Used with permission from the author Leslie H. Sobin M.D., FRCPathCARCINOID by Leslie H. Sobin M.D., FRCPath Chief
By the shores of Duodenum
where the Villi ply the chyle
Heed Ampulla's tale of Carcinoid
beside the River Bile.
There had come three Pious Patches
from the distant ileal bowel
Most concerned with submucosal growths
were they fair or foul.
Oh do tell us Great Ampulla
savants say they're Carcinoid
Does it mean we're doomed or is it
something that we can avoid.
So upon the slopes of Oddi
Pious Patches harkened well
To the teachings of Ampulla
as diurnal acid fell.
Now genetically they're endocrine
a tribe diffuse spread wide
From well north of the Pylorus
to the colon's distal side.
They're derived from the Kulchitsky clan for silver they've attractions
Filled with amines hormones peptides a rich source of gut reactions.
Tell us why they turn malignant
and a course aimed at aggression
Is it overstimulation
or perhaps gene derepression?
Can they ever be benign
and alike an adenoma
Or are all potential dragons
and akin to carcinoma?
They're most frequent in appendix
where behavior's largely mellow
Filled with serotonin granules
on cut surface brightly yellow.
If they compromise the lumen
the result is suppuration
It's a blessing in disguise
leads to early extirpation.
Woe the Carcinoids of ileum
present when more advanced
Can be into mesenteric fat
their distant spread's enhanced.
Nodules those within the rectum
by palpation are detected
They are typically well localized
and easily resected.
Often having acid phosphatase
and nesting in the wall
Masquerading as prostatic
do avoid this overcall.
In the duodenum there exists
Somatostatinoma
It's a lesion quite distinctive
with small bodies of psammoma.
When anemia is pernicious
then in gastric
wall are grown Tiny carcinoid-like foci
their potential is unknown.
Gastrinoma lies in pancreas
as far as near the spleen
Causing many peptic ulcers
on the shores of Duode'en.
An appendiceal variety
has goblet cells and mucin
Can be dangerous aggressive
more metastases producing.
Note the Carcinoid's growth patterns
they're of diagnostic use
You'll find insular trabecular
gland-like and diffuse.
Almost all argyrophilic
about half argentaffin
With an enolase they're positive
dense granules by EM.
Periodically their name is changed
for instance APUDoma
Neuroendocrinic tumor
or Kulchitsky carcinoma.
Although changing names is stylish
it adds little but confusion
Stick to what is widely understood
yes that is my conclusion.
So the Pious Patches back they sailed
to Ileum's far shore
To the enigmatic carcinoid
and what fate had in store.
The author Leslie H. Sobin M.D., FRCPath Chief
Dr. Sobin serves as director of the Center for Scientific Publications. About two thirds of his time is available to the Division of Gastrointestinal Pathology. Dr. Sobin is associate editor of the AFIP Atlas of Tumor Pathology, chairman of the TNM/Prognostic Factors Project of the International Union Against Cancer and member of the World Health Organization (WHO) Expert Advisory Panel on Cancer.
Dr. Sobin is professor of pathology at the Uniformed Services University of the Health Sciences (USUHS) and adjunct professor of pathology, Georgetown University Medical College.