Two different types of carcinoid tumors of the lung: immunohistochemical and ultrastructural investigation and their histogenetic consideration.

Carcinoid tumors have been an interesting clinical and pathological entity for pathologists because of their unique histopathologic pattern of "Zellballen" (cell ball) and the hormones they produce demonstrable by histochemical and biochemical methods, including immunohistochemistry, and the presence of cytoplasmic dense-core particles demonstrable by electron microscopy. Since carcinoid tumors were established as an entity more than a century ago by Oberndorfer, who was credited with coining the term "carcinoid," meaning carcinoma-like tumors, tumors presenting with similar characteristics have been reported in most of parenchymal organs, including lungs. Carcinoid tumors in the lungs usually occur as bronchocentric tumors and present with typical histopathologic characteristics of carcinoid tumors, but they may present with significant variation in their cellular compositions, in contrast to the midgut carcinoid tumors. In the latter, tumor cells are quite similar to enterochromaffin granule containing crypt cells, which are regarded as their progenitor cells. Currently, a similar histogenetic explanation is applied to all carcinoid tumors occurring elsewhere. The bronchus is one of the most common anatomic sites in which the carcinoid tumors occur. However, bronchial carcinoid tumors differ from the midgut counterparts in microscopic appearance, showing more variability in cellular shape and composition from the classical form of midgut carcinoid tumors. In the lungs, neuroendocrine cells (NEC) are normally found in two different ways. Firstly, they are found as randomly scattered single cells (Kultchitsky cells) similar to enteric counterparts, and, secondly, they are found in aggregates known as "neuroepithelial bodies" (NEB) usually found in the branching point of bronchi. Interestingly, they keep a close anatomic relationship with parasympathetic nerve structures and even form synapses. NEB are usually found in the early stage of fetal development and are claimed to play an important role in the branching of bronchi and regeneration of bronchial epithelial cells following tissue injury. They are claimed to play an important function as a chemoreceptor apparatus related to oxygen tension of the breathing air. To test the hypothesis that histopathologic variability found in bronchial carcinoids may be related to the fact that lungs are endowed with more than one type of NEC, the author reviewed 36 cases of bronchial carcinoids and found 8 cases in which tumor cells varied significantly from typical carcinoids in cell shape and arrangement. Tumor cells tend to be spindly with frequent presence of S-100-positive sustentacular cells. The latter was designated as type II carcinoid and the rest as type I. Ultrastructurally, tumor cells in type I exhibited features more typical for epithelial cells. The tumor cells were usually polygonal, forming closely packed cell masses, and cell membranes were closely apposed with frequent primitive cell junctions. The membrane-bound dense-core granules were of variable size and appearance and larger than those seen in type II in which the size of granules ranged from 160 to 350 nm. In 2 cases of type I, frequent cells contained myelin bodies similar to those found in type II alveolar cells. In 14 cases of type I tumors, tumor cells formed lumens into which microvilli were converging. In 5 cases, some areas showed increased cell size exceeding the usual limit of pathologist's comfortable range of small cells. In 2 cases, the tumor contained areas of adenocarcinoma. Tumor cells in type II were rather oblong and closely packed without any intercellular spaces and the majority of tumor cells contained dense-core granules typical for so-called P granules. These cells seem to give out slender cell processes containing a few dense-core granules. In rare foci, groups of thin cell processes aggregate where profiles of processes cut at different angles can be seen. In such areas one can recognize the profiles of microtubules in many of them. In one tumor, which was previously reported by the author (Ultrapath 2001;25:207), microtubule-containing dendrites were common, as seen esthesioneuroblastomas. They appeared similar to dendrites of neurons. In addition to these chief cells, there were variable numbers of agranulated cells usually found at the periphery of cell balls bordering the interstitium. Some of these cells contained large aggregates of polymorphic dense bodies. However, no definite premelanosomes were found in our series. The results indicate that there exist at least two different types of carcinoid tumors in the lungs and their immunohistochemical and ultrastructural characteristics are quite different. The type I tumors are quite similar to those found in the midgut and their histogenesis might be similar. The type II tumors showed rather definite neural features in their immunophenotypic and ultrastructural characteristics, which is difficult to explain by the same histogenesis applied to type I. We postulate that type II tumors have a different histogenesis from type I. They may derive from NEC of neuroepithelial bodies rather than Kultchitsky cells. In this regard, it is interesting to note the similarity between neuroepithelial bodies of the lungs and olfactory bulbs in their cellular composition and anatomic arrangement of epithelial cells and nerves, and the similarity between tumors they produce, bronchial carcinoid tumors in our type II and olfactory neuroblastomas. It is concluded that there are two types of bronchial carcinoid tumors having two different histogenetic pathways. Detailed analysis of the ultrastructural characteristics is the best and definite means to differentiate two types of pulmonary carcinoid tumors.

Metastasizing middle ear carcinoid: an unusual case report, with focus on ultrastructural and immunohistochemical findings.

BACKGROUND: There are only 4 unequivocal cases of metastasizing middle ear carcinoid previously reported. OBJECTIVE: To present a case of metastasizing middle ear carcinoid, to review previously reported cases, and to discuss the clinical nature of this tumor, which is similar to "orthotopic" carcinoids bearing definite metastatic potential. STUDY DESIGN: Case report. PATIENT, INTERVENTION, RESULTS: We present a 72-year-old woman who developed ipsilateral parotid gland and cervical lymph node metastases 8 and 11 months after surgical removal of a primary middle ear lesion. She subsequently required 2 revision procedures and radiotherapy for local recurrences. Her case was complicated by nonsurgically induced permanent facial nerve paralysis, the cause of which remains obscure. At the end of the 8-year follow-up, the patient was alive with locally, recurrent tumor eroding the cranial base and invading the posterior intracranial fossa but with no signs of metastases. MAIN OUTCOME MEASURES: Light microscopy and immunohistochemical analysis. CONCLUSION: Considering the reported high rate of recurrence and their consequent metastases, a middle ear carcinoid should be classified as a neuroendocrine low-grade carcinoma.

[Morphological features of pulmonary and thymic carcinoid tumor].

Morphological features of atypical and typical subtypes of pulmonary and thymic carcinoid tumors have been studied by pathohistological, immunohistochemical and electron-microscopic methods. There are the main principles of differential diagnostics in the article.

Ultrastructure of ECL cells in Mastomys after long-term treatment with H2 receptor antagonist loxtidine.

Gastric ECL-cell hyperplasia and carcinoids (ECLoma) develop after 1 year in rats treated with omeprazole or 2 months in Mastomys treated with loxtidine. The aim of this study was to examine the ultrastructure of ECL cells in Mastomys after loxtidine treatment with an attempt to evaluate whether an impairment of autophagy was involved in the tumorigenesis. Mastomys were given loxtidine for 8 or 27 weeks. Morphological analysis of ECL cells showed that (1) cell size was not increased after 8 or 27 weeks; (2) secretory vesicles, a hallmark feature of welldifferentiated ECL cells, were unchanged after 8 weeks but reduced after 27 weeks; (3) granules were reduced after 8 or 27 weeks; (4) microvesicles were unchanged after the treatment; and (5) vacuoles and lipofuscin bodies were found occasionally after 8 weeks but not at 27 weeks. In addition, the appearance of ECL-cell ultrastructure differed between loxtidine-treated Mastomys and rats treated with omeprazole or subjected to antrectomy, but was similar between Mastomys treated with loxtidine for 27 weeks and mice deficient in CCK(2) receptor. We suggest that the ultrastructure of ECL cells in Mastomys after long-term treatment with loxtidine displayed an impaired formation of vacuoles and lipofuscin bodies, markers of the autophagic pathway.

Malignant Brenner tumor of the ovary with transformation to trabecular carcinoid: an immunocytochemical and electron microscopic study.

Ovarian Brenner tumors are typically of surface epithelial-stromal origin; however, cases associated with mature cystic teratoma and/or struma ovarii possibly have a teratomatous derivation. Although argyrophil cells have been described in ovarian Brenner tumors and in urinary bladder epithelium, we are not aware of any previous reports of carcinoid arising from a malignant Brenner tumor of the ovary. In this study, we describe an 85-year-old woman who had a low-grade malignant Brenner tumor with progressive proliferation of neuroendocrine cells and transformation to trabecular carcinoid as demonstrated by immunocytochemistry and electron microscopy.

Ghrelin-producing well-differentiated neuroendocrine tumor (carcinoid) of tailgut cyst. Morphological, immunohistochemical, ultrastructural, and RT-PCR study of a case and review of the literature.

Well-differentiated neuroendocrine tumors (carcinoids) arising in the presacral space are rare neoplasms that can arise in association with either sacrococcygeal teratomas or tailgut cysts. Although tumors arising in tailgut cysts are more frequent than those associated with teratomas, they are still very rare, and only 13 cases have been reported in the literature. We describe the first case of a carcinoid composed of ghrelin-producing cells arising in a tailgut cyst. Ghrelin production was demonstrated using immunohistochemistry, electron microscopy, and reverse transcription-polymerase chain reaction methods. A 73-year-old woman with back and pelvic pain was found to have a presacral mass histologically diagnosed, on needle biopsy, as a well-differentiated neuroendocrine tumor. Workup did not show another primary tumor or metastatic disease. The patient underwent laparoscopic resection of the mass, and the pathological diagnosis of the surgical specimen was of a tailgut cyst-associated carcinoid composed of ghrelin-producing cells. In addition, we have accurately reviewed the literature on presacral carcinoids, associated or unassociated with tailgut cysts, to give the reader a comprehensive overview of these very rare tumor types.

Lipid-rich and clear cell neuroendocrine tumors ("carcinoids") of the appendix: potential confusion with goblet cell carcinoid.

The so-called clear cell change has been described in neuroendocrine tumors at several locations. Those associated with von Hippel Lindau disease are pathognomonically "clear" and the cytoplasmic appearance has been ascribed to intracytoplasmic lipid. However, lipid has not been demonstrated in all cases of clear cell carcinoid tumors. Such variants have not been described in carcinoid tumors of the appendix and cases with a prominent proportion of clear or more correctly, lipid-rich cytoplasm may bear a superficial resemblance to goblet cell carcinoid and/or signet ring adenocarcinoma. Seven cases, in 5 females and 2 males ranging in age from 22 to 65 years, were noted to have a population of lipid-rich and vacuolated clear cells accounting for 25% or more of the tumor population. The carcinoid tumors were incidental in all cases with 4 of patients presenting with appendicitis, 2 with concomitant mucinous cystadenocarcinomas of the appendix and 1 with an adenocarcinoma of the ascending colon. Morphologically, the tumors had a nested and trabecular pattern and were composed of an admixture of microvesicular and clear lipid-rich cells. There were no mitoses, areas of necrosis of lymphovascular invasion and all cases extended to the mesoappendix. All cases were positive for synaptophysin, chromogranin, and serotonin but negative for inhibin. Three cases were examined ultrastructurally, and showed the presence of intracytoplasmic lipid and neurosecretory granules. None of the patients have shown evidence of recurrent disease. The importance of recognizing this variant of carcinoid tumor in the appendix is to avoid confusion with goblet cell carcinoid tumors with or without a signet ring adenocarcinoma. The presence of multi-vacuolated, foamy and clear cells, some resembling signet ring or goblet cells, in otherwise classic carcinoid tumors is rare but should be considered in this context in the appendix.

Using electron microscopy and multivariate cluster analysis to determine diagnosis and prognosis in cases of neuroendocrine lung carcinoma.

OBJECTIVE: To establish reproducible electron microscopic criteria for identifying the four major types of neuroendocrine tumors of the lung: carcinoid; atypical carcinoid; large cell neuroendocrine carcinoma; and small cell carcinoma. METHODS: Measurements were made on electron micrographs using a digital image analyzer. Sixteen morphometric variables related to tumor cell differentiation were assessed in 27 tumors. The examination under electron microscopy revealed that all of the tumors could be classified as belonging to one of the four categories listed above. Cluster analysis of the morphometry variables was used to group the tumors into three clusters, and Kaplan-Meier survival function curves were employed in order to draw correlations between each cluster and survival. RESULTS: All three clusters of neuroendocrine carcinomas were found to be associated with survival curves, demonstrating the prognostic significance of electron microscopic features. The tumors fell into three well-defined clusters, which represent the spectrum of neuroendocrine differentiation: typical carcinoid (cluster 1); atypical carcinoid and large cell neuroendocrine carcinoma (cluster 2); and small cell carcinoma (cluster 3). Cluster 2 represents an intermediate step in neuroendocrine carcinogenesis, between typical carcinoid tumors and small cell carcinomas. CONCLUSIONS: Our findings confirm that electron microscopy is useful in making the diagnosis and prognosis in cases of lung tumor.

Diagnóstico e prognóstico dos tumores pulmonares neuroendócrinos mediante microscopia eletrônica e análise multivariavel de agrupamento / Using electron microscopy and multivariate cluster analysis to determine diagnosis and prognosis in cases of neuroendocrine lung carcinoma

OBJECTIVE: To establish reproducible electron microscopic criteria for identifying the four major types of neuroendocrine tumors of the lung: carcinoid; atypical carcinoid; large cell neuroendocrine carcinoma; and small cell carcinoma. METHODS: Measurements were made on electron micrographs using a digital image analyzer. Sixteen morphometric variables related to tumor cell differentiation were assessed in 27 tumors. The examination under electron microscopy revealed that all of the tumors could be classified as belonging to one of the four categories listed above. Cluster analysis of the morphometry variables was used to group the tumors into three clusters, and Kaplan-Meier survival function curves were employed in order to draw correlations between each cluster and survival. RESULTS: All three clusters of neuroendocrine carcinomas were found to be associated with survival curves, demonstrating the prognostic significance of electron microscopic features. The tumors fell into three well-defined clusters, which represent the spectrum of neuroendocrine differentiation: typical carcinoid (cluster 1); atypical carcinoid and large cell neuroendocrine carcinoma (cluster 2); and small cell carcinoma (cluster 3). Cluster 2 represents an intermediate step in neuroendocrine carcinogenesis, between typical carcinoid tumors and small cell carcinomas. CONCLUSIONS: Our findings confirm that electron microscopy is useful in making the diagnosis and prognosis in cases of lung tumor.

OBJETIVO: Estabelecer, com ajuda do microscópio eletrônico, critérios que possibilitem uma diferenciação mais exata entre os quatro tipos maiores de tumores neuroendócrinos pulmonares: tumor carcinóide típico e atípico, carcinoma de grandes células neuroendócrino e carcinoma de pequenas células. MÉTODOS: Todos os tumores foram avaliados morfometricamente e 16 variáveis foram relacionadas com diferenciação das células tumorais; estas variáveis foram analisadas sob microscopia eletrônica com ajuda de um analisador de imagem digital em 27 tumores. A avaliação através da microscopia eletrônica revelou que todos os tumors investigados podiam ser classificados a um dos quarto tipos listados acima. A análise das variáveis morfométricas foi usada para agrupar os tumores em três grandes grupos, os quais foram relacionados à sobrevivência pelas curvas de Kaplan Meier. RESULTADOS: Os três grupos de carcinoma neuroendócrino associaram-se às curvas da sobrevivência, as quais mostraram características ultrastruturais na microscopia eletrônica de significância prognóstica distinta. Os tumores foram contidos em três grupos bem definidos, que representam o espectro da diferenciação neuroendócrina: tumor carcinóide (grupo 1); tumor carcinóide atípico e carcinoma de grandes células neuroendócrino (grupo 2); e carcinoma de pequenas células (grupo 3). O grupo 2 representa um espectro intermediário na carcinogênese neuroendócrina, entre o carcinóide típico e o carcinoma de pequenas células. CONCLUSÕES: Nossos achados confirmam que a microscopia eletrônica é uma ferramenta útil no diagnóstico e prognóstico dos casos de tumores pulmonares.

Application of light microscopical and ultrastructural immunohistochemistry in the study of goblet cell carcinoid in the appendix.

BACKGROUND: Goblet cell carcinoids appear less frequently in the appendix than do other carcinoids. In the presented work a case with a goblet cell carcinoid of the appendix is described. METHODS: Routine histological and histochemical methods were employed, with a combination of histochemistry and immunohistochemistry on one section and light and electron microscopical immunohistochemisty on paraffin-embedded material, were applied to identify the type of the carcinoid and to reveal the fine structure of cell types in the tumour nests of the appendix. RESULTS: During the biopsy of a patient who had undergone appendectomy, an infiltration with clusters of goblet cells in the submucosa of the appendix was found. After a second operation of right-sided hemicolectomy, similar clusters of goblet cells were detected in the muscle layers of the caecum. After 18 months the patient died from cirrhosis and had not developed metastases or any recurrence. Immunohistochemically the serotonin-, somatostatin-, chromogranin A- and synaptophysin-positive endocrine cells were basally attached to mucin-secreting cells. The combined staining revealed simultaneously present endocrine cells (chromogranin-A-positive) and mucin-secreting cells (PAS- or alcian blue-positive). The ultrastructural immunohistochemistry showed that chromogranin A-positive cells had discoid and pleomorphic granules and were located in tumour nests or as single cells in the appendiceal wall. CONCLUSION: The combined histochemical and immunohistochemical procedure and the ultrastructural immunohistochemistry on archival material could contribute in clarifying the diagnosis of goblet cell carcinoid.

Carcinoid tumor of the renal pelvis: consideration on the histogenesis.

Carcinoid tumor of the renal pelvis is an extremely rare neoplasm and only two cases have been previously reported in the English-language literature. Reported herein is a third case of carcinoid tumor arising in the renal pelvis. The tumor extending from the left renal pelvis into the left kidney was incidentally found in a 55-year-old Japanese woman. Macroscopically, the tumor was predominantly located in the dilated renal pelvis and was grayish-white on cut surface. Microscopically, neoplastic cells proliferated with a ribbon-like, trabecular, tubular and solid pattern. Furthermore, the tumor focally invaded the kidney parenchyma. No precursor lesion of neuroendocrine tumor was observed in the peripheral urothelial epithelium. Neither urothelial carcinoma nor teratoma component was observed within the tumorous mass. The cytoplasm of neoplastic cells was focally positive for Grimelius stain and focally positive for chromogranin A and synaptophysin. However, no neoplastic cells reacted with cytokeratins 7 and 20. Ultrastructurally, neoplastic cells contained dense core granules in the cytoplasm. Urologists and pathologists should recognize that carcinoid tumor may arise from the renal pelvis.

Carcinoid tumor of the middle ear.

The patient was a 32 year-old man who was first seen in 2003 for 2 years hearing loss. On otoscopic examination, a whitish mass could be observed through the intact tympanic membrane. High resolution computed tomography showed a tumor like lesion in the middle ear with no evidence of bone destruction. A tympanomastoidectomy was performed. Light microscopy showed fragments of cellular tissue in which both glandular and trabecular growth pattern could be identified Immunohistochemical examinations showed positive staining of the tumor cells for cytokeratin and chromogranin. The diagnosis of carcinoid tumor should be considered in all cases of adenomatous neoplasms of the middle ear and mastoid. Conservative surgical excision is the treatment of choice, and local recurrence following complete excision is uncommon.

Frizzled-7 dictates three-dimensional organization of colorectal cancer cell carcinoids.

Progression of colorectal cancer (CRC) involves spatial and temporal occurrences of epithelial-mesenchymal transition (EMT), whereby tumour cells acquire a more invasive and metastatic phenotype. Subsequently, the disseminated mesenchymal tumour cells must undergo a reverse transition (mesenchymal-epithelial transition, MET) at the site of metastases, as most metastases recapitulate the pathology of their corresponding primary tumours. Importantly, initiation of tumour growth at the secondary site is the rate-limiting step in metastasis. However, investigation of this dynamic reversible EMT and MET that underpins CRC morphogenesis has been hindered by a lack of suitable in vitro models. To this end, we have established a unique in vitro model of CRC morphogenesis, which we term LIM1863-Mph (morphogenetic). LIM1863-Mph cells spontaneously undergo cyclic transitions between two-dimensional monolayer (migratory, mesenchymal) and three-dimensional sphere (carcinoid, epithelial) states. Using RNAi, we demonstrate that FZD7 is necessary for MET of the monolayer cells as loss of FZD7 results in the persistence of a mesenchymal state (increased SNAI2/decreased E-cadherin). Moreover, FZD7 is also required for migration of the LIM1863-Mph monolayer cells. During development, FZD7 orchestrates either migratory or epithelialization events depending on the context. Our findings strongly implicate similar functional diversity for FZD7 during CRC morphogenesis.

Tumor carcinoide: informe de un caso / Carcinoid tumor: a case report

Se presenta el caso de una niña de 14 años de edad, remitida al Hospital Pediátrico “Pedro Agustín Pérez”, que presentó un tumor carcinoide. Se señala la procedencia, la evolución de la historia de la enfermedad actual y se señalan los aspectos clínicos que ayudaron a realizar el diagnóstico, así como las alteraciones encontradas en los estudios complementarios realizados. Se expone el tipo de incisión elegida por el cirujano, los hallazgos de la operación y el estado en que se encontró el apéndice cecal. Se realizan comentarios finales, donde se muestra la incidencia de esta enfermedad y se describen los síntomas más importantes del cuadro clínico del tumor carcinoide funcional y las sustancias activas que favorecen su mecanismo de producción. Además, se describen los aspectos macroscópicos y microscópicos de esta entidad nosológica. Se expone la evolución postoperatoria de la paciente intervenida y se muestran fotos macro y microscópica del apéndice cecal y de la tumoración, respectivamente.(AU)

Ultrastructure and chromogranin A immunogold labelling of ECL cell carcinoids.

Poorly differentiated neuroendocrine cells can be difficult to recognise. Sensitive methods are needed to label cells that have lost their ultrastructural features and have reduced concentrations of neuroendocrine markers. In gastric neoplasms, enterochromaffin-like cells might dedifferentiate and lose their characteristic granules and secretory vesicles, making detection of such cells increasingly difficult. However, chromogranin A (CgA) immunogold labelling could provide sensitive and specific detection of gastric neuroendocrine cells. We present ultrastructural findings, CgA immunogold labelling as well as conventional immunohistochemical findings of two human enterochromaffin-like cell carcinoids. Electron-dense granules of poorly differentiated cells were less intensely labelled than granules in well-differentiated cells. Granules with atypical shape as well as punctuate granules previously found in neuroendocrine neoplasms were also CgA labelled. The CgA labelling efficacy after antigen retrieval in an alkaline solution was higher after heating in an autoclave at 135 degrees C compared to a microwave at 100 degrees C for both granules and secretory vesicles without significant deterioration of the ultrastructure. In conclusion, the use of CgA immunogold labelling could ensure a specific classification of cells with neuroendocrine granules and be a supplement to immunohistochemical examination of poorly differentiated tumours.

A new simplified catalyzed signal amplification system for minimizing non-specific staining in tissues with supersensitive immunohistochemistry.

We investigated non-specific staining in a catalyzed reporter deposition (CARD) reaction and improved its blocking methods in supersensitive immunohistochemistry, based on our simplified catalyzed signal amplification (CSA) system (Hasui et al. 2002). In the CARD reaction using biotinyl tyramide, non-specific staining could be reduced by pretreatment with a casein solution or 3% bovine serum albumin (BSA)-phosphate buffer saline (PBS) with 0.1% Tween 20. In the CARD reaction using FITC-labeled tyramide, non-specific staining could be blocked by pretreatment with 0.3% BSA-PBS with 0.1% Tween 20 or 3% polyethylene glycol-PBS with 01% Tween 20. Thus, our new simplified CSA system features: 1) destruction of the endogenous peroxidase activity; 2) blocking of the nonspecific reaction of the primary antibody; 3) a primary antibody reaction; 4) blocking of the non-specific reaction of the polymer reagent by casein treatment; 5) a polymer reaction; 6) blocking of the non-specific reaction of CARD reaction by casein treatment; 7) a CARD reaction; and 8) detection of deposited tyramide. This new system proved useful for detecting an extremely low amount of antigen in the endogenous biotin-rich tissues such as the gastrointestinal tract and liver. By this method, the Ki67 antigen in the G1 phase cell cycle could be detected and a metabolic disorder of the Ki67 antigen was implicated in a carcinoid tumor in the stomach. We believe that this new simplified CSA system represents a new standard of supersensitive immunohistochemistry for use in light-microscopic investigation.

Expression of occludin in human rectal carcinoid tumours as a possible marker for glandular differentiation.

AIMS: To examine whether or not the tight junction-associated transmembrane protein occludin is expressed in rosette or gland-like structures in human rectal carcinoid tumours. The tight junction is crucial for the formation and maintenance of organized tubular structures in glandular epithelia. Previous studies have reported the presence of glandular structures in carcinoid tumours, though they are not believed to arise from glandular epithelium. METHODS AND RESULTS: The expression profiles of occludin in 40 carcinoid tumours were examined immunohistochemically, using an anti-occludin monoclonal antibody. In eight (20%) samples of typical carcinoid tumours, a small number of rosette-like tubular structures outlined by occludin were detected. CONCLUSIONS: Tight junction-associated molecules, including occludin, are thought to be one of the most characteristic structural markers of polarized glandular structures. The results of the present study provide supportive evidence that carcinoid tumour cells are capable of glandular differentiation.