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Immunohistochemical
expression of estrogen and progesterone receptors in primary pulmonary
neuroendocrine tumors.Arch Pathol Lab Med. 2008 Dec;132(12):1889-95.
Context: Lung and
breast carcinomas are among the most prevalent cancers.Advances in
cancer therapies can provide survival benefit and be potentially
curative, even in metastatic disease. Due to the high prevalence of
these carcinomas, it is not unusual to encounter lung nodule(s) in a
patient with breast carcinoma, and distinguishing between primary and
metastatic disease is
critical for management/treatment. Occasionally neuroendocrine
differentiation is present in breast carcinoma, making its distinction
from pulmonary/nonpulmonary neuroendocrine tumors in the lung difficult.
OBJECTIVE: To assess estrogen and progesterone receptor expression in
the entire spectrum of pulmonary neuroendocrine tumors. DESIGN:
Seventy-one neuroendocrine neoplasms including typical carcinoids (42),
atypical carcinoids (7), small cell carcinomas (14), large cell
neuroendocrine carcinomas (2), and combined small cell carcinomas (6)
were evaluated for estrogen and progesterone receptors. Mammary and
non-small cell lung carcinomas were also stained for comparison.
RESULTS: The entire spectrum of neuroendocrine neoplasms demonstrated
focal to diffuse estrogen (typical carcinoid, 23; atypical carcinoid, 6;
small cell carcinoma, 8; large
cell neuroendocrine carcinoma, 2; combined small cell carcinoma, 4) and
progesterone (typical carcinoid, 11; atypical carcinoid, 2; small cell
carcinoma, 7; large cell neuroendocrine carcinoma, 0; combined small
cell carcinoma, 2) expression. There was no correlation between sex and
estrogen/progesterone status. Estrogen and progesterone staining were
also noted in endothelial cells.Relative to neuroendocrine carcinomas,
mammary carcinomas expressed estrogen and
progesterone more frequently. Non-small cell carcinomas had greater and
similar immunoreactivity for estrogen and progesterone, respectively.
CONCLUSIONS: Although estrogen and progesterone receptor staining is
frequently associated with breast and gynecologic primaries, it can also
be observed in "nontarget" organs. Therefore, presence of estrogen
and/or progesterone expression in
neuroendocrine tumors involving the lung should not exclude a primary
pulmonary neoplasm.
Reclassification of
neuroendocrine tumors improves the separation of carcinoids and the
prediction of survival. J Thorac Oncol. 2008 Dec;3(12):1410-5.
INTRODUCTION:
The classification of neuroendocrine lung tumors has changed over the
last decades. Reliable diagnoses are crucial for the quality of clinical
databases. The purpose of this study is to determine to which extent the
use of different diagnostic criteria of neuroendocrine lung tumors has
influenced the classification of these tumors. The prognostic
information of tumor, node,
metastasis descriptors was also evaluated. METHODS: We retrieved 110
tumors from the period 1989 to 2007. All tumors were reclassified
according to the World Health Organization classification of 2004.
Tumor, node, metastasis descriptors were evaluated. RESULTS: By
reclassification, the diagnoses on 48 tumors (44%) were changed. More
diagnoses were changed in the older part of the material. A
significantly different survival was shown for all patients in relation
to tumor size (p < 0.0001). An endobronchial component was seen in 54%,
31%, and 11% of typical carcinoid, atypical carcinoid, and large cell
neuroendocrine carcinoma,respectively with no impact on survival (p =
0.90). For all included patients the survival was significantly worse
for patients having metastasis to N1 nodes as
compared with N0 (p = 0.03). However, the number of removed lymph nodes
were insufficient for definitive determination of the prognostic impact
of node metastases. Regarding the revised diagnoses, a significant
difference in survival between typical carcinoid, atypical carcinoid,
large cell neuroendocrine carcinoma and small cell carcinoma was noted
(p < 0.005). CONCLUSION: Tumors must be rediagnosed before entering a
central database. Tumor and node seem to be
useful predictors of survival.
A case of large cell
neuroendocrine carcinoma in a patient with sarcoidosis.Nihon Kokyuki
Gakkai Zasshi. 2008 Jul;46(7):574-7.
A 60-year-old
female smoker presented with bloody sputum and back pain. A computed
tomographic (CT) scan of the chest revealed a mass lesion in S(1+2) of
the left lung and hilarmediastinal lymphadenopathy. TBLB revealed small
cell carcinoma. At first, we thought that the patient's clinical staging
was c-T4N2M0 IIIB disease. However, it was pointed out she had had
hilar-mediastinal lymphadenopathy 7 years previously. Though FDG-PET
revealed an increased uptake in the hilar-mediastinal lymph node, she
was determined to have surgery. The
resected specimen revealed the swollen lymph nodes to be sarcoidosis,
accompanying a large cell neuroendocrine carcinoma (LCNEL). She was
treated with a combination chemotherapy consisting of cisplatin and
VP-16 and radiotherapy concurrently. Chest CT revealed a partial
response of the primary site after 3 courses of chemoradiotherapy.
Information on concomitant malignancies
accompanying sarcoidosis is limited. Although the main types of
concomitant malignancy are lung cancer, and lymphoma, there has been no
description of LCNEC as a concomitant malignancy. In sarcoidosis
patients, clinicians should be alert to the possibility of concomitant
malignancy. |
