Histopathology Image of Large Cell Neuroendocrine Carcinoma 1

Large cell neuroendocrine carcinoma (LCNEC) is a neuroendocrine tumor comprising a subgroup of large cell carcinoma and is a type of lung cancer showing a neuroendocrine characteristic similar to that of small cell lung carcinoma In our institution, we started to diagnose LCNEC by immunostaining in 2002, and we herein report 9 patients diagnosed with LCNEC from January 2002 to May 2008. The average patient age was 74.9, male/female ratio was 8/1, and all 9 patients had a smoking history. Pathological stages IA/IB/IIB/IIIA comprised 4/1/2/2, respectively. Peripherally located and lobulated tumors were noted on preoperative computed tomography (CT), and moderate uptake of fluoro-2-deoxy-D-glucose (FDG), which balanced with the size, was recognized on positron emission tomography (PET). All 9 patients underwent surgery and 7 underwent radical surgery. Postoperative adjuvant chemotherapy was performed for 4 patients. Three showed recurrence, and 2 of these 3 died of the primary disease. The remaining 7 patients have survived to date. The possibility of LCNEC must be considered when peripherally located lung cancer with lobulation is noted on CT and shows moderate uptake of FDG for its size on PET, and multimodal treatment is needed if the diagnosis is determined postoperatively.

Reclassifying bronchial-pulmonary carcinoma: Differentiating histological type in biopsies by immunohistochemistry. Rev Port Pneumol. 2009 Nov/Dez;15(6):1101-1119.

The current state of molecular knowledge on lung cancer demands a histological classification which goes beyond small-cell and non-small-cell carcinoma to provide support for tailored therapy in aiding in understanding of the drugs currently available. As diagnosis and follow-up in the vast majority of lung cancer cases is based on biopsies and cytology samples, Immunohistochemical Bronchial Pulmonary Carcinoma Classification (IBPCC) is necessary to reveal the raft of characteristics available. This provides morphological support for the WHO's 1999/2004 classification, in addition to an understanding of carcinogenesis. The immunohistochemical panel clarifies the main morphology and cytology characteristics to maintain the leading histological types as squamous cell carcinoma (high weight molecular cytokeratins/HWMC), adenosquamous carcinoma (CK7, TTF1, HWMA), neuroendocrine carcinoma (Chrg, Syn, CD56, TTF1, Ki67), adenocarcinoma (CK7, CK20, TTF1) and bring the polymorphic and pleomorphic carcinomas under a single banner of pleomorphic carcinoma (Ck7, TTF1, HWMC, VMT, Desmin, Actin) which shelters large cell carcinomas and sarcomatoid carcinomas. Lung cancer chemotherapy will still be based on platinum and gemcitabine for the near future and the IBPCC is a simple and efficient tool for streamlining the registration of lung cancer histological characteristics in biopsies and other reduced samples to support clinical evidence and trials. Rev Port Pneumol 2009; XV (6): 1101-1119 Key-words: Bronchial-pulmonary carcinoma, immunohistochemistry.

Downregulation of drs tumor suppressor gene in highly malignant human pulmonary neuroendocrine tumors. Oncol Rep. 2009 Jun;21(6):1367-72.

Neuroendocrine tumors in the lung fall into four categories: typical carcinoid tumor (TC), atypical carcinoid tumor (AC), large-cell neuroendocrine carcinoma (LCNEC) and small-cell lung carcinoma (SCLC), in ascending order of malignancy. The drs gene was originally isolated as a suppressor against v-src transformation and was shown to induce apoptosis in human cancer cells. The expression of drs was markedly downregulated in various human cancer tissues and cell lines. Furthermore, drs knockout mice showed a tumor-prone phenotype, indicating that drs acts as a tumor suppressor gene in malignant tumor formation. To clarify the role of the drs gene in the development of human pulmonary neuroendocrine tumors, we examined the expression of drs mRNA in tissue specimens from 3 cases of TC, 4 cases of AC, 2 cases of LCNEC, and 11 cases of SCLC by in situ mRNA hybridization. Four cases of normal lung and bronchial epithelia, 8 samples of normal brain tissue, and 2 cases of tumorlets in the lung were also examined. The drs mRNA was definitely expressed in all normal tissues of the lung and brain, and 3 TC and 2 tumorlet tissues. The expression of drs mRNA was also detected in 2 of 2 LCNEC tissues and 3 of 4 AC tissues, although the signals were weak. On the other hand, drs mRNA was not detected in 10 of 11 SCLC tissues. Downregulation of drs mRNA was also observed in 3 of 4 SCLC cell lines that were examined by reverse transcriptase-polymerase chain reaction (RT-PCR). Neither gross deletion nor rearrangement of the drs genome was detected in these cell lines by Southern blot analysis. Our results indicate that the downregulation of drs is correlated with the development of SCLC, a highly malignant pulmonary neuroendocrine tumor.

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