More terminology issues for new pathologists

--------Primary ovarian carcinoid:

1 second most common monodermal teratoma

2. Present in pure form (15%) and with other teratomatous elements (85%)

3. May occur at any age, but most patients are peri- or postmenopausal women with nonspecific symptoms.

4. Carcinoid syndrom may occur in some patients

5. Growth patters includ insular, trabecular, mixed, and mucinous types, just as carcinoids of the GI tracts.

6. Specific and sensitive marker is chromoganin. Synatophysin is fine also.

7. Always consider to rule out GI metastatic carcinoid. The prognosis is different. Clinical history, tumor components, size, location may help you. If patients have the history of GI carcinoid, the chance of metastasis is high. If ovarian carcinoid tumor with other teratomatous elements, the possibility of ovarian primary is high.Pathologists do not need to mention definitely it is primary or second carcinoid in the report even though you can say "favor for...."

8. My personal experience is that CDX2 stain may have some value to distinguish ovarian carcinoid from GI ones. Most GI carcinoids (especially upper GI, appendix) are positive for CDX2 in the literatures. My current study shows that almost all the ovarian carcinoids are negative for CDX2. 

--------- Strumal carcinoid

1. Ovarian tumor contains both carcinoid and thyroid tissue.

2. The tumors can be in pure form with only carcinoid and thyroid components or associated with dermoid cysts.

3. The tumors are almost always clinically benign.

4. The two components may be contiguous or intimately admixed (more often).

5. Stains: TTF-1 for thyroid component and chromogranin or synaptophysin for carcinoid component.