large cell neuroendocrine carcinoma

Large Cell Neuroendocrine Carcinoma (LCNEC) Description

Large cell neuroendocrine carcinoma (LCNEC) is a rare and aggressive type of cancer that can occur in various parts of the body, including the lungs. Here are some key features that describe LCNEC:

• Cell size: LCNEC cells are typically larger than those found in other types of lung cancers.
• Neuroendocrine differentiation: LCNEC cells have neuroendocrine characteristics, which means they produce and secrete hormones.
• Histologic features: LCNEC is characterized by large cells with a moderate-to-large amount of cytoplasm, polygonal cell shape, lower nucleus-to-cytoplasm (N:C) ratio, coarsely granular or vesicular chromatin, and prominent nucleoli [8].
• Immunohistochemical expression: LCNEC cells express immunohistochemical markers that are typical of neuroendocrine tumors.
• Aggressive behavior: LCNEC is a high-grade tumor with aggressive behavior, characterized by rapid growth and potential for metastasis.

Overall, LCNEC is a rare and aggressive type of cancer that requires prompt diagnosis and treatment. Its unique features make it distinct from other types of lung cancers.

References:

[1] Apr 9, 2024 — Large cell neuroendocrine carcinoma (LCNEC) is a rare pulmonary tumor, with features of both small cell lung cancer (SCLC) and non-small cell ... [1] [2] Oct 10, 2022 — It originates from argyrophilic cells in the lung and has the morphology and differentiation characteristics of a neuroendocrine tumor [1, 2]. [3] by V Corbett · 2021 · Cited by 37 — Introduction. Large cell neuroendocrine carcinoma (LCNEC) is a rare subgroup of high grade neuroendocrine cancer that can occur throughout the body (Figure 1). [4] by MK Baine · 2020 · Cited by 46 — LCNEC is characterized by larger cell size, moderate-to-large amount of cytoplasm, polygonal cell shape, lower N

Overview of Large Cell Neuroendocrine Carcinoma (LCNEC)

Large cell neuroendocrine carcinoma (LCNEC) is a rare and aggressive type of cancer that originates from the neuroendocrine cells in various parts of the body, such as the lungs, pancreas, or stomach. LCNEC is characterized by its large cell size and high mitotic activity.

Common Symptoms

The symptoms of LCNEC vary depending on the location and extent of the tumor. However, some common symptoms include:

• Abdominal discomfort: A dull ache to sharp or stabbing pain in the abdomen, which can be a sign of pancreatic or gastric LCNEC [5].
• Weight loss: Unintentional weight loss is a common symptom of many cancers, including LCNEC [8].
• Fatigue: Feeling extremely tired or weak, even after resting, can be a symptom of LCNEC [8].
• Low blood sugar levels (hypoglycemia): In some cases, LCNEC in the pancreas can cause low blood sugar levels, leading to symptoms such as sweating, shakiness, dizziness, and extreme hunger [4].

Other Possible Symptoms

Depending on the location of the tumor, other possible symptoms may include:

• Difficulty breathing: If the tumor is located in

Diagnosing Large Cell Neuroendocrine Carcinoma (LCNEC)

To diagnose LCNEC, a combination of tests and procedures are used to determine the presence and extent of the tumor.

• Imaging Studies: Imaging tests such as CT scans and MRI provide a three-dimensional picture of the inside of the body, helping to determine whether the tumor has spread to other parts of the body [5].
• Blood Tests: Blood chemistry tests, complete blood count (CBC), and biochemical markers are used to assess the overall health and detect any abnormalities that may be related to LCNEC [2].
• Biopsy: A biopsy is performed to obtain fluid or tissue samples from the tumor. The sample is then examined under a microscope to check for cancer cells [3].
• Pathological Diagnosis: The pathologic diagnosis of LCNEC is mainly based on the microscopic appearance of the tumor cells, the mitotic rate, and the amount of intra-tumoral necrosis [4][8].

Additional Diagnostic Tools

• Neuroendocrine Markers: Staining for neuroendocrine markers (NCAM, SYN, CGA, PGP9.5) is recommended to confirm the diagnosis. At least 10% of cells should be positive with at least one marker [6].
• Differential Diagnoses: The differential diagnoses of LCNEC include basaloid SCC, large cell carcinoma (with NE morphology or NE markers), adenocarcinoma, SCLC, and AC [7].

These diagnostic tests and procedures are used to determine the presence and extent of LCNEC, which is essential for developing an effective treatment plan.

Treatment Options for Large Cell Neuroendocrine Carcinoma (LCNEC)

Large cell neuroendocrine carcinoma (LCNEC) is a rare and aggressive type of cancer that can be challenging to treat. The treatment options for LCNEC are similar to those for small cell lung cancer, as the two conditions share many similarities.

Chemotherapy

Chemotherapy is often used as a first-line treatment for LCNEC. A combination of chemotherapy drugs such as etoposide and either cisplatin or carboplatin is commonly used [2]. This treatment approach has been shown to be effective in improving prognosis and survival rates in patients with LCNEC.

Adjuvant Chemotherapy

In some cases, adjuvant chemotherapy may be recommended after surgery to remove the tumor. The most common regimen used for adjuvant chemotherapy in LCNEC is a fluoropyrimidine-based combination, which includes 5-fluorouracil, leucovorin, and oxaliplatin [4].

Biological Therapy

Biological therapy, also known as biotherapy or biological response modifiers (BRMs), may be used to treat LCNEC. This type of treatment uses substances that stimulate the immune system to attack cancer cells.

Perioperative Chemotherapy

Research has shown that perioperative chemotherapy can improve overall survival (OS) in patients with LCNEC [7]. This approach involves administering chemotherapy before and after surgery to remove the tumor.

First-Line Therapy

The most commonly used first-line therapy for advanced LCNEC is platinum-etoposide, which is similar to the treatment used for small cell lung cancer [8].

It's essential to note that each patient's situation is unique, and the best course of treatment will depend on various factors, including the stage and location of the tumor, as well as the patient's overall health.

References:

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[4] - Search result 4: "The largest group (14) of patients received adjuvant fluoropyrimidine-based regimens, including 5-fluorouracil, leucovorin, oxaliplatin combination regimen..."

[5] - Search result 5: "Biological therapy is commonly used to treat neuroendocrine cancer. It is also called biotherapy or biological response modifiers (BRMs)."

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[7] - Search result 7: "The study found that perioperative chemotherapy was associated with better OS than surgery alone; a better five-year OS was observed in non-triple-positive..."

[8] - Search result 8: "Platinum-etoposide is the most used first-line therapy in treating advanced LCNEC, which is similar to the treatment used for small cell lung cancer..."

Differential Diagnosis of Large Cell Neuroendocrine Carcinoma (LCNEC)

Large cell neuroendocrine carcinoma (LCNEC) is a type of lung cancer that can be challenging to diagnose due to its similarity in appearance with other types of cancers. The differential diagnosis for LCNEC includes:

• Atypical carcinoid tumor: This is a moderately differentiated neuroendocrine carcinoma that shares some similarities with LCNEC, but has a more favorable prognosis [5].
• Small cell lung carcinoma (SCLC): SCLC and LCNEC are both high-grade neuroendocrine carcinomas, and can be difficult to distinguish from each other based on morphology alone [7]. However, SCLC tends to have a higher mitotic rate and Ki-67 labeling index than LCNEC [6].
• Adenocarcinoma: This is the most common type of lung cancer, and can sometimes be mistaken for LCNEC due to its similar appearance under the microscope [5].

Key Features for Differential Diagnosis

To distinguish LCNEC from these other types of cancers, several key features should be considered:

• Neuroendocrine morphology: LCNEC is characterized by a neuroendocrine architecture with rosettes and trabecules, which can be seen in some cases of atypical carcinoid tumor [2].
• Expression of neuroendocrine markers: The expression of chromogranin A (CGA) and other neuroendocrine markers can help to confirm the diagnosis of LCNEC [2].
• Mitotic rate and Ki-67 labeling index: These measures of proliferative rate can be used to distinguish SCLC from LCNEC, as SCLC tends to have a higher mitotic rate and Ki-67 labeling index than LCNEC [6].

References

[1] MK Baine. Practical approach to diagnostic challenges with large cell neuroendocrine carcinoma using illustrative examples of main differential diagnoses. 2020.

[2] H Popper. Neuroendocrine morphology and marker expression in large cell neuroendocrine carcinoma. 2021.

[3] MK Baine. Scenarios related to the diagnosis of LCNEC include cases with either NE morphology but lack of NE marker expression or vice versa. According to the WHO classification, LCNEC is a type of non-small cell lung cancer (NSCLC). 2020.

[4] Large cell neuroendocrine carcinoma is an aggressive, poorly differentiated carcinoma composed of large cells with neuroendocrine architecture. 2020.

[5] Differential diagnosis includes atypical carcinoid tumor (moderately differentiated neuroendocrine carcinoma), small cell carcinoma, and adenocarcinoma. 2020.

[6] Z Yang. The cornerstone of the classification is proliferative rate of the tumor cells, as assessed by mitotic rate and Ki-67 labeling index. However, this can be challenging in some cases. 2022.

[7] Oct 10, 2022. The main differential diagnosis of LCNEC includes SCLC and other types of NSCLC. As a high-grade neuroendocrine carcinoma, SCLC and LCNEC have similar morphological features.