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Progression after spontaneous regression in lung large cell neuroendocrine carcinoma: Report of a curative resection.

Tomizawa K, Suda K, Takemoto T, Iwasaki T, Sakaguchi M, Kuwano H, Mitsudomi T - Thorac Cancer (2015)

Bottom Line: An 85-year-old woman presented with a 2.8-cm nodule in the right upper lung lobe on chest computed tomography.She had a good postoperative course with no complications.Physicians and surgeons should be aware that radiographic regression of a pulmonary nodule does not necessarily exclude the possibility of lung cancer.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Division of Thoracic Surgery, Kinki University Osaka, Japan ; Department of General Surgical Science, Graduate School of Medicine, Gunma University Maebashi, Gunma, Japan.

ABSTRACT
We present the first reported case of lung large cell neuroendocrine carcinoma (LCNEC) with spontaneous regression followed by progression. An 85-year-old woman presented with a 2.8-cm nodule in the right upper lung lobe on chest computed tomography. After four months, the tumor decreased to 1.8 cm and remained unchanged in size for the next three months, but it grew to 8.6 cm and invaded the mediastinal fat tissue after approximately one year. Ultrasound echo-guided percutaneous biopsy revealed the tumor to be LCNEC. The patient underwent a right upper lobectomy with lymph node dissection. She had a good postoperative course with no complications. Physicians and surgeons should be aware that radiographic regression of a pulmonary nodule does not necessarily exclude the possibility of lung cancer.

No MeSH data available.


Related in: MedlinePlus

(a) Biopsy tissue. The tumor showed a proliferation of tumor cells with large and irregular nuclei and necrosis (hematoxylin and eosin [H&E] stain, × 200). (b–d) Surgical resected tissue. The histopathological findings from were similar to that from the biopsy tissue (b: H&E stain, × 40 and c: H&E stain, ×400, respectively). (d) We diagnosed a large cell neuroendocrine carcinoma based on immunohistochemical study; the tumor was positive for synaptophysin.
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fig02: (a) Biopsy tissue. The tumor showed a proliferation of tumor cells with large and irregular nuclei and necrosis (hematoxylin and eosin [H&E] stain, × 200). (b–d) Surgical resected tissue. The histopathological findings from were similar to that from the biopsy tissue (b: H&E stain, × 40 and c: H&E stain, ×400, respectively). (d) We diagnosed a large cell neuroendocrine carcinoma based on immunohistochemical study; the tumor was positive for synaptophysin.

Mentions: The patient was referred to our hospital for curative pulmonary resection in March 2013. Her physical examination was unremarkable, and her blood examination, including tumor markers, showed anemia with a hemoglobin value of 10.2 mg/dL. The cause of the anemia was not clear despite scrutiny. In April 2013, the size of the tumor shadow decreased from 2.8 to 1.8 cm (Fig 1b). We strongly suspected the tumor was benign rather than malignant and planned to perform a follow-up imaging examination. The tumor shadow remained unchanged for the next three months (Fig 1c). In July 2013, the patient was diagnosed with rheumatoid arthritis and began to receive glucocorticoid treatment. In January 2014, the tumor increased from 1.8 to 4.8 cm (Fig 1d) and a TBLB of the tumor was performed with suspicions of inflammatory disease or malignancy; however results of the TBLB were inconclusive. A chest CT scan was repeated in June 2014 and showed that the tumor shadow had further enlarged to 8.6 cm, with swelling of the mediastinal lymph nodes and suspected invasion of the superior vena cava and chest wall (Fig 1e). FDG-PET showed uptake within the tumor with a maximal standard uptake value of 23.6, but did not show uptake within the mediastinal lymph nodes. An ultrasound-guided biopsy of the tumor revealed a proliferation of tumor cells with large and irregular nuclei (Fig 2a). We diagnosed primary lung cancer, cT4N0M0, stage IIIA, according to the TNM (tumor node metastasis) Classification of Malignant Tumors (7th edition).


Progression after spontaneous regression in lung large cell neuroendocrine carcinoma: Report of a curative resection.

Tomizawa K, Suda K, Takemoto T, Iwasaki T, Sakaguchi M, Kuwano H, Mitsudomi T - Thorac Cancer (2015)

(a) Biopsy tissue. The tumor showed a proliferation of tumor cells with large and irregular nuclei and necrosis (hematoxylin and eosin [H&E] stain, × 200). (b–d) Surgical resected tissue. The histopathological findings from were similar to that from the biopsy tissue (b: H&E stain, × 40 and c: H&E stain, ×400, respectively). (d) We diagnosed a large cell neuroendocrine carcinoma based on immunohistochemical study; the tumor was positive for synaptophysin.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4567013&req=5

fig02: (a) Biopsy tissue. The tumor showed a proliferation of tumor cells with large and irregular nuclei and necrosis (hematoxylin and eosin [H&E] stain, × 200). (b–d) Surgical resected tissue. The histopathological findings from were similar to that from the biopsy tissue (b: H&E stain, × 40 and c: H&E stain, ×400, respectively). (d) We diagnosed a large cell neuroendocrine carcinoma based on immunohistochemical study; the tumor was positive for synaptophysin.
Mentions: The patient was referred to our hospital for curative pulmonary resection in March 2013. Her physical examination was unremarkable, and her blood examination, including tumor markers, showed anemia with a hemoglobin value of 10.2 mg/dL. The cause of the anemia was not clear despite scrutiny. In April 2013, the size of the tumor shadow decreased from 2.8 to 1.8 cm (Fig 1b). We strongly suspected the tumor was benign rather than malignant and planned to perform a follow-up imaging examination. The tumor shadow remained unchanged for the next three months (Fig 1c). In July 2013, the patient was diagnosed with rheumatoid arthritis and began to receive glucocorticoid treatment. In January 2014, the tumor increased from 1.8 to 4.8 cm (Fig 1d) and a TBLB of the tumor was performed with suspicions of inflammatory disease or malignancy; however results of the TBLB were inconclusive. A chest CT scan was repeated in June 2014 and showed that the tumor shadow had further enlarged to 8.6 cm, with swelling of the mediastinal lymph nodes and suspected invasion of the superior vena cava and chest wall (Fig 1e). FDG-PET showed uptake within the tumor with a maximal standard uptake value of 23.6, but did not show uptake within the mediastinal lymph nodes. An ultrasound-guided biopsy of the tumor revealed a proliferation of tumor cells with large and irregular nuclei (Fig 2a). We diagnosed primary lung cancer, cT4N0M0, stage IIIA, according to the TNM (tumor node metastasis) Classification of Malignant Tumors (7th edition).

Bottom Line: An 85-year-old woman presented with a 2.8-cm nodule in the right upper lung lobe on chest computed tomography.She had a good postoperative course with no complications.Physicians and surgeons should be aware that radiographic regression of a pulmonary nodule does not necessarily exclude the possibility of lung cancer.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Division of Thoracic Surgery, Kinki University Osaka, Japan ; Department of General Surgical Science, Graduate School of Medicine, Gunma University Maebashi, Gunma, Japan.

ABSTRACT
We present the first reported case of lung large cell neuroendocrine carcinoma (LCNEC) with spontaneous regression followed by progression. An 85-year-old woman presented with a 2.8-cm nodule in the right upper lung lobe on chest computed tomography. After four months, the tumor decreased to 1.8 cm and remained unchanged in size for the next three months, but it grew to 8.6 cm and invaded the mediastinal fat tissue after approximately one year. Ultrasound echo-guided percutaneous biopsy revealed the tumor to be LCNEC. The patient underwent a right upper lobectomy with lymph node dissection. She had a good postoperative course with no complications. Physicians and surgeons should be aware that radiographic regression of a pulmonary nodule does not necessarily exclude the possibility of lung cancer.

No MeSH data available.


Related in: MedlinePlus