Abstract
Pulmonary large cell neuroendocrine carcinoma (LCNEC) is a rare and aggressive malignant tumor, which was proposed as a novel type of neuroendocrine tumor in 1991. Although it is categorized as a non-small cell lung carcinoma, the precise pathological condition is unknown due to its rare occurrence. The present study outlines the case of a patient presenting with an LCNEC that exhibited pagetoid spread from the region of the primary tumor to the bronchial epithelium (distance, >30 mm). The pagetoid spread was unconfirmed preoperatively, however, was identified by intraoperative rapid diagnosis. This caused us to suffer the perioperative decision of additional resection and resulted in an incomplete resection, as suture of the bronchus was not possible. Pagetoid spread, which is often apparent in the breast, presents as a rare pattern of infiltration of cancer cells when a massive carcinoma is identified beneath the intraepithelial spread. Although preoperative diagnosis of pagetoid spread is difficult due to its rarity and undefined clinical features, it is important for surgeons and pathologists treating lung cancer patients to be aware of potential pagetoid spread in the thoracic region.
Highlights
Travis et al [1] proposed pulmonary large cell neuroendocrine carcinoma (LCNEC) as a novel category of neuroendocrine tumor in 1991
The present study describes a case of pulmonary LCNEC exhibiting
Pathology of the postoperative sample revealed that the tumor was a stage pT1bN0M0 LCNEC, pathologic stage 1A [3] and that there was extensive one layer invasion to the central side in the bronchial epithelium, termed pagetoid spread (Fig. 2C)
Summary
Travis et al [1] proposed pulmonary large cell neuroendocrine carcinoma (LCNEC) as a novel category of neuroendocrine tumor in 1991. Positron emission tomography‐CT demonstrated a marked accumulation of fluorodeoxyglucose in the tumor, with a maximum standardized uptake value of 7.82 This indicated that the lesion was a type of lung cancer, stage cT1bN0M0. Considering the age and lung function of the patient, a pneumonectomy was not performed and the surgery was concluded with a sleeve lobectomy and was determined to be a microscopically incomplete resection. Pathology of the postoperative sample revealed that the tumor was a stage pT1bN0M0 LCNEC, pathologic stage 1A [3] and that there was extensive one layer invasion to the central side in the bronchial epithelium, termed pagetoid spread (Fig. 2C). Careful review of the biopsied specimen during a preoperative bronchoscopy revealed that the tumor invasion was already present as pagetoid spread surrounding the second carina (Fig. 2D). The patient remained healthy without any signs of recurrence for 30 months following the surgery, as determined by systemic work‐up including enhanced chest CT, brain magnetic resonance imaging and bone scintigraphy
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