Gujrat - 389 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.48953

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    Figures

  [Figure 1], [Figure 2]

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