Used with permission from the author Leslie H. Sobin M.D., FRCPath

CARCINOID 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


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.