Mixed Small Cell and Large Cell Neuroendocrine Carcinoma of the Endometrium
A Case Report and Literature Review
DOI:
https://doi.org/10.21141/PJP.2021.05Keywords:
Endometrial Neoplasms, Neuroendocrine Carcinoma, Large Cell Carcinoma, Small Cell CarcinomaAbstract
Neuroendocrine carcinoma (NEC) of the endometrium is a rare, aggressive subtype of endometrial cancer. We report a 61-year-old female with a history of breast cancer, s/p modified radical mastectomy, chemotherapy, radiotherapy and hormonal (tamoxifen) therapy, who presented with post-menopausal bleeding. Patient underwent TAH-BSO with lymph node dissection, and was diagnosed with a mixed small cell neuroendocrine carcinoma (SCNEC) and large cell neuroendocrine carcinoma (LCNEC), confirmed by positive immunohistochemical staining for neuroendocrine markers. No other lesions were identified on PET-CT, making a primary endometrial NEC the most likely diagnosis. We review the clinical and pathologic characteristics of endometrial neuroendocrine carcinomas.
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References
1. Lortet-Tieulent J, Ferlay J, Bray F, Jemal A. International patterns and trends in endometrial cancer incidence, 1978-2013. J Natl Cancer Inst. 2018;110(4):354-61. PMID: 29045681. https://doi.org/10.1093/jnci/djx214.
2. Laudico AV, Mirasol-Lumague M, Medina V, Mapua CA, Valenzuela FG, Pukkala E. Philippine Cancer Society 2015 Philippine Cancer Facts and Estimates. Available from: www.philcancer.org.ph/wp-content/uploads/2017/07/2015-PCS-Ca-Facts-Estimates_CAN090516.pdf. Accessed April 14, 2021.
3. Macaurog BA, Toral JAB, Clinical characteristics and prognosis of young Filipino women ages 30 and below with endometrial cancer: a ten-year retrospective cohort study. PJGO. 2019;16(1):19-24.
4. Cree IA, Malpica A, McCluggage WG. WHO Classification of Tumours, 5th ed, vol. 4. Female genital tumours. Lyon, International Agency for Research on Cancer; 2020.
5. Yi KC. Neuroendocrine tumors of the female reproductive tract: a literature review. J Pathol Transl Med. 2015;49(6):450-61. PMID: 26459408. PMCID: PMC4696532. https://doi.org/10.4132/jptm.2015.09.20.
6. Pocrnich CE, Ramalingam P, Euscher ED, Malpica A. Neuroendocrine carcinoma of the endometrium: a clinicopathologic study of 25 cases. Am J Surg Pathol. 2016;40(5):577–86. PMID: 26945341. PMCID: PMC5998806. https://doi.org/10.1097/PAS.0000000000000633.
7. van Hoeven KH, Hudock JA, Woodruff JM, Suhrland MJ. Small cell neuroendocrine carcinoma of the endometrium. Int J Gynecol Pathol. 1995;14(1):21–9. PMID: 7883422. https://doi.org/10.1097/00004347-199501000-00005.
8. Cortesi L, De Matteis E, Rashid I, et al. Distribution of second primary malignancies suggests a bidirectional effect between breast and endometrial cancer: a population-based study. Int J Gynecol Cancer. 2009;19(8):1358-63. PMID: 20009890. https://doi.org/10.1111/IGC.0b013e3181b9f5d5.
9. Albores-Saavedra J, Martinez-Benitez B, Luevano E. Small cell carcinomas and large cell neuroendocrine carcinomas of the endometrium and cervix: polypoid tumors and those arising in polyps may have a favorable prognosis. Int Gynecol Pathol. 2008;27(3):333–9. PMID: 18580310. https://doi.org/10.1097/PGP.0b013e31815de006.
10. Mulvany NJ, Allen DG. Combined large cell neuroendocrine and endometrioid carcinoma of the endometrium. Int J Gynecol Pathol. 2008;27(1):49–57. PMID: 18156975. https://doi.org/10.1097/pgp.0b013e31806219c5.
11. Sato H, Kanai G, Kajiwara H, Itoh J, Osumara RY. Small-cell carcinoma of the endometrium presenting as cushing’s syndrome. Endocr J. 2010;57(1):31-8. PMID: 19834252. https://doi.org/10.1507/endocrj.k09e-212.
12. Deodhar KK, Kerkar RA, Suryawanshi P, Menon H, Menon S. Large cell neuroendocrine carcinoma of the endometrium: an extremely uncommon diagnosis, but worth the efforts. J Cancer Res Therap. 2011;7(2):211-3. PMID: 21768718. https://doi.org/10.4103/0973-1482.82942.
13. Nguyen MT, Han L, Minors AM, et al. Rare large cell neuroendocrine tumor of the endometrium: a case report and review of the literature. Int J Surg Case Rep. 2013;4(8):651–5. PMID: 23792474. PMCID: PMC3710906. https://doi.org/10.1016/j.ijscr.2013.04.027.
14. Ariura M, Kasajima R, Miyagi Y, et al, Combined large cell neuroendocrine carcinoma and endometrioid carcinoma of the endometrium: a shared gene mutation signature between the two histological components Int Cancer Conf J. 2017; 6(1):11–5. PMID: 31149461. PMCID: PMC6498361. https://doi.org/10.1007/s13691-016-0263-9.
15. Kumar NB, Hart WR. Metastases to the uterine corpus from extragenital cancers. A clinicopathologic study of 63 cases. Cancer. 1982;50(10):2163-9. PMID: 7127256. https://doi.org/10.1002/1097-0142(19821115)50:10<2163::aid-cncr2820501032>3.0.co;2-f.
16. Choi S, Joo JW, Do SI, Kim HS. Endometrium-limited metastasis of extragenital malignancies: a challenge in the diagnosis of endometrial curettage specimens. Diagnostics (Basel). 2020;10(3):150. PMID: 32164210. PMCID: PMC7151118. https://doi.org/10.3390/diagnostics10030150.
17. Stewart CJR, Crum CP, McCluggage WG, et al. Guidelines to aid in the distinction of endometrial and endocervical carcinomas, and the distinction of independent primary carcinomas of the endometrium and adnexa from metastatic spread between these and other sites. Int J Gynecol Pathol. 2019;38 Suppl 1(Iss 1 Suppl 1):S75-92. PMID: 30550485. PMCID: PMC6296834. https://doi.org/10.1097/PGP.0000000000000553.
18. Cancer Genome Atlas Research Network; Kandoth C, Schultz N, et al. Integrated genomic characterization of endometrial carcinoma. Nature. 2013;497(7447):67–73. PMID: 23636398. PMCID: PMC3704730. https://doi.org/10.1038/nature12113.
2. Laudico AV, Mirasol-Lumague M, Medina V, Mapua CA, Valenzuela FG, Pukkala E. Philippine Cancer Society 2015 Philippine Cancer Facts and Estimates. Available from: www.philcancer.org.ph/wp-content/uploads/2017/07/2015-PCS-Ca-Facts-Estimates_CAN090516.pdf. Accessed April 14, 2021.
3. Macaurog BA, Toral JAB, Clinical characteristics and prognosis of young Filipino women ages 30 and below with endometrial cancer: a ten-year retrospective cohort study. PJGO. 2019;16(1):19-24.
4. Cree IA, Malpica A, McCluggage WG. WHO Classification of Tumours, 5th ed, vol. 4. Female genital tumours. Lyon, International Agency for Research on Cancer; 2020.
5. Yi KC. Neuroendocrine tumors of the female reproductive tract: a literature review. J Pathol Transl Med. 2015;49(6):450-61. PMID: 26459408. PMCID: PMC4696532. https://doi.org/10.4132/jptm.2015.09.20.
6. Pocrnich CE, Ramalingam P, Euscher ED, Malpica A. Neuroendocrine carcinoma of the endometrium: a clinicopathologic study of 25 cases. Am J Surg Pathol. 2016;40(5):577–86. PMID: 26945341. PMCID: PMC5998806. https://doi.org/10.1097/PAS.0000000000000633.
7. van Hoeven KH, Hudock JA, Woodruff JM, Suhrland MJ. Small cell neuroendocrine carcinoma of the endometrium. Int J Gynecol Pathol. 1995;14(1):21–9. PMID: 7883422. https://doi.org/10.1097/00004347-199501000-00005.
8. Cortesi L, De Matteis E, Rashid I, et al. Distribution of second primary malignancies suggests a bidirectional effect between breast and endometrial cancer: a population-based study. Int J Gynecol Cancer. 2009;19(8):1358-63. PMID: 20009890. https://doi.org/10.1111/IGC.0b013e3181b9f5d5.
9. Albores-Saavedra J, Martinez-Benitez B, Luevano E. Small cell carcinomas and large cell neuroendocrine carcinomas of the endometrium and cervix: polypoid tumors and those arising in polyps may have a favorable prognosis. Int Gynecol Pathol. 2008;27(3):333–9. PMID: 18580310. https://doi.org/10.1097/PGP.0b013e31815de006.
10. Mulvany NJ, Allen DG. Combined large cell neuroendocrine and endometrioid carcinoma of the endometrium. Int J Gynecol Pathol. 2008;27(1):49–57. PMID: 18156975. https://doi.org/10.1097/pgp.0b013e31806219c5.
11. Sato H, Kanai G, Kajiwara H, Itoh J, Osumara RY. Small-cell carcinoma of the endometrium presenting as cushing’s syndrome. Endocr J. 2010;57(1):31-8. PMID: 19834252. https://doi.org/10.1507/endocrj.k09e-212.
12. Deodhar KK, Kerkar RA, Suryawanshi P, Menon H, Menon S. Large cell neuroendocrine carcinoma of the endometrium: an extremely uncommon diagnosis, but worth the efforts. J Cancer Res Therap. 2011;7(2):211-3. PMID: 21768718. https://doi.org/10.4103/0973-1482.82942.
13. Nguyen MT, Han L, Minors AM, et al. Rare large cell neuroendocrine tumor of the endometrium: a case report and review of the literature. Int J Surg Case Rep. 2013;4(8):651–5. PMID: 23792474. PMCID: PMC3710906. https://doi.org/10.1016/j.ijscr.2013.04.027.
14. Ariura M, Kasajima R, Miyagi Y, et al, Combined large cell neuroendocrine carcinoma and endometrioid carcinoma of the endometrium: a shared gene mutation signature between the two histological components Int Cancer Conf J. 2017; 6(1):11–5. PMID: 31149461. PMCID: PMC6498361. https://doi.org/10.1007/s13691-016-0263-9.
15. Kumar NB, Hart WR. Metastases to the uterine corpus from extragenital cancers. A clinicopathologic study of 63 cases. Cancer. 1982;50(10):2163-9. PMID: 7127256. https://doi.org/10.1002/1097-0142(19821115)50:10<2163::aid-cncr2820501032>3.0.co;2-f.
16. Choi S, Joo JW, Do SI, Kim HS. Endometrium-limited metastasis of extragenital malignancies: a challenge in the diagnosis of endometrial curettage specimens. Diagnostics (Basel). 2020;10(3):150. PMID: 32164210. PMCID: PMC7151118. https://doi.org/10.3390/diagnostics10030150.
17. Stewart CJR, Crum CP, McCluggage WG, et al. Guidelines to aid in the distinction of endometrial and endocervical carcinomas, and the distinction of independent primary carcinomas of the endometrium and adnexa from metastatic spread between these and other sites. Int J Gynecol Pathol. 2019;38 Suppl 1(Iss 1 Suppl 1):S75-92. PMID: 30550485. PMCID: PMC6296834. https://doi.org/10.1097/PGP.0000000000000553.
18. Cancer Genome Atlas Research Network; Kandoth C, Schultz N, et al. Integrated genomic characterization of endometrial carcinoma. Nature. 2013;497(7447):67–73. PMID: 23636398. PMCID: PMC3704730. https://doi.org/10.1038/nature12113.
Published
06/29/2021
How to Cite
Uyboco, J., Cruz, M. A., Cenizal, M. C., So, J., Bello, M., & Moran, J. (2021). Mixed Small Cell and Large Cell Neuroendocrine Carcinoma of the Endometrium: A Case Report and Literature Review. PJP, 6(1), 43–49. https://doi.org/10.21141/PJP.2021.05
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Case Reports
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