THE SUBMUCOSAL gastrointestinal carcinoids occur chiefly in the appendix and ileum, as reported by Gosset and Masson.1 They arise from argentaffine cells of the crypts of Lieberkühn, of the same origin (Masson2) as neurofibromata of the inflamed appendix, called "little carcinoma" by Lubarsch,* "carcinoid malignancy" by Oberndorfer,† and paragangliomata by Lewis and Geschickter.4 They are characterized by Humphreys5 as "far from harmless" and classed as Grade 1 (Broders) adenocarcinoma by Dockery, Ashburn, and Waugh.6
In the usual clinical course of a carcinoid tumor gastrointestinal bleeding resulting from ulceration or bowel obstruction from intussusception is rare, in contrast to instances of more rapidly progressing malignant processes. However, bowel obstruction may progress slowly from tumor invasion of the bowel wall, without decrease in general health, weight loss, or secondary anemia. Roentgenological examination of such a carcinoid tumor may give evidence of buckling of the bowel6 or