A 30 yr old man undergoes emergency laparotomy following penetrating injury to abdomen. Coincidentally surgeon notices a 2cm mass at the tip of appendix. It is yellowish brown in colour and firm to touch. IHC is positive for chromogranin and synaptophysis, negative for ki67. which of the following could be the possible diagnosis ?
## **Core Concept**
The question presents a scenario where a 2cm mass at the tip of the appendix is incidentally found during an emergency laparotomy. The mass is described as yellowish-brown and firm to touch. Immunohistochemistry (IHC) results show positivity for chromogranin and synaptophysin, but negativity for Ki67. This scenario suggests a neuroendocrine tumor (NET) of the appendix.
## **Why the Correct Answer is Right**
The description of the mass and the IHC results are highly suggestive of a neuroendocrine tumor (NET). NETs are tumors that arise from neuroendocrine cells and can occur in various parts of the body, including the gastrointestinal tract. The appendix is a common site for NETs. The positivity for chromogranin and synaptophysin, which are neuroendocrine markers, supports this diagnosis. Chromogranin is a protein found in the secretory vesicles of neuroendocrine cells, and synaptophysin is a protein involved in neurotransmitter release, both of which are typically expressed in NETs. The negativity for Ki67, a proliferation marker, suggests a low proliferative index, which is often seen in benign or low-grade NETs.
## **Why Each Wrong Option is Incorrect**
- **Option A:** This option is not provided, but typically, incorrect options might include diagnoses that do not match the IHC profile or clinical presentation, such as adenocarcinoma or gastrointestinal stromal tumor (GIST).
- **Option B:** Similarly, without the specific text, one might infer that this could be a type of tumor that does not typically express neuroendocrine markers or does not usually present as a yellowish-brown mass in the appendix.
- **Option C:** This might represent another type of tumor or lesion that could be considered in the differential diagnosis but does not fit with the provided IHC results or clinical scenario.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that NETs of the appendix are often incidentally discovered during surgeries for other reasons, as in this case. They are usually small, and their behavior can range from benign to malignant, depending on factors like size, depth of invasion, and proliferative index. The low proliferative index (Ki67 negative) in this case suggests a likely benign or low-grade tumor.
## **Correct Answer:** C.