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Goblet cell carcinoid in ascitic fluid

Dear Dr. Bedrossian, Goblet cell carcinoid (GCC) is a rare appendiceal tumor exhibiting both neuroendocrine and glandular differentiation. This entity is also referred to as ‘‘adenocarcinoid,’’ ‘‘mucinous carcinoid,’’ ‘‘microglandular goblet cell carcinoma,’’ and ‘‘mixed adenocarcinoma carcinoid.’’ It is considered a separate entity from the classic appendiceal endocrine tumor and appendiceal adenocarcinoma in its behavior and prognosis. Medical literature is sparse in cytologic description of GCC both in effusion and fine-needle aspiration (FNA) cytology. The diagnosis of metastatic GCC in body cavity fluids may be especially challenging. Not only unfamiliarity with its cytologic features due to its rarity but also overlapping morphology with benign reactive mesothelial cells and histiocytes may cause difficulties in arriving at an accurate diagnosis. Here, we present a case of GCC in a 67-year-old female who complained of abdominal and rectal pain, and bloating. Abdominal and pelvic CT showed minimally enlarged left ovary, pelvic ascites and multiple small omental nodules measuring up to 3 mm consistent with carcinomatosis. The preoperative laboratory tests demonstrated an elevated cancer antigen (CA) 125 and carcinoembryonic antigen (CEA). With a preoperative diagnosis of probable ovarian cancer, the patient underwent a laparoscopy. On laparoscopy, there was carcinomatosis involving the anterior abdominal wall, omentum, mesentery, liver, small bowel, and bilateral fallopian tubes and ovaries. The appendix was large, firm, and bulky suggesting an appendiceal primary. An appendectomy and bilateral salpingoophorectomy along with staging biopsies were done. Ascitic fluid was drained. Surgical specimen and the drained ascitic fluid were submitted for pathologic examination. Cytologic Findings