Large cell neuroendocrine carcinoma originating from the uterine endometrium: a report on magnetic resonance features of 2 cases with very rare and aggressive tumor.
Bottom Line: Neuroendocrine carcinomas (NEC) of the female genital tract are aggressive and uncommon tumors, which usually involve the uterine cervix and ovary, and are seen very rarely in the endometrium.Only less than 10 cases of large cell NEC (LCNEC) of the endometrium have been reported in the literature and their radiological findings are not well described.In both cases, the uterine body was enlarged and the tumor occupied part of the uterine cavity.
Affiliation: Department of Obstetrics and Gynecology.
Neuroendocrine carcinomas (NEC) of the female genital tract are aggressive and uncommon tumors, which usually involve the uterine cervix and ovary, and are seen very rarely in the endometrium. Only less than 10 cases of large cell NEC (LCNEC) of the endometrium have been reported in the literature and their radiological findings are not well described. We report here two cases of pathologically proven LCNEC of the uterine endometrium. In both cases, the uterine body was enlarged and the tumor occupied part of the uterine cavity. Endometrial mass exhibited heterogeneous high intensity on T2-weighted magnetic resonance (MR) images, and diffusion-weighted MR images revealed high intensity throughout the tumor, consistent with malignancy. LCNEC is a highly malignant neoplasm without particular findings in terms of diagnostic imaging and pathology, so its preoperative definitive diagnosis is very difficult. However, when laboratory test, pathologic diagnosis and MR imaging suggest a poorly differentiated uterine malignancy, positron emission tomography-computed tomography scan should be performed as a general assessment to help with diagnosis.
No MeSH data available.
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Mentions: A 73-year-old woman (gravida 2, para 2), having no history of gynecologic disorders, visited a local hospital with lumbago and abdominal distention and was referred to the Kobe University Hospital as soon as the presence of large uterine tumor was detected by computed tomography (CT) imaging. The histopathological examination of the biopsy specimen from the endometrium suggested a diagnosis of LCNEC, and the one from the cervix had no malignant finding. Physical examination revealed that she had enlarged uterus and right supraclavicular lymphadenopathy. The laboratory tests were unremarkable, except for the elevation of serum neuronspecific enolase (NSE; 630 ng/mL; reference level, <12 ng/mL), cancer antigen 125 (202 U/mL; reference level, <35 U/mL), lactate dehydrogenase (3038 IU/L; reference level, 115∼217 IU/L), and interleukin receptor-2 (767 U/mL; reference level, 122∼466 U/mL). MR images of lower abdomen, but not of the upper, was performed. It demonstrated a diffusely swollen endometrial mass exhibiting hypointensity to myometrium on T1-weighted images, and slightly high heterogeneous intensity on T2-weighted images (Figure 1A). The tumor involved both the myometrium and endometrium. Extensive pelvic and paraaortic lymphadenopathies were also identified. On diffusion weighted imaging the mass and lymph nodes showed remarkably hyperintensity (Figure 1B). Following above, whole body FDG-PET/CT was performed; it revealed increased FDG uptake in the uterus, multiple lymph nodes and bones (Figure 1C). Because the metastasis to right supraclavicular lymph node and bones were identified, the clinical stage was determined to be 4b. The surgery was not performed, because of the aggressive nature and advanced stage of the tumor. The patient refused the systemic chemotherapy, so shifted to palliative care. Five weeks after her first visit to our hospital, she died of respiratory failure. In autopsy examination, the uterus was diffusely enlarged, and accompanied with a 6 cm sized submucosal type leiomyoma. Microscopically, neoplastic cells with prominent nucleoli arranged in nesting pattern showing extensive areas of geographic necrosis. In addition, the tumor cells exhibited remarkable increase of mitotic counts and immunohistochemistry revealed diffuse positivity for synaptophysin, chromograninA (Figure 2), NSE and p53. A diagnosis of LCNEC of the endometrium was made.
No MeSH data available.