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Endometrial large cell neuroendocrine carcinoma： a case report
Reina Sato, Aiko Kawano, Hiroyuki Shigeta
Department of Obstetrics and Gynecology, Yokohama Municipal Citizen’s Hospital, Yokohama, Japan
Objectives
Endometrial large cell neuroendocrine carcinoma (LCNEC) is
extremely rare. We report a case of combined large cell
neuroendocrine and endometrioid adenocarcinoma of the
endometrium.
Results
Papanicolaou smear of the cervix: AGC
Endometrial smear: endometrial adenocarcinoma Grade1-2.
Endometrial biopsy: endometrial adenocarcinoma Grade1.
Postoperative diagnosis:
combined large cell neuroendocrine carcinoma and
endometrioid adenocarcinoma FIGO stage 1b (T1bN0M0).
Large cell
neuroendocrine
carcinoma
Serum tumor markers: CEA
Case
3.0IU/ml
CA19-9 30.3IU/ml
CA125 19.9IU/ml
A 61-year-old woman (para4, gravida4) visited our hospital
for post-menopausal bleeding.
Preoperative diagnosis: Endometrioid adenocarcinoma,
FIGO stage1b (T1bN0M0).
Transvaginal sonography showed endometrial thichening.
Performed operation: Modified radical hysterectomy
bilateral salpingo-oophorectomy
pelvic lymphadenectomy
Conclusions
Although we recommended her the postoperative
chemotherapy, she denied further treatment.
No evidence of recurrence was observed for one year
after surgery.
Endomerial LCNEC is extremely rare. However, when we
obtained the result of endometrioid adenocarcinoma by
endometrial biopsy, we need to keep in mind that it may
contain a small part of another histological cancer including
LCNEC.
Endometrioid
adenocarcinoma,
G1
Microscopic examination revealed that the tumor
infiltrated more than half of the myometrium.
Most of the tumor was characterized by endometrioid
adenocarcinoma Grade1, however, there was a small
portion consisting of solid tumor with necrotic
tendency. It was composed of malignant large-sized
cells with hyperchromatic nuclei. Immunohistologically,
it was positive for synaptophysin and NSE.
References
Malignant large-sized
cells with hyperchromatic
nuclei
Tadashi Terada, Large cell neuroendocrine carcinoma with
sarcomatous changes of the endometrium: A case report with
immunohistochemical studies and molecular genetic study of
KIT and PDGFRA. Pathology, 2010; 206: 420-5.
Grossly, a polypoid tumor (3.5×2.5×2.1cm3) was
found in the uterine corpus.
Immunohistochemical
examination:
Positive for synaptophysin.
Magnetic resonance imaging (MRI) showed a mass
(3.0×2.5×2.1cm3) in the endometrium and
myometrial invasion was suspected in the upper
half part of the uterus. Bilateral adnexae were
normal.
Computed tomography (CT) examination showed
no lymphadenopathy.
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Lorena Posligua, et al., Combined Large Cell
Neuroendocrine Crcinoma and Papillary Serous Carcinoma
of the Endometrium With Pagetoid Spread. Arch Pathol Lab
Med, 2008; 132: 1821-1824.
Both ovaries and fallopian tubes were unremarkable,
and total of 27 lymph nodes dissected by operation were
all negative for cancer.
Kedar K, et al., Large cell neuroendocrine carcinoma of the
endometrium: An extremely uncommon diagnosis, but worth
the efforts. Journal of Cancer Reserch and Therapeutics,
2011, 7-2: 211-213.
Albores-Saavedra J, et al., Small Cell Carcinomas and Large
Cell Neuroendocrine Crcinomas of the Endometrium and
Cervix: Polypoid Tumors and Those Arising in Polyp May a
Favorble Prognosis. Int J Gynecol Pathol 2008; 27: 333-9.