1
|
Moses J, Moon HD. Neuroendocrine hyperplasia in mucinous borderline ovarian tumour. Pathology 2023; 55:571-573. [PMID: 36759285 DOI: 10.1016/j.pathol.2022.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/10/2022] [Accepted: 10/20/2022] [Indexed: 01/21/2023]
Affiliation(s)
- Joanne Moses
- Department of Pathology, LabPlus, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Hyejin Dana Moon
- Department of Pathology, LabPlus, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand.
| |
Collapse
|
2
|
Qiu J, Xu J, Yao G, Zhu F, Wang Y, Fu Y. An Ovarian Large-Cell Neuroendocrine Carcinoma Accompanied by Clear Cell Carcinoma with Specific High Level of AFP: Case Report and Review of the Literature. Cancer Manag Res 2022; 14:2235-2241. [PMID: 35909650 PMCID: PMC9326035 DOI: 10.2147/cmar.s366771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/22/2022] [Indexed: 11/23/2022] Open
Abstract
Large cell neuroendocrine carcinoma (LCNEC) is a rare histological subtype of ovarian cancer. A few cases have been reported in the literature with extreme invasiveness and a poor prognosis. However, there still have not been accepted criteria for diagnosis and treatment of LCNEC. Here we report an unmarried 37 year-old woman who was diagnosed with LCNEC associated with clear cell carcinoma and the tumor index was manifested with a specific increase of AFP. The case received six courses of etoposide and carboplatin chemotherapy as an adjuvant therapy after primary curative surgery. However, she relapsed within 6 months after surgery and metastasized rapidly to distant organs despite combined chemotherapy of paclitaxel, cisplatin, and bevacizumab, and died 18 months after primary surgery. This is the first reported case of LCNEC manifested with a specific increase of AFP and characteristically metastasized to the spine as recurrence. Reviewing our case as well as previously reported cases, LCNEC present with aggressive malignancy and vulnerable to distant metastasis through a hematogenous approach, we conjectured that adding Bevacizumab in primary chemotherapy may be beneficial to extend disease-free survival. But so far there is no recommendation of this regimen for treatment of LCNEC in current guidelines. Further research is needed to confirm this view so as to find the best treatment of LCNEC and improve the prognosis of these patients.
Collapse
Affiliation(s)
- Jian Qiu
- Department of Obstetrics and Gynaecology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, 313000, People’s Republic of China
| | - Jiewei Xu
- Department of General Surgery, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, 313000, People’s Republic of China
| | - Guorong Yao
- Department of Obstetrics and Gynaecology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, 313000, People’s Republic of China
| | - Fengjia Zhu
- Department of Obstetrics and Gynaecology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, 313000, People’s Republic of China
| | - Yanyan Wang
- Department of Pathology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, 313000, People’s Republic of China
| | - Yunfeng Fu
- Department of Gynecologic Oncology, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, 310006, People’s Republic of China
- Correspondence: Yunfeng Fu, Department of Gynecologic Oncology, Women’s Hospital, School of Medicine, Zhejiang University, Xueshi Road #2, Hangzhou, 310006, People’s Republic of China, Tel +86-571-87061501, Fax +86-571-87061878, Email
| |
Collapse
|
3
|
Ryzhkova D, Mitrofanova L, Tsoy U, Grineva E, Schlyakhto E. Dual-tracer PET/CT imaging to determine tumor heterogeneity in a patient with metastatic ACTH-secreting neuroendocrine neoplasm: A case report and literature review. Front Endocrinol (Lausanne) 2022; 13:958442. [PMID: 36133304 PMCID: PMC9483167 DOI: 10.3389/fendo.2022.958442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION We present a case of a patient with disseminated ACTH-secreting neuroendocrine neoplasm with biologic heterogeneity between a primary tumor and metastases. The diagnosis was obtained and multidisciplinary management was conducted with a positron emission tomography/computed tomography (PET/CT) scan with Gallium-68 [68Ga]-labeled dodecanetetraacetic acid-tyrosine-3-octreotate ([68Ga]-DOTA-TATE) and Fluor-18 [18F]-fluorodeoxyglucose ([18F]-FDG). CASE REPORT A PET/CT scan revealed a difference between [68Ga]-DOTA-TATE and [18F]-FDG uptake in primary tumor and several metastases. PET/CT showed high [18F]-FDG uptake and lack of [68Ga]-DOTA-TATE in the primary tumor, whereas both [68Ga]-DOTA-TATE and [18F]-FDG hyperaccumulation were identified in the majority of metastases. Despite positive [68Ga]-DOTA-TATE PET/CT, which is associated with high affinity with the somatostatin receptor 2 subtype, immunohistochemical examination revealed overexpression of the somatostatin receptor 5 subtype only. Perhaps, this explained the ineffectiveness of the treatment with "cold" somatostatin analogs. CONCLUSION This case had an aggressive clinical course, despite cytoreductive surgical treatment and somatostatin analog therapy. PET/CT imaging with two tracers is a molecular tool that demonstrates a biologic heterogeneity between a primary tumor and metastases and yields additional information that may influence the choice of the patient management strategy.
Collapse
Affiliation(s)
- Daria Ryzhkova
- Nuclear Medicine Department, Almazov National Medical Research Center, Saint Petersburg, Russia
- *Correspondence: Daria Ryzhkova,
| | - Lubov Mitrofanova
- Department of Pathomorphology, Almazov National Medical Research Center, Saint Petersburg, Russia
| | - Uliana Tsoy
- Department of Neuroendocrinological Tumors, Almazov National Medical Research Center, Saint Petersburg, Russia
| | - Elena Grineva
- Institution of Endocrinology, Almazov National Medical Research Center, Saint Petersburg, Russia
| | | |
Collapse
|
4
|
Emerging Therapeutic Concepts and Latest Diagnostic Advancements Regarding Neuroendocrine Tumors of the Gynecologic Tract. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57121338. [PMID: 34946283 PMCID: PMC8703600 DOI: 10.3390/medicina57121338] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 12/21/2022]
Abstract
Neuroendocrine neoplasms (NENs) are particularly rare in all sites of the gynecological tract and include a variety of neoplasms with variable prognosis, dependent on histologic subtype and site of origin. Following the expert consensus proposal of the International Agency for Research on Cancer (IARC), the approach in the latest World Health Organization (WHO) Classification System of the Female Genital Tumours is to use the same terminology for NENs at all body sites. The main concept of this novel classification framework is to align it to all other body sites and make a clear distinction between well-differentiated neuroendocrine tumors (NETs) and poorly differentiated neuroendocrine carcinomas (NECs). The previous WHO Classification System of the Female Genital Tumours featured more or less the same principle, but used the terms ‘low-grade neuroendocrine tumor’ and ‘high-grade neuroendocrine carcinoma’. Regardless of the terminology used, each of these two main categories include two distinct morphological subtypes: NETs are represented by typical and atypical carcinoid and NEC are represented by small cell neuroendocrine carcinoma (SCNEC) and large cell neuroendocrine carcinoma (LCNEC). High-grade NECs, especially small cell neuroendocrine carcinoma tends to be more frequent in the uterine cervix, followed by the endometrium, while low-grade NETs usually occur in the ovary. NENs of the vulva, vagina and fallopian tube are exceptionally rare, with scattered case reports in the scientific literature.
Collapse
|
5
|
Caruso G, Sassu CM, Tomao F, Di Donato V, Perniola G, Fischetti M, Benedetti Panici P, Palaia I. The puzzle of gynecologic neuroendocrine carcinomas: State of the art and future directions. Crit Rev Oncol Hematol 2021; 162:103344. [PMID: 33933568 DOI: 10.1016/j.critrevonc.2021.103344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 04/05/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022] Open
Abstract
Primary gynecologic neuroendocrine carcinomas (gNECs) are a heterogeneous spectrum of rare and highly aggressive neoplasms, accounting for about 2% of all gynecologic malignancies, which mostly resemble the small cell lung carcinoma (SCLC). Due to the lack of standardized treatment guidelines, their management poses a noteworthy clinical challenge. Currently, cumulative data retrieved from the management of SCLC and from retrospective studies supports a multimodality strategy, based on surgery, chemotherapy, and radiotherapy. Nevertheless, the prognosis remains poor and recurrences are extremely frequent. Hence, there is an urgent need for novel treatment options and promising molecular targets. Recently, there has been an increasing interest on the potential role of immune checkpoint inhibitors, especially in the recurrent setting. However, only scant evidence exists and there is still a long road ahead. A solid collaboration between gynecologists and oncologists worldwide is required to improve the treatment of these puzzling tumors.
Collapse
Affiliation(s)
- Giuseppe Caruso
- Department of Maternal and Child Health and Urological Sciences, University of Rome "Sapienza", Policlinico "Umberto I", Rome, Italy.
| | - Carolina Maria Sassu
- Department of Maternal and Child Health and Urological Sciences, University of Rome "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Federica Tomao
- Department of Gynecologic Oncology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, University of Rome "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Giorgia Perniola
- Department of Maternal and Child Health and Urological Sciences, University of Rome "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Margherita Fischetti
- Department of Maternal and Child Health and Urological Sciences, University of Rome "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, University of Rome "Sapienza", Policlinico "Umberto I", Rome, Italy
| | - Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, University of Rome "Sapienza", Policlinico "Umberto I", Rome, Italy
| |
Collapse
|
6
|
Peng X, Wang H. Primary pure large cell neuroendocrine carcinoma of the ovary: A rare case report and review of literature. Medicine (Baltimore) 2020; 99:e22474. [PMID: 33285672 PMCID: PMC7717854 DOI: 10.1097/md.0000000000022474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Ovarian large cell neuroendocrine carcinoma (LCNEC), or ovarian non-small cell neuroendocrine carcinoma, which is a newly described tumour in the classification of primary ovarian neoplasms by the World Health Organization, is a rare entity that is frequently associated with a surface epithelial and germ cell neoplasm component. Few cases have been reported in the literature, and only 18 primary pure ovarian LCNEC cases have been reported so far, including our 1 case. Ovarian LCNEC is a highly aggressive tumor with a poor prognosis even at an early stage. PATIENT CONCERNS We report a case of a 55-year-old postmenopausal woman who complained of abdominal pain. CT examination revealed a mass in the right adnexial region and CA125 level was elevated. DIAGNOSIS She underwent a exploratory laparotomy, and diagnosed as LCNEC histopathologically. INTERVENTIONS Cytoreductive surgery was administered to the patient, and had accepted 5 cycles of chemotherapy consisting of paclitaxel and cisplatin. OUTCOMES Follow-up for 12 months showed no clinical or radiological evidence of disease recurrence. CONCLUSION This case is 1 of the ovarian LCNEC which is a rare and extremely malignant tumor. Diagnosis requires histopathology and immunohistochemistry. The treatment includes primary cytoreductive surgery followed by chemotherapy.
Collapse
|
7
|
Burkeen G, Chauhan A, Agrawal R, Raiker R, Kolesar J, Anthony L, Evers BM, Arnold S. Gynecologic large cell neuroendocrine carcinoma: A review. Rare Tumors 2020; 12:2036361320968401. [PMID: 33194158 PMCID: PMC7605029 DOI: 10.1177/2036361320968401] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/30/2020] [Indexed: 01/05/2023] Open
Abstract
Large cell neuroendocrine carcinomas (LCNEC) are rare, aggressive high-grade neuroendocrine neoplasms within the neuroendocrine cell lineage spectrum. This manuscript provides a detailed review of published literature on LCNEC of gynecological origin. We performed a PubMed search for material available on gynecologic LCNEC. We analyzed 104 unique cases of gynecologic LCNECs, of which 45 were cervical primary, 45 were ovarian, 13 were uterine, and 1 was vaginal. A total of 45 cases of cervical LCNEC were identified with a median age of 36 years. Median overall survival was 16 months. We identified 45 ovarian LCNEC cases in the published literature with a median age of 54 years. Median overall survival was 8 months. 13 LCNEC cases of uterine origin were identified; 12 out of 13 were of endometrial origin and the median age was 71 years. The majority of patients presented with Stage III/IV disease (stages I-IV were 31%, 8%, 38%, and 23%, respectively). Gynecologic LCNEC is an aggressive malignancy. Our current understanding of the disease biology is very limited. Efforts are required to better understand the genomic and molecular characterizations of gynecological LCNEC. These efforts will elucidate the underlying oncogenic pathways and driver mutations as potential targets.
Collapse
Affiliation(s)
- Grant Burkeen
- Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Aman Chauhan
- Division of Medical Oncology, University of Kentucky, Lexington, KY, USA.,Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Rohitashva Agrawal
- Division of Medical Oncology, University of Kentucky, Lexington, KY, USA
| | - Riva Raiker
- Department of Internal Medicine, University of Kentucky, Lexington, KY, USA
| | - Jill Kolesar
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA.,Department of Pharmacy Practice and Science, University of Kentucky, Lexington, KY, USA
| | - Lowell Anthony
- Division of Medical Oncology, University of Kentucky, Lexington, KY, USA.,Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - B Mark Evers
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA.,Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Susanne Arnold
- Division of Medical Oncology, University of Kentucky, Lexington, KY, USA.,Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
8
|
Tsuyoshi H, Yashiro K, Yamada S, Yamamoto M, Onuma T, Kurokawa T, Yoshida Y. Role of diagnostic laparoscopy in patients with large cell neuroendocrine carcinoma of the ovary with cancerous peritonitis: case report and review of the literature. J Ovarian Res 2019; 12:95. [PMID: 31615543 PMCID: PMC6792242 DOI: 10.1186/s13048-019-0571-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 09/21/2019] [Indexed: 11/23/2022] Open
Abstract
Background Large cell neuroendocrine carcinoma is a very rare ovarian neoplasm that has a poor clinical outcome even in the early stage, and there is as yet no established treatment. Diagnostic laparoscopy has been used to determine the possibility of primary optimal cytoreductive surgery or neoadjuvant chemotherapy in patients with advanced epithelial ovarian cancer. However, the role of diagnostic laparoscopy is still unclear in large cell neuroendocrine carcinoma due to its rarity. Case presentation A 31-year-old woman with abdominal distention was referred to our hospital. She was strongly suspected of having advanced ovarian cancer because of a huge pelvic mass, massive ascites, and their appearance on medical imaging. However, cytological examinations from ascitic fluid by abdominal paracentesis did not show any malignant cells. She underwent diagnostic laparoscopy to evaluate the possibility of primary optimal cytoreductive surgery, and only tissue sampling was performed for pathological diagnosis because of the countless disseminated lesions of various sizes in the intraperitoneal organs. The patient had no postoperative complications, leading to the early start of postoperative chemotherapy. Conclusions To date, there have been no systematic reviews that focused on determining the treatment strategy using laparoscopy. Diagnostic laparoscopy can be helpful to determine the optimal treatment, including primary debulking surgery, neoadjuvant chemotherapy, or best supportive care, assisting in decision-making particularly for patients with advanced large cell neuroendocrine carcinoma with carcinomatous peritonitis.
Collapse
Affiliation(s)
- Hideaki Tsuyoshi
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
| | - Kenji Yashiro
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Shizuka Yamada
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Makoto Yamamoto
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Toshimichi Onuma
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Tetsuji Kurokawa
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Yoshio Yoshida
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaizuki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| |
Collapse
|
9
|
Wei J, Wang Y, Li P, Fan L, Li M, Wang Z. Small-cell carcinoma-associated ovarian mucinous carcinoma: A case report and literature review. Pathol Res Pract 2019; 215:152619. [PMID: 31585810 DOI: 10.1016/j.prp.2019.152619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 11/24/2022]
Abstract
Neuroendocrine neoplasm-associated ovarian mucinous carcinoma occurs extremely rarely. Here, we report an ovarian composite tumor consisting of small-cell carcinoma and mucinous carcinoma in a 51-year-old woman presented with abdominal distention. Ultrasonography revealed the presence of a complex irregular cystic solid mass. Microscopic findings showed pulmonary-type small-cell carcinoma-associated, intestinal-type ovarian mucinous carcinoma-with positive results for several neuroendocrine markers (chromogranin, CD56) and the thyroid transcription factor-1. The patient underwent total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and six cycles of adjuvant chemotherapy but died eight months after the surgery due to disease progression. Few reports are available in China on this clinicopathological feature in this composite tumor type. The timely identification of ovarian small-cell carcinoma among other ovarian tumors is critically important to the accurate and prompt determination of the therapy due to its high invasiveness and metastatic potential.
Collapse
Affiliation(s)
- Jie Wei
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, the Air Force Military Medical University. No.169 Changlexi Road, Xincheng District, Xi'an 710032, PR China.
| | - Yingmei Wang
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, the Air Force Military Medical University. No.169 Changlexi Road, Xincheng District, Xi'an 710032, PR China.
| | - Peifeng Li
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, the Air Force Military Medical University. No.169 Changlexi Road, Xincheng District, Xi'an 710032, PR China.
| | - Linni Fan
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, the Air Force Military Medical University. No.169 Changlexi Road, Xincheng District, Xi'an 710032, PR China.
| | - Mingyang Li
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, the Air Force Military Medical University. No.169 Changlexi Road, Xincheng District, Xi'an 710032, PR China.
| | - Zhe Wang
- State Key Laboratory of Cancer Biology, Department of Pathology, Xijing Hospital and School of Basic Medicine, the Air Force Military Medical University. No.169 Changlexi Road, Xincheng District, Xi'an 710032, PR China.
| |
Collapse
|
10
|
Yang X, Chen J, Dong R. Pathological features, clinical presentations and prognostic factors of ovarian large cell neuroendocrine carcinoma: a case report and review of published literature. J Ovarian Res 2019; 12:69. [PMID: 31345245 PMCID: PMC6657379 DOI: 10.1186/s13048-019-0543-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/10/2019] [Indexed: 02/08/2023] Open
Abstract
Background There is no consensus on the optimal chemotherapy regimen and the prognostic factors for ovarian large cell neuroendocrine carcinoma (LCNEC), a rare type of tumor. The objective of the present study is to present the case of a recent encounter of pure ovarian LCNEC and perform a brief review to summarize the clinicopathological features and prognostic factors of 57 cases of LCNEC patients that have been previously reported. Method: case presentation Eligible studies were searched for online and 57 cases with clear follow-up data were found to have been reported. We present the 58th case, which is of a 70-year-old woman with stage IIIc primary pure LCNEC of the ovary. The initial symptom of this patient was abdominal distension (more than 2 months). A recent ultrasound test showed a solid-cystic mass occupying the pelvic and abdominal cavity. She received two courses of cisplatin-etoposide chemotherapy as an adjuvant therapy. No signs of nonclinical or radiological evidence of disease recurrence was found at follow-up examinations during the first 3 months after operation. A retrospective review of these 58 cases was conducted and survival curves were estimated. Using the Kaplan-Meier method. Conclusion The patients included were aged between 18 and 80 years. A Kaplan-Meier survival curve revealed that the median overall survival was 10.000 months, while 26 (44.83%) patients died within 12 months. We compared the overall mean survival time of all patients with that of stage I patients (42.418 vs 42.047 months), which suggests that ovarian LCNEC has a very poor prognosis even at stage I. Mean survival was longer for patients who had undergone postoperative chemotherapy than for those without postoperative chemotherapy (48.082 vs 9.778 months). A small series, such as this, does not provide adequate data to establish a firm correlation between the postoperative chemotherapy and prognosis (p = 0.176). In our review of 58 cases with ovarian LCNEC, prognosis was unfavorable in most cases. Given the rarity of LCNEC, it is highly recommended that a global medical database of ovarian LCNEC and a standard system of diagnosis and treatment is established.
Collapse
Affiliation(s)
- Xiaohang Yang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, China
| | - Junyu Chen
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, China.,Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruiying Dong
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, China.
| |
Collapse
|
11
|
Agarwal L, Gupta B, Jain A. Pure Large Cell Neuroendocrine Carcinoma of the Ovary with Metastasis to Cervix: A Rare Case Report and Review of Literature. J Clin Diagn Res 2016; 10:ED01-ED03. [PMID: 27790443 DOI: 10.7860/jcdr/2016/21639.8554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 07/05/2016] [Indexed: 11/24/2022]
Abstract
Ovarian Large Cell Neuroendocrine Carcinoma (LCNEC) is a recently described rare entity, which even more rarely occurs in a 'pure' form without any associated surface epithelial-stromal or germ cell component. Cervix metastasis of ovarian LCNEC has not been reported previously. We report here a case of ovarian LCNEC in a 35-year-old female who presented with abdominal pain and amenorrhea. Grossly the left ovary showed a solid cystic tumour measuring 6 cm in diameter. Histological examination showed a pure LCNEC without any associated component, confirmed by immunohistochemistry. Metastatic tumour deposits with numerous lymphovascular emboli were identified in the cervix. A comprehensive review of literature along with the various differential diagnosis is discussed.
Collapse
Affiliation(s)
- Lakshmi Agarwal
- Assistant Professor, Department of Pathology, Govt Medical College , Kota, Rajasthan, India
| | - Bhawna Gupta
- Senior Resident, Department of Pathology, Govt Medical College , Kota, Rajasthan, India
| | - Ayushi Jain
- Senior Resident, Department of Pathology, Govt Medical College , Kota, Rajasthan, India
| |
Collapse
|
12
|
Vora M, Lacour RA, Black DR, Turbat-Herrera EA, Gu X. Neuroendocrine tumors in the ovary: histogenesis, pathologic differentiation, and clinical presentation. Arch Gynecol Obstet 2015; 293:659-65. [PMID: 26306985 DOI: 10.1007/s00404-015-3865-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 08/18/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Primary neuroendocrine tumors in the ovary are rare. These tumors arise from the neuroendocrine cell system of ovarian stroma and surface epithelium, and may also arise from teratoma. We present four primary ovarian neuroendocrine tumors and compare clinicopathologic findings based on tumor histogenesis and site of origin. DESIGN Four primary ovarian neuroendocrine tumors were identified from our 10-year departmental archives. H&E slides and immunostains were reviewed and the diagnoses were confirmed. Clinical history, imaging studies, and follow-up data were obtained from medical records. RESULTS Patients' ages ranged from 26 to 63. All patients presented with abdominal discomfort and unilateral or bilateral ovarian masses. MRI and CT scans from cases 1 and 2 revealed a solid ovarian mass with no extra-ovarian extension. In case 1, the patient also had a cystic mass in the opposite ovary and an elevated urine 5-HIAA. Microscopically, case 1 revealed a well-differentiated carcinoid tumor with no surface epithelial involvement, and a mature teratoma in the contralateral ovary. Case 2 revealed a stromal carcinoid within the ovarian parenchyma. Imaging studies from cases 3 and 4 showed large complex masses with peritoneal implants and ascites. In both cases 3 and 4, tumor grossly involved both ovarian parenchyma and surface epithelium with multiple pelvic implants. In addition, liver metastases were present in case 4. Microscopically, these tumors were poorly differentiated carcinoma with neuroendocrine differentiation. Histologic sections revealed extensive necrosis, and both cases showed positivity for neuroendocrine markers. CONCLUSIONS Primary neuroendocrine tumors in the ovary are rare and consist of a group of heterogeneous malignancies that express similar immunohistochemical markers. Primary neuroendocrine tumors that are limited to the ovarian parenchyma often arise from ovarian stroma and teratoma, and are carcinoid tumors with a good prognosis. Neuroendocrine tumors that arise from surface epithelium or dedifferentiate from de novo carcinoma often involve both ovarian stroma and surface epithelium and clinically present as aggressive malignancies with poor prognoses.
Collapse
Affiliation(s)
- Moiz Vora
- Department of Pathology, Louisiana State University Health Sciences Center, 1501 King's Highway, Shreveport, LA, 71103, USA
| | - Robin A Lacour
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, 1501 King's Highway, Shreveport, LA, 71103, USA
| | - Destin R Black
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, 1501 King's Highway, Shreveport, LA, 71103, USA
| | - Elba A Turbat-Herrera
- Department of Pathology, Louisiana State University Health Sciences Center, 1501 King's Highway, Shreveport, LA, 71103, USA.,Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, 1501 King's Highway, Shreveport, LA, 71103, USA
| | - Xin Gu
- Department of Pathology, Louisiana State University Health Sciences Center, 1501 King's Highway, Shreveport, LA, 71103, USA.
| |
Collapse
|
13
|
Taube ET, Denkert C, Pietzner K, Dietel M, Sehouli J, Darb-Esfahani S. Prognostic impact of neuroendocrine differentiation in high-grade serous ovarian carcinoma. Virchows Arch 2014; 466:333-42. [PMID: 25522951 DOI: 10.1007/s00428-014-1710-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 11/29/2014] [Accepted: 12/08/2014] [Indexed: 01/07/2023]
Abstract
Neuroendocrine differentiation in high-grade serous ovarian carcinomas has only rarely been described. However, in our consultancy experience, we have been pointed at a case of neuroendocrine relapse in a patient with high-grade serous ovarian carcinoma where retrospectively, a minor neuroendocrine component in the primary tumor could be detected. Hypothesizing that immunohistochemical evidence of neuroendocrine differentiation might be more frequent in ovarian carcinoma than suspected by morphology, we immunophenotyped the tissue microarrays (TMAs) of a cohort of 178 high-grade serous carcinomas for chromogranin and synaptophysin expression. Synaptophysin expression was found in 12 (6.7 %) out of 172 patients, and chromogranin A expression was seen in 36 (20.7 %) out of 174 patients. Kaplan-Meier analysis revealed that carcinomas with synaptophysin expression of >20 % of positive cells (n = 4) had a significantly shorter survival time than those with 0-20 % of positive cells (p < 0.0001). Synaptophysin expression remained a significant prognostic factor in multivariate analysis (HR = 10.82, 95 % confidence interval 3.10-37.71, p < 0.0001), independently of age, FIGO stage, and residual tumor after surgery. A trend toward shorter survival was seen in patients with tumors that expressed chromogranin, irrespective of the amount of positive cells (p = 0.173). A neuroendocrine differentiation is important to keep in mind when a neuroendocrine tumor of unknown primary is detected in regional or temporal connection with an ovarian carcinoma. A minor neuroendocrine component in ovarian high-grade serous carcinomas might imply a dismal prognosis.
Collapse
MESH Headings
- Adult
- Aged
- Biomarkers, Tumor/metabolism
- Cell Differentiation
- Chromogranins/metabolism
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Immunophenotyping
- Kaplan-Meier Estimate
- Middle Aged
- Neoplasms, Cystic, Mucinous, and Serous/diagnosis
- Neoplasms, Cystic, Mucinous, and Serous/metabolism
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Neurosecretory Systems/pathology
- Ovarian Neoplasms/diagnosis
- Ovarian Neoplasms/metabolism
- Ovarian Neoplasms/pathology
- Prognosis
- Retrospective Studies
- Synaptophysin/metabolism
Collapse
Affiliation(s)
- E T Taube
- Institute of Pathology, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany,
| | | | | | | | | | | |
Collapse
|
14
|
Ki EY, Park JS, Lee KH, Bae SN, Hur SY. Large cell neuroendocrine carcinoma of the ovary: a case report and a brief review of the literature. World J Surg Oncol 2014; 12:314. [PMID: 25314924 PMCID: PMC4210534 DOI: 10.1186/1477-7819-12-314] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 10/03/2014] [Indexed: 11/10/2022] Open
Abstract
Large cell neuroendocrine carcinoma (LCNC) of the ovary, or ovarian undifferentiated non-small cell carcinoma of neuroendocrine type, is a rare entity that is frequently associated with ovarian surface epithelial tumors. Few cases have been reported in the literature. LCNC is an aggressive tumor with tendency to present at advanced stages and to cause death after a short postoperative duration. We report three cases of LCNC diagnosed histopathologically. Immunohistochemically, the tumor cells were positive for chromogranin A, NSE, CD56, and pancytokeratin. The patients were treated postoperatively with combination chemotherapy. Due to the rarity of LCNC, the general consensus on standard therapy is not established. Although most patients are at stage I, the biological aggressiveness and poor prognosis of the tumors have been reported in previous reports despite extensive surgery and chemotherapy.
Collapse
Affiliation(s)
| | | | | | | | - Soo Young Hur
- Department of Obstetrics and Gynecology, Seoul St, Mary's Hospital, The Catholic University of Korea, Banpodaero, Seocho-Gu, Seoul, Korea.
| |
Collapse
|
15
|
Lin CH, Lin YC, Yu MH, Su HY. Primary pure large cell neuroendocrine carcinoma of the ovary. Taiwan J Obstet Gynecol 2014; 53:413-6. [DOI: 10.1016/j.tjog.2013.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2013] [Indexed: 10/24/2022] Open
|
16
|
Ding DC, Chu TY, Hsu YH. Large-cell neuro-endocrine carcinoma associated with borderline mucinous tumor of the ovary. Taiwan J Obstet Gynecol 2014; 53:270-2. [PMID: 25017285 DOI: 10.1016/j.tjog.2013.04.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2013] [Indexed: 11/16/2022] Open
Affiliation(s)
- Dah-Ching Ding
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan; Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
| | - Tang-Yuan Chu
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan; Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Yung-Hsiang Hsu
- Department of Pathology, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
17
|
Large Cell Neuroendocrine Carcinoma of the Ovary and Its Skin Metastases: A Case Report and Review of the Literature. W INDIAN MED J 2014; 63:667-72. [PMID: 25803388 DOI: 10.7727/wimj.2014.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 04/02/2014] [Indexed: 11/18/2022]
Abstract
Large cell neuroendocrine carcinoma in the gynaecological organs affects the uterine cervix and ovary. Large cell neuroendocrine carcinoma of the ovary is extremely rare, and prognosis is quite poor even when diagnosed at an early stage. These tumours respond poorly to standard chemotherapy regimens. The clinical observation of skin metastasis in patients with epithelial ovarian cancer is relatively uncommon, occurring in only 3.5% of patients. These lesions are observed mostly in skin of the abdominal wall adjacent to the primary ovarian tumours. Metastatic skin lesions on extremities are much more rare; it is reported that only 12% of epithelial ovarian carcinoma skin metastases occur on the limbs. Skin metastasis due to large cell neuroendocrine carcinoma of the ovary has not been previously reported. We report the case of a large cell neuroendocrine tumour of the ovary with skin metastases on extremities appearing two months after surgery in a 68-year old woman.
Collapse
|
18
|
Abstract
Tumors of the diffuse neuroendocrine cell system (DNES) may arise in any component of the gynecologic tract, including the vulva, vagina, cervix, endometrium, and ovary. Overall such tumors in the gynecologic tract are rare, constituting only 2% of gynecologic cancers, comprising a spectrum of tumors of variable biologic potential. Due to the rarity of such tumors, pathologists experience may be limited and these may present diagnostic challenges. Currently the nomenclature employed is still that of the pulmonary classification systems, carcinoid, atypical carcinoid, small and large cell neuroendocrine carcinoma that broadly correlates to low/grade 1, intermediate/grade 2, and high grade/grade 3 of the WHO gastroenteropancreatic neuroendocrine tumors classification. Furthermore in keeping with the lung, proliferative rate is assessed based on mitotic index rather than Ki-67 staining. In this review we cover select neuroendocrine tumors of the gynecologic tract.
Collapse
Affiliation(s)
- Marjan Rouzbahman
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | | |
Collapse
|
19
|
Asada K, Kawana K, Teshima S, Saito A, Kawabata M, Fujii T. Poor prognosis of ovarian cancer with large cell neuroendocrine carcinoma: Case report and review of published works. J Obstet Gynaecol Res 2013; 40:869-72. [DOI: 10.1111/jog.12235] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kayo Asada
- Department of Obstetrics and Gynecology; Faculty of Medicine; The University of Tokyo; Tokyo Japan
- Department of Obstetrics and Gynecology; The Fraternity Memorial Hospital; Tokyo Japan
| | - Kei Kawana
- Department of Obstetrics and Gynecology; Faculty of Medicine; The University of Tokyo; Tokyo Japan
| | - Shinichi Teshima
- Department of Pathology; The Fraternity Memorial Hospital; Sumida-ku Japan
| | - Ako Saito
- Department of Obstetrics and Gynecology; The Fraternity Memorial Hospital; Tokyo Japan
| | - Masakiyo Kawabata
- Department of Obstetrics and Gynecology; The Fraternity Memorial Hospital; Tokyo Japan
| | - Tomoyuki Fujii
- Department of Obstetrics and Gynecology; Faculty of Medicine; The University of Tokyo; Tokyo Japan
| |
Collapse
|
20
|
|
21
|
Oshita T, Yamazaki T, Akimoto Y, Tanimoto H, Nagai N, Mitao M, Sakatani A, Kaneko M. Clinical features of ovarian large-cell neuroendocrine carcinoma: Four case reports and review of the literature. Exp Ther Med 2011; 2:1083-1090. [PMID: 22977625 DOI: 10.3892/etm.2011.325] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 07/27/2011] [Indexed: 11/05/2022] Open
Abstract
The objective of the present study was to present 4 recently encountered ovarian large-cell neuroendocrine carcinoma (LCNEC) cases, and to evaluate their clinicopathological features in the context of the previously reported 29 LCNEC cases. First, we described the clinical features of 4 recently encountered cases. Routine H&E staining and immunohistochemistry for CD56, synaptophysin and chromogranin A were performed on sections of both the LCNEC and epithelial carcinoma components. Clinical data for the total of 33 LCNEC cases were summarized, and the Kaplan-Meier survival curve was estimated. Our cases were observed in women aged 42-81 years. One case is clinically classified as FIGO stage IV with multiple metastases, and the others are classified as FIGO stages Ic, IIc and IIIb by post-surgical findings. Pathological features, assessed by H&E staining, were similar to lung LCNEC, and at least one neuroendocrine marker was positive staining in both LCNEC and the epithelial component. One case was pure type LCNEC and the others were mixed carcinoma. Paclitaxel/carboplatin chemotherapy was performed for all cases and 3 of the 4 treatments were effective. The prognoses of our cases were as follows: 1 in stage Ic died from the disease after only 2 months, but the others survived, with or without recurrence, for 32-64 months, whereas the total 5-year survival of the 33 LCNEC cases was 34.9%. In summary, our 3 LCNEC cases revealed ordinary chemo-sensitivity, resulting in a better prognosis than those previously described, apart from 1 case which exhibited aggressive behavior. For the future, a retrospective survey to elucidate the prognostic factors and prospective clinical studies to evaluate the efficacy of treatment modalities of ovarian LCNEC are necessary, particularly for aggressive LCNEC cases.
Collapse
Affiliation(s)
- Takafumi Oshita
- Department of Obstetrics and Gynecology, Miyoshi Central Hospital, Miyoshi, Hiroshima
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Kim JM, Shin HC, Kim MJ. Ovarian Large Cell Neuroendocrine Carcinoma Associated with Endocervical-like Mucinous Borderline Tumor - A Case Report and Literature Review -. KOREAN JOURNAL OF PATHOLOGY 2011. [DOI: 10.4132/koreanjpathol.2011.45.5.523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jun Mo Kim
- Department of Pathology, Yeungnam University College of Medicine, Daegu, Korea
| | - Hyeong Chan Shin
- Department of Pathology, Yeungnam University College of Medicine, Daegu, Korea
| | - Mi Jin Kim
- Department of Pathology, Yeungnam University College of Medicine, Daegu, Korea
| |
Collapse
|
23
|
Affiliation(s)
- M F Aslam
- Department of Obstetrics and Gynaecology, Maimonides Medical Center, Brooklyn, NY, USA.
| | | | | |
Collapse
|
24
|
Chênevert J, Bessette P, Plante M, Têtu B, Dubé V. Mixed ovarian large cell neuroendocrine carcinoma, mucinous adenocarcinoma, and teratoma: A report of two cases and review of the literature. Pathol Res Pract 2009; 205:657-61. [DOI: 10.1016/j.prp.2009.01.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 12/18/2008] [Accepted: 01/28/2009] [Indexed: 11/28/2022]
|
25
|
Monoclonality of composite large cell neuroendocrine carcinoma and mucinous epithelial tumor of the ovary: a case study. Int J Gynecol Pathol 2009; 28:55-8. [PMID: 19047907 DOI: 10.1097/pgp.0b013e31817fb419] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A rare case of mixed carcinoma of the ovary is reported, composed of a large cell neuroendocrine carcinoma and a mucinous borderline endocervical tumor. The large cell neuroendocrine carcinoma was composed of solid nests, sheets, and trabeculae of medium to large-sized cells, and was positive for synaptophysin. The mucinous epithelial tumor varied in appearance from a borderline to an intraepithelial carcinoma, and showed sparsely scattered immunoreactivity for chromogranin-A. Using an X-chromosome clonality assay, these 2 components showed patterns of monoclonality. These results suggest that the large cell neuroendocrine carcinoma may have arisen from the mucinous epithelial tumor.
Collapse
|
26
|
Dundr P, Fischerová D, Povýsil C, Cibula D. Primary pure large-cell neuroendocrine carcinoma of the ovary. Pathol Res Pract 2008; 204:133-7. [PMID: 18164557 DOI: 10.1016/j.prp.2007.09.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Revised: 09/14/2007] [Accepted: 09/21/2007] [Indexed: 01/05/2023]
Abstract
We report a case of a 73-year-old female with a rare simultaneous occurrence of three tumors: ovarian carcinoma, endometrial carcinoma, and breast carcinoma. The ovarian tumor was a primary pure large-cell neuroendocrine carcinoma. Grossly, the left ovary was enlarged by a solid tumor that measured 9 x 7 x 7 cm. Histologically, the tumor consisted of large cells with irregular hyperchromatic nuclei and a moderate amount of eosinophilic cytoplasm. In some areas, the tumor cells were arranged in solid sheets; however, the predominant pattern was cribriform and solid-alveolar, with palisaded tumor cells located peripherally. The tumor cells showed multiple mitotic figures (up to 43 mitoses/10 HPF). Large areas of tumor necrosis were found. Immunohistochemically, the tumor cells were positive for EMA, synaptophysin, chromogranin, CD56, and CEA. Cytokeratin 20 was positive focally. Primary large-cell neuroendocrine carcinoma of the ovary is a rare tumor. To the best of our knowledge, only 4 cases of a pure tumor of this type have been reported to date.
Collapse
Affiliation(s)
- Pavel Dundr
- Department of Pathology, 1st Faculty of Medicine and General Teaching Hospital, Charles University, Studnickova 2, Prague 12800, Czech Republic.
| | | | | | | |
Collapse
|
27
|
Grandjean M, Legrand L, Waterkeyn M, Baurain JF, Jadoul P, Donnez J, Marbaix E. Small cell carcinoma of pulmonary type inside a microinvasive mucinous cystadenocarcinoma of the ovary: a case report. Int J Gynecol Pathol 2007; 26:426-31. [PMID: 17885493 DOI: 10.1097/pgp.0b013e318039373a] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report the occurrence of a small cell carcinoma of pulmonary type developed within a large borderline mucinous cystic tumor of the ovary, with another focus of microinvasive mucinous adenocarcinoma, in a 32-year-old woman. The small cell carcinoma expresses several neuroendocrine markers, thyroid transcription factor 1 and parathyroid hormone. Carbohydrate antigen 15.3 and carcinoembryonic antigen were focally detected but not cancer antigen 125. Cytokeratin 20 was immunolabeled in several mucinous carcinomatous glands but not in the neuroendocrine cells. The p53 protein was abnormally abundant, including in the borderline tumor. Progesterone receptor was heterogeneously immunodetected, whereas estrogen receptor labeling was weak and limited. This unusual immunohistochemical pattern further enhances the singularity of this quite exceptional tumor association.
Collapse
Affiliation(s)
- Marie Grandjean
- Department of Gynecology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, avenue Hippocrate, 10, B-1200 Bruxelles, Belgique
| | | | | | | | | | | | | |
Collapse
|
28
|
Veras E, Deavers MT, Silva EG, Malpica A. Ovarian nonsmall cell neuroendocrine carcinoma: a clinicopathologic and immunohistochemical study of 11 cases. Am J Surg Pathol 2007; 31:774-82. [PMID: 17460463 DOI: 10.1097/01.pas.0000213422.53750.d1] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Nonsmall cell neuroendocrine carcinoma (NSCNEC) of the ovary is a rare and aggressive tumor commonly associated with other surface epithelial and germ cell neoplasms. In this study, we present the clinicopathologic and immunohistochemical features of 11 such cases seen at The University of Texas M.D. Anderson Cancer Center in a 16-year period (1990 to 2005). Patients ranged in age from 22 to 63 years (mean 46.7). The most common presentation was abdominal/pelvic pain (6 cases), followed by ascites (2 cases), pelvic mass, vaginal bleeding, and abdominal bloating (1 case each). Tumors were mostly unilateral, cystic, or solid/cystic and ranged in size from 5 to 26 cm (mean 16.2). In 8 cases, NSCNEC was associated with other epithelial neoplasms, including mucinous neoplasms of low malignant potential, mucinous carcinoma, endometrioid carcinoma, mixed endometrioid and mucinous carcinoma, and a high-grade carcinoma, not otherwise specified. In 2 cases, the tumor was associated with a mature cystic teratoma; one of them also containing an invasive moderately differentiated adenocarcinoma. A single case was associated with a benign ovarian cyst. The latter case had a dermoid cyst in the contralateral ovary. NSCNEC represented anywhere from 10% to 90% of the ovarian tumor. Microscopically, the neuroendocrine component was usually composed of large and/or intermediate oval to round cells. In 2 cases, the intermediate cells were intermixed with small cells. Three cases had also spindle cells. The neoplastic cells were mostly arranged in a solid pattern, nests, or trabeculae. All tumors had a brisk mitotic activity. Immunoperoxidase studies for keratin cocktail, cytokeratin (CK) 7, CK20, CAM 5.2, chromogranin A, synaptophysin, NSE, CD56, and c-kit were performed and the cases stained as follows: keratin cocktail 6/6, CK7 4/5, CK20 3/5, CAM 5.2 3/3, chromogranin A 8/11, synaptophysin 9/9, NSE 1/1, CD56 4/8, and c-kit 5/7. According to the International Federation of Gynecology and Obstetrics staging system, 4 cases were stage I tumors, 3 cases were stage III tumors, and 4 cases were stage IV tumors. Seven patients were treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy followed by chemotherapy. One patient had a bilateral salpingo-oophorectomy with omentectomy and appendectomy followed by chemotherapy; 1 patient had a total abdominal hysterectomy with right salpingo-oophorectomy followed by chemotherapy; one had a bilateral salpingo-oophorectomy followed by chemotherapy, and one had a right salpingo-oophorectomy with appendectomy followed by chemotherapy. Five patients died of disease at 2, 3, 9, 20, and 36 months. One patient is alive with disease at 8 months and 5 are alive without evidence of disease at 11, 28, 37, 66, and 68 months. Four of 5 patients who died of disease had either stage III or IV tumors and 3 of 5 patients who are alive without evidence of disease have stage I tumors. In summary, ovarian NSCNEC is an aggressive tumor with a tendency to present at advanced stage and cause death within a mean of 17 months after diagnosis; however, some patients, particularly those with stage I disease and/or those who have received platinum-based therapy, may have a more favorable prognosis.
Collapse
Affiliation(s)
- Emanuela Veras
- Department of Pathology, The University of Texas Medical School at Houston, Houston, TX 77030, USA
| | | | | | | |
Collapse
|
29
|
Abstract
Large cell neuroendocrine carcinoma of the ovary is a recently described tumour entity that is now included in the WHO classification of primary ovarian neoplasms. Although mostly in stage I at diagnosis, this tumour shows an aggressive clinical behaviour with subsequent metastases and mean survival is less than one year. In addition to the neuroendocrine carcinoma, most cases also have a malignant surface epithelial tumour component. I here report a 64-year-old woman who was operated on for a right-sided ovarian large cell neuroendocrine carcinoma without a surface epithelial component, which constitutes only the second reported tumour of this "pure" kind. Histological and immunohistochemical findings are described and a review of the literature is presented. The patient was treated postoperatively with chemotherapy. She developed bleomycin-induced lung fibrosis that responded well to treatment with steroids. There have been no signs of local tumour recurrence or metastases at follow-up examinations during the first 9 months after the operation.
Collapse
Affiliation(s)
- C F Lindboe
- Department of Pathology, Sørlandet Sykehus HF, Kristiansand, Norway.
| |
Collapse
|
30
|
Choi YD, Lee JS, Choi C, Park CS, Nam JH. Ovarian neuroendocrine carcinoma, non-small cell type, associated with serous carcinoma. Gynecol Oncol 2007; 104:747-52. [PMID: 17229461 DOI: 10.1016/j.ygyno.2006.11.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Revised: 10/13/2006] [Accepted: 11/02/2006] [Indexed: 12/20/2022]
Abstract
BACKGROUND Neuroendocrine carcinoma of the non-small cell type of the ovary is a rare aggressive tumor, interestingly associated with either a surface epithelial tumor or teratoma. CASE A 71-year-old woman presented with a pelvic mass and underwent a total abdominal hysterectomy with a bilateral salpingo-oophorectomy. Pathology examination showed a 6.5 cm in greatest dimension ovarian tumor composed of neuroendocrine carcinoma of the non-small cell type and serous carcinoma. Immunohistochemical studies including keratin 7, WT-1, and neuroendocrine markers demonstrated differences in the two components. Microsatellite instability (MSI) analysis using five polymorphic markers also showed a different pattern in the two components. CONCLUSION This is the first report of an ovarian neuroendocrine carcinoma, non-small cell type, associated with a serous carcinoma. Immunohistochemistry and MSI are very helpful in making a definite diagnosis.
Collapse
Affiliation(s)
- Yoo Duk Choi
- Department of Pathology, Chonnam National University Medical School, 5 Hak-dong, Dong-gu, Gwangju, 501-749, Republic of Korea
| | | | | | | | | |
Collapse
|
31
|
Yasuda M, Kajiwara H, Osamura YR, Hirasawa T, Muramatsu T, Murakami M, Takagi M, Tadokoro M, Kobayashi Y, Inayama Y, Miyagi E, Nakatani Y. Ovarian carcinomas with neuroendocrine differentiation: Review of five cases referring to immunohistochemical characterization. J Obstet Gynaecol Res 2006; 32:387-95. [PMID: 16882264 DOI: 10.1111/j.1447-0756.2006.00419.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To review five ovarian carcinomas with varying degrees of neuroendocrine differentiation (ND) using an immunohistochemical study focused on the relationship with morphological features. METHODS ND was immunohistochemically analyzed using 21 antibodies by an indirect immunoperoxidase method, and ploidy pattern was analyzed using paraffin sections. RESULTS The tumors were divided according to tumor cell size into 'small-sized' for case 1, 'intermediate-sized' for cases 2 and 3, and 'large-sized' for cases 4 and 5. Expressions of neuroendocrine markers and argyrophil reaction tended to be strengthened as tumor cell size increased. Cases 1, 2 and 3 showed diploid pattern and cases 4 and 5 showed aneuploid pattern. CONCLUSION ND of ovarian carcinomas is closely related to morphological features represented by the cell size. Therefore, ovarian carcinomas with ND should be defined because the disease entity is not successfully integrated irrespective of the highly malignant potential.
Collapse
Affiliation(s)
- Masanori Yasuda
- Department of Pathology, School of Medicine, Tokai University, Kanagawa, Japan.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Rund CR, Fischer EG. Perinuclear Dot-Like Cytokeratin 20 Staining in Small Cell Neuroendocrine Carcinoma of the Ovary (Pulmonary-Type). Appl Immunohistochem Mol Morphol 2006; 14:244-8. [PMID: 16785798 DOI: 10.1097/01.pai.0000155796.49278.62] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary ovarian small cell carcinomas are rare tumors that are subclassified into the hypercalcemic (HT) and the pulmonary type (PT), and each tumor type has different clinicopathologic characteristics. However, overlapping morphologic features can make the distinction between these lesions difficult. The PT small cell carcinoma is very rare, with only one series and a few case reports published. The authors report two additional cases of this entity and also report for the first time the immunohistochemical finding of perinuclear dot-like staining with cytokeratin 20. This staining pattern has been reported only for Merkel cell carcinoma and salivary gland small cell carcinoma. The authors suggest that the punctate CK20 staining is a useful tool in the diagnostic distinction of PT small cell carcinoma from HT small cell carcinoma, from other primary ovarian tumors such as granulosa cell tumors, and from metastatic neuroendocrine tumors originating at primary sites such as the lung. Since the authors' conclusions are based on two cases of this rare entity, additional cases will need to be studied in the future.
Collapse
Affiliation(s)
- Chad R Rund
- Department of Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | | |
Collapse
|
33
|
Bing Z, Adegboyega PA. Metastasis of Small Cell Carcinoma of Lung Into an Ovarian Mucinous Neoplasm: Immunohistochemistry as a Useful Ancillary Technique for Diagnosis and Classification of Rare Tumors. Appl Immunohistochem Mol Morphol 2005; 13:104-7. [PMID: 15722802 DOI: 10.1097/00129039-200503000-00017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The authors report the first case of ovarian mucinous adenocarcinoma with metastasis from a synchronous small cell neuroendocrine carcinoma of the lung. A 62-year-old white woman presented with weight loss and increased abdominal girth. She was found to have a large, complex cystic mass in the pelvis, and during the staging evaluation, a large, right pulmonary hilar mass was detected. Bronchial brushing as well as transbronchial fine-needle aspiration was diagnostic of small cell carcinoma. The patient received 3 cycles of chemotherapy with carboplatin and subsequently underwent a supracervical hysterectomy and bilateral salpingo-oophorectomy. A large, multiloculated cystic mass was found arising from the right ovary. Microscopic examination disclosed a mucinous neoplasm with both mucinous cystadenoma and mucinous papillary adenocarcinoma components. A microscopic focus of cells with "atypical" cytomorphologic features was detected within the mucinous neoplasm. Immunohistochemistry showed that group of cells to be positive for thyroid transcription factor 1 and chromogranin, confirming them to be metastasis from the pulmonary small cell neuroendocrine carcinoma. This case, in addition to being the first reported case of such metastasis, also highlights the diagnostic utility of immunohistochemistry as a reliable and very useful ancillary technique for the diagnosis of neoplasms with unusual clinical and/or histomorphologic presentations. The clinical and prognostic implications are also discussed.
Collapse
Affiliation(s)
- Zhanyong Bing
- Division of Surgical Pathology, Department of Pathology, The University of Texas Medical Branch, Galveston, TX 77555-0588
| | | |
Collapse
|
34
|
Ohira S, Itoh K, Shiozawa T, Horiuchi A, Ono K, Takeuchi H, Hosoda W, Konishi I. Ovarian Non-Small Cell Neuroendocrine Carcinoma With Paraneoplastic Parathyroid Hormone-related Hypercalcemia. Int J Gynecol Pathol 2004; 23:393-7. [PMID: 15381910 DOI: 10.1097/01.pgp.0000139655.18062.12] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ovarian tumors associated with hypercalcemia due to ectopic secretion of parathyroid hormone (PTH) are extremely rare. A 33-year-old woman presented with a pelvic mass and profound hypercalcemia accompanied by an elevated serum level of PTH. Laparotomy demonstrated a left ovarian tumor that on histological examination was a neuroendocrine carcinoma of non-small cell type admixed with a component of endometrioid adenocarcinoma. After left salpingo-oophorectomy, the serum calcium and PTH levels normalized. The cells of the neuroendocrine carcinoma were positive for neuron-specific enolase, synaptophysin, chromogranin A, and PTH. Hypercalcemia and elevated serum PTH levels recurred during tumor relapse, and the patient died of disease 6 months postoperatively. This is the eleventh case of neuroendocrine carcinoma of non-small cell type associated with surface epithelial neoplasm of the ovary, and the first such tumor to be associated with hypercalcemia.
Collapse
Affiliation(s)
- Satoshi Ohira
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Chen KTK. Composite Large-Cell Neuroendocrine Carcinoma and Surface Epithelial-Stromal Neoplasm of the Ovary. Int J Surg Pathol 2000; 8:169-174. [PMID: 11493984 DOI: 10.1177/106689690000800214] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The clinicopathologic features of two cases of composite large-cell neuroendocrine carcinoma and surface epithelial-stromal neoplasm of the ovary are reported and those of eight previously published cases reviewed. The patients ranged in age from 22 to 77 years (mean, 56 years). The surface epithelial-stromal neoplasm was an endometrioid adenocarcinoma in one case, a mucinous cystadenoma in one case, and a mucinous adenocarcinoma in eight cases. The large-cell neuroendocrine carcinoma in these tumors may represent dedifferentiation of the neuroendocrine cells present in the surface epithelial-stromal tumor. This composite tumor type is highly aggressive. Of eight patients with follow-up information, all had died of disseminated tumor; six within 10 months, and two in 19 months and 3 years, respectively, after diagnosis. Only the neuroendocrine carcinoma component was found in the metastatic sites. Int J Surg Pathol 8(2):169-174, 2000
Collapse
Affiliation(s)
- Karl T. K. Chen
- Department of Pathology, Saint Agnes Medical Center, Fresno, California
| |
Collapse
|