APUDomas & Carcinoid

Tumors
Dr. RICHARD
 Apud Cells
• This is a diffuse system of endocrine cells
that utilises amino acids,or derivatives of
amino acids, as chemical messengers
mediating paracrine & neurocrine effects.
• APUD-Amine Precursor uptake and
Decarboxylation.
• They are divided into two broad
categories:
– Enterochromaffin cells
– Entero-endocrine cells
 Enterochromaffin Cells
• Cells found in small groups at bases of
intestinal crypts named for their staining
after chromate fixation.
• They secret 5-HT (5-hydroxytryptamine or
5-hydroxytryptophan) & Kallikrein, and
give rise to the classical carcinoid tumors.
 Entero-endocrine cells
• These are non-chromaffin, and secrete a
multiplicity of gut regulatory peptides. They are
found scattered in the crypt and villous
epithelium and in the bowel wall.
• The cells are capable of producing more than 1
peptide but are identified by their major product
when neoplasms develop eg gastrinoma,
somatostatinoma, Insulinomas etc
• They are rare but most of them arise in the
pancreas rather than the intestine.
 Notes
• Carcinoids arising from else where often
metastazise to mesenteric lymphnodes
and the liver.
• Extensive metastases lead to carcinoid
syndrome (tachycardia, sweaty skin,
flushing, anxiety & diarrhoea) due to
excessive production of 5-HT &
prostsglandins.
 Note…
• APUDomas often pursue an indolent
course, growing relatively slowly &
metastasizing late.
• Some individuals have an inherited familial
predisposition: they are said to have a
multiple endocrine neoplasia (MEN)
syndrome.