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APUDOMAS (Diffuse Endocrine

System)

J. O. Ogunbiyi
Department of Pathology
University College
Hospital
Ibadan, Nigeria
Introduction

These are tumours of


APUD cells. Some
secrete the normal
hormone of their
presumptive cell of
origin and are called
orthoendocrine.
 The APUD cells derive their
name from the initial letters
associated with their three
most important properties:
 A high content of amines
 The capacity for amine
precursor uptake
 The presence of amino acid
decarboxylase, which converts
amino acids into amines.
 Cells with these properties
have been grouped together as
the APUD system.
 They contain characteristic
granules on electron
microscopy
 and secrete polypeptides, or
amines, or both
The cells included here are:
 The chromaffin cell system- These are
found in the adrenal medulla and in
association with the paravertebral
plexuses.
 The non-chromaffin cells of the
paraganglia (Carotid body, glomus
jugulare).
 The argentaffin (Kultschitzky) cells.
( found in the intestine). Similar cells occur
in the salivary glands, pancreas, and
bronchial mucosa.
. The argyrophil cells. These are widely
distributed in the intestine.
Other neuroectodermal
cells are present in the
stomach and small intestine
These are responsible for
secretion of VIP,
cholecystokinin, gastrin,
5HT, etc
They include

 Pancreatic islet cells,


Thyroid C cells,
Parathyroid cells,
Melanocytes,
Hypothalamic
neuroendocrine cells,
Some cells of the anterior
pituitary, and
The autonomic neurons
The following syndromes
are accompanied by
apudomata
 Hypoglycaemia (pancreatic
ß-islet cell hypersecretion)
 The glucagonoma syndrome
 The Zollinger-Ellison
syndrome (in which there is
hyperplasia of the G cells of
the pyloric antrum or of the B-
cells of the pancreas).
 The Verner-Morrison
syndrome (pancreatic cholera)
 WDHA (watery diarrhea,
hypokaleamia, and
achlorhydria) syndrome.

 Non-ß islet cell tumour, SCLC,


MCT, malignant carcinoid,
mast cell tumours, and
neuroblastoma. In all of these,
there is XS VIP secretion
 Cushing’s syndrome / (ectopic
ACTH syndrome) consisting
hypokaleamia alkalosis,
diabetes mellitus,
hyperpigmented skin, muscle
wasting with weakness.
 May be found with SCLC,
bronchial carcinoid, carcinoid
of thymus, pancreatic islet cell
tumour, MTC, pheo, ovarian
carcinoma
The carcinoid syndrome.
Those of the foregut tend to
be secretory and active
unlike the hindgut ones that
tend to be inactive
The somatostatin
syndrome.

D-cell tumours of the


pancreas.

The MEN syndromes