Pure Large Cell Neuroendocrine Research Articles

P3.13C.09 First-Line Treatments for Advanced Pure Large Cell Neuroendocrine Tumors (LCNEC):Insights from a Global Clinico-Genomic Study

P3.13C.09 First-Line Treatments for Advanced Pure Large Cell Neuroendocrine Tumors (LCNEC):Insights from a Global Clinico-Genomic Study

Exploring systemic treatment approaches for advanced pure large cell neuroendocrine carcinoma (LCNEC): A multicenter retrospective analysis.

Exploring systemic treatment approaches for advanced pure large cell neuroendocrine carcinoma (LCNEC): A multicenter retrospective analysis.

P66.08 Differential Expression of INSM1 Between Pure SCLC and LCNEC After Surgical Resection and Its Clinicopathological Significance

According to WHO diagnostic criteria, both Small cell lung cancer (SCLC) and Large cell neuroendocrine (LCNEC) are categorized into high grade neuroendocrine carcinoma, based on morphological features and immunostaining of neuroendocrine markers including CD56, chromogranin A (CgA) and synaptophysin (Syn). However, the above markers have limited satisfactory significance of specificity and sensitivity. Insulinoma-associated protein 1 (INSM1) is highly expressed in SCLC cells as a zinc finger protein, and numerous studies have shown that INSM1 positive staining has a strong correlation with NE differentiation in SCLC and an alternative diagnostic biomarker for SCLC, but few studies are involved in LCNEC and its significance remains unclear in LCNEC. The aim of this study was to investigate the potential of INSM1 as a neuroendocrine marker by comparing the expression of INSM1 in SCLC and LCNEC and its clinicopathological significance. 347 surgically resected lung cancer including 290 pure SCLC and 57 pure LCNEC samples were retrieved in this retrospective study. INSM1 expression was detected by immunohistochemistry staining in SCLC and LCNEC tissue microarrays. The different expression of INSM1 between SCLC and LCNEC as well as the correlation with clinicopathological features including gender, age, smoking history, tumor location, AJCC 7th stage, reginal lymph node metastasis, pleural invasion and tumor thrombosis were analyzed by chi-square test. Of the included patients, male/female ratio was 2.33 (203/87) in SCLC and 10.4 (52/5) in LCNEC, the smoker rate was 64.5% (187/290) in SCLC and 43.9% (25/57) in NSCLC. According to the AJCC Cancer Staging Manual (7th edition), the SCLC patients were 29.0% (84/290) in stage I, 27.2% (79/290) in stage II, 40.7% (118/290) in stage III, and 3.1% (9/290) in stage IV, while the NSCLC patients were 49.1% (28/57) in stage I, 26.3% (15/57) in stage II, and 24.6% (14/57) in stage III, respectively. INSM1 was localized in the nucleus of lung cancer cells, a significant higher positive rate was detected in SCLC than that in LCNEC (271/290,93.4% in SCLC; 32/57,56.1% in LCNEC; p<0.05). INSM1 protein expression significantly correlated with smoking history (p=0.023), pleural invasion (p=0.010), and a positive trend of regional lymph node metastasis (p=0.052) in SCLC, but did not correlate with any of the clinicopathological features in LCNEC (p＞0.05). INSM1 protein was found no prognostic significance neither in SCLC nor in LCNEC (p＞0.05). INSM1 protein is highly expressed in SCLC and positively correlated with pleural invasion and smoking history. In contrast, INSM1 expression in LCNEC is significant lower and does not correlated with such clinicopathological features. Further research needs to be done on exploring the potential different underlying mechanisms and diagnostic significance of INSM1 in SCLC and LCNEC.

Pure large cell neuroendocrine carcinoma of the gallbladder, is surgical relentlessness beneficial? A case report and literature review

Pure large cell neuroendocrine carcinoma of the gallbladder is a rare disease. However, the prognosis of this aggressive tumor is poor with short survival after diagnosis. We are describing in this manuscript a case of pure large cell neuroendocrine carcinoma in which survival exceeded 26 months, after performing two curative surgeries. We are reporting the case of a 68-year-old woman with a history of recovered right breast carcinoma and operated 6 years later for a completely asymptomatic gallbladder tumor of 31 mm. In this case, curative surgery was performed allowing monobloc resection of the gallbladder and the hepatic segments IVb and V, a lymph node dissection was performed to. The histological examination of the specimen and immunohistochemistry confirms that the tumor was a grade 3 pure large cell neuroendocrine carcinoma of gallbladder with lymph node invasion, the hepatic and biliary surgical margins were free. Postoperative adjuvant chemotherapy was administered and the evolution was eventless until the discovery at 20 months of a lymph node considered being metastatic recurrence. A second surgery was performed allowing removal of three lymph nodes. This time, a different protocol of chemotherapy was administered to our patient who remains alive and without recurrence at 26 months from her first surgery. Surgical relentlessness with free margins resections associated with appropriate chemotherapy probably improves the survival of patients suffering from this rare and aggressive tumor.

MON-916 Pure Large Cell Neuroendocrine Carcinoma (LCNEC) of the Gall Bladder in a Patient with Down Syndrome - a Rare Case of an Aggressive Tumor of the Gall Bladder

Background: Pure large cell neuroendocrine carcinoma of the gall bladder (LCNEC-GB) is an extremely rare entity, with only 12 such cases reported in literature to date. None has been reported in a patient with genetic disorders. We describe the case of a patient with pure LCNEC-GB in the presence of Down syndrome and prior biliary atresia.Case:A 49-year-old female with Down Syndrome and history of neonatal surgery for congenital duodenal atresia presented with fever, vague abdominal discomfort and 6 month history of 15 pound weight loss. CT abdomen revealed a 5 X 4.2 cm exophytic, heterogeneously enhancing mass in the gall bladder fossa extending into segment 4B-5 of liver with mild intrahepatic biliary dilation, along with a 9 cm cystic lesion in continuity with the duodenum which was confirmed to a dilated duodenal anastomosis (from prior biliary surgery) on endoscopy. There was high suspicion for malignancy (gall bladder carcinoma versus intrahepatic cholangiocarcinoma) and subsequent metastatic workup including tumor markers, staging CT chest, MRI of the abdomen and diagnostic laparoscopy was negative.The patient underwent robotic converted to open en bloc resection of the gallbladder mass with segment 4B-5 liver resection and adherent loops of small bowel as well as resection of the dilated duodenal anastomosis followed by reconstruction with a gastrojejunostomy and Roux-en-Y/small bowel entero-enterostomy and closure of duodenotomy.Pathology demonstrated poorly differentiated “pure” large cell neuroendocrine carcinoma (G3), 6 cm in greatest dimension, with invasion of liver, duodenum and stomach, negative liver and gastric/small bowel margins. Lymphovascular invasion (LVI) was present with no perineural invasion (PNI), and 3/15 lymph nodes involved. Staging was determined to be pT4pN1.Patient was considered for adjuvant chemotherapy based on few case reports (platinum/etoposide) but unfortunately developed systemic complaints of fevers, fatigue, pain in bones and joints 2 months post operatively. Workup revealed metastatic disease which was confirmed on biopsy. Several small satellite liver lesions were also identified which was consistent with metastatic hepatic disease. Patient and family elected to proceed with hospice. Patient died within 4 months of surgery.Conclusion:Pure LCNEC-GB is an extremely rare and aggressive tumor with a poor prognosis as seen in our patient. This is the first reported case of pure LCNEC-GB in a patient with a genetic syndrome, although it is unknown if it had any causal relationship with the tumor. Prior biliary atresia/post -surgical inflammation may have also contributed to its pathogenesis by plausible development of metaplasia and expression of neuroendocrine cells which are normally absent in the gall bladder. Our case might help shed some light into pathogenesis and genetic basis if any of this rare entity.

Repeat liver resection for pure large cell neuroendocrine carcinoma of the gallbladder: a favorable outcome

BackgroundThe pure large cell type is a rare variant of primary neuroendocrine carcinoma of the gallbladder. Few reports have mentioned extended survival. Although a multimodal treatment has been described in the treatment of such rare disease, redo liver resection has not yet been mentioned.Case reportA 67-year-old lady was found to have poorly differentiated, high grade, pure large cell neuroendocrine tumor of the gallbladder after cholecystectomy for gallstones. After the diagnosis, staging workup showed a lesion in segment IVB/V of the liver, and chromogranin was elevated (982 mcg/L). The patient underwent central inferior hepatectomy and wedge excision of a lesion in segment III (discovered intra-operatively), with hilar lymphadenectomy. Three months after the first liver resection, she developed a new liver lesion II/III and underwent left lateral liver resection. The patient remained disease-free for 4 months following the second liver resection but then developed recurrent liver disease and was started on chemotherapy. Further progression led to multi-organ failure and death at 26 months from initial diagnosis.ConclusionThis is the first reported repeat liver resection in such a rare disease that has led to extended overall survival. We suggest that a group of selected patients with this rare malignancy, and liver-limited disease, may benefit from repeated liver resection.

Primary pure large cell neuroendocrine carcinoma of the ovary

Neuroendocrine tumors are more common in the female genital tract than in the male genital tract, and most are uterine small cell carcinomas or ovarian carcinoid tumors. Most ovarian tumors are associated with surface epithelial tumors, SertolieLeydig cell tumors, teratoma, small cell carcinoma, pulmonary-type and undifferentiated carcinoma, and nonsmall cell lung cancer [1]. Large cell neuroendocrine carcinoma (LCNEC) of the ovary is unusual and defined as an extremely malignant tumor with an aggressive lethal outcome. For this original and updated review, we searched the databases of PubMed Clinical Queries, MEDLINE, Cochrane Library and UpToDate. We also hand-searched relevant journals and reference lists of identified articles. The keywords used were “ovary”, “pure LCNEC”, and “immunohistochemistry”. We found that only 37 cases of ovarian tumor involving LCNEC associated with surface epithelial stromal tumors and/or teratoma have been reported to date [2e5]. In addition, seven cases of primary LCNEC of the ovary without any associated component have been described [2,3,6e8]. Herein, we present the case of a patient with stage IV primary pure LCNEC of the ovary with liver metastasis and carcinomatosis. A 50-year-old married, Taiwanese female, G3P3, was referred by a clinical oncologist for the evaluation of a pelvic mass. She denied specific systemic disease, a gynecological history, and undergoing major operations previously. She also denied any significant symptoms, such as compression sensation, lower abdominal pain, or abnormal vaginal bleeding. Because of an increased abdominal circumference and a palpable 20-cmmass in the abdomen that had been present for 2 weeks, she was referred by a clinical oncologist and underwent a suboptimal debulking operation with total abdominal hysterectomy, bilateral salpingo-oophorectomy, partial

Extrapulmonary neuroendocrine small and large cell carcinomas: a review of controversial diagnostic and therapeutic issues

Extrapulmonary neuroendocrine carcinoma (EPNEC) is a heterogeneous and rare group of high-grade neoplasms occurring in different organs. They usually share a poor prognosis, but diagnostic and therapeutic options still include several controversial issues, due to the rarity of this condition and to differences in architecture and cell size, being some cases pure small cell carcinomas, other pure large cell neuroendocrine carcinomas and some others combined/mixed neuroendocrine carcinomas with a conventional non-neuroendocrine carcinoma. In addition, the therapeutic strategy varies in different organs (surgery and/or chemotherapy and/or radiation therapy and/or targeted treatments), and clinicians and pathologists are asked to interact to reach an accurate classification of every single case, as well as the most appropriate selection of the treatment options, even considering different time points of each EPNEC natural history. This overview highlights controversial pathological and clinical issues and summarizes possible solutions to most of such EPNEC-related problems.

High grade neuroendocrine lung tumors: Pathological characteristics, surgical management and prognostic implications

Among non-small cell lung cancers (NSCLC), large cell carcinoma (LCC) is credited of significant adverse prognosis. Its neuroendocrine subtype has even a poorer diagnosis, with long-term survival similar to small cell lung cancer (SCLC). Our purpose was to review the surgical characteristics of those tumors. The clinical records of patients who underwent surgery for lung cancer in two French centers from 1980 to 2009 were retrospectively reviewed. We more particularly focused on patients with LCC or with high grade neuroendocrine lung tumors. High grade neuroendocrine tumors were classified as pure large cell neuroendocrine carcinoma (pure LCNEC), NSCLC combined with LCNEC (combined LCNEC), and SCLC combined with LCNEC (combined SCLC). There were 470 LCC and 155 high grade neuroendocrine lung tumors, with no difference concerning gender, mean age, smoking habits. There were significantly more exploratory thoracotomies in LCC, and more frequent postoperative complications in high grade neuroendocrine lung tumors. Pathologic TNM and 5-year survival rates were similar, with 5-year ranging from 34.3% to 37.6% for high grade neuroendocrine lung tumors and LCC, respectively. Induction and adjuvant therapy were not associated with an improved prognosis. The subgroups of LCNEC (pure NE, combined NE) and combined SCLC behaved similarly, except visceral pleura invasion, which proved more frequent in combined NE and less frequent in combined SCLC. Survival analysis showed a trend toward a lower 5-year survival in case of combined SCLC.Therefore, LCC, LCNEC and combined SCLC share the same poor prognosis, but surgical resection is associated with long-term survival in about one third of patients.

Pure Large Cell Neuroendocrine Carcinoma of Ovary: A Rare Clinical Entity and Review of Literature

Large cell neuroendocrine carcinoma (LCNEC) of the ovary is a rare tumor and is now included in the World Health Organization tumor classification. Its prognosis is generally very poor even when the diagnosis is made at an early stage. We report a case of pure large cell neuroendocrine tumour of ovary, appearing 9 months following laparoscopic type I hysterectomy, bilateral pelvic lymph node dissection with ovarian preservation of anatomically normal looking ovaries performed for a cervical biopsy diagnosis of cervical intraepithelial neoplasia grade III with foci of invasion. The rarity lies in the rapid onset (9 months) of a large tumor following conservation of an anatomically normal ovaries. Surgical debulking and five cycles of chemotherapy (Etoposide and Cisplatin) were administered to the woman. She is on followup with no clinical or radiological evidence of disease recurrence for 6 months.