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APUDOMAS (Diffuse Endocrine System)
J. O. Ogunbiyi
Department of Pathology
University College Hospital
Ibadan, Nigeria
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Introduction
These are tumours of APUD cells.
Some secrete the normal hormone of
their presumptive cell of origin and are
called orthoendocrine. Those
secreting hormones of other apud cells
are called paraendocrine tumours.
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 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.
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 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
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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.
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Other neuroectodermal cells are present in the
stomach and small intestine
These are responsible for secretion of VIP,
cholecystokinin, gastrin, 5HT, etc
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They include
 Pancreatic islet cells,
Thyroid C cells,
Parathyroid cells,
Melanocytes,
Hypothalamic neuroendocrine cells,
Some cells of the anterior pituitary, and
The autonomic neurons
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The following syndromes are accompanied by
apudomata
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 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)
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 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
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 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
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The carcinoid syndrome.
Those of the foregut tend to be secretory and
active unlike the hindgut ones that tend to be
inactive
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The somatostatin syndrome.
D-cell tumours of the pancreas.
The MEN syndromes
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